|
HC WHEAT IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200066
|
|
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 WHEELCHAIR MANAGEMENT EA 15 MIN
|
Facility
|
OP
|
$98.84
|
|
|
Service Code
|
CPT 97542
|
| Hospital Charge Code |
42000032
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$23.47 |
| Max. Negotiated Rate |
$88.96 |
| Rate for Payer: Aetna Commercial |
$84.01
|
| Rate for Payer: Aetna Medicare |
$25.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.89
|
| Rate for Payer: BCBS Complete |
$39.54
|
| Rate for Payer: BCBS MAPPO |
$24.71
|
| Rate for Payer: BCBS Trust/PPO |
$81.26
|
| Rate for Payer: BCN Commercial |
$76.85
|
| Rate for Payer: BCN Medicare Advantage |
$24.71
|
| Rate for Payer: Cash Price |
$79.07
|
| Rate for Payer: Cofinity Commercial |
$85.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.71
|
| Rate for Payer: Healthscope Commercial |
$88.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.01
|
| Rate for Payer: Nomi Health Commercial |
$81.05
|
| Rate for Payer: PACE Senior Care Partners |
$23.47
|
| Rate for Payer: PACE SWMI |
$24.71
|
| Rate for Payer: PHP Commercial |
$84.01
|
| Rate for Payer: PHP Medicare Advantage |
$24.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.25
|
| Rate for Payer: Priority Health HMO/PPO |
$85.99
|
| Rate for Payer: Priority Health Medicare |
$24.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$66.22
|
| Rate for Payer: Railroad Medicare Medicare |
$24.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$86.98
|
| Rate for Payer: UHC Core |
$82.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.71
|
| Rate for Payer: UHC Exchange |
$24.71
|
| Rate for Payer: UHC Medicare Advantage |
$24.71
|
| Rate for Payer: VA VA |
$24.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.13
|
|
|
HC WHEELCHAIR MANAGEMENT EA 15 MIN
|
Facility
|
IP
|
$98.84
|
|
|
Service Code
|
CPT 97542
|
| Hospital Charge Code |
42000032
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$64.25 |
| Max. Negotiated Rate |
$88.96 |
| Rate for Payer: Aetna Commercial |
$84.01
|
| Rate for Payer: BCBS Trust/PPO |
$80.68
|
| Rate for Payer: BCN Commercial |
$76.38
|
| Rate for Payer: Cash Price |
$79.07
|
| Rate for Payer: Cofinity Commercial |
$85.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.07
|
| Rate for Payer: Healthscope Commercial |
$88.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.01
|
| Rate for Payer: Nomi Health Commercial |
$81.05
|
| Rate for Payer: PHP Commercial |
$84.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.25
|
| Rate for Payer: Priority Health HMO/PPO |
$85.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$66.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$86.98
|
| Rate for Payer: UHC Core |
$82.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.13
|
|
|
HC WHIRLPOOL
|
Facility
|
OP
|
$92.60
|
|
|
Service Code
|
CPT 97022
|
| Hospital Charge Code |
42000012
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$21.99 |
| Max. Negotiated Rate |
$83.34 |
| Rate for Payer: Aetna Commercial |
$78.71
|
| Rate for Payer: Aetna Medicare |
$24.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.94
|
| Rate for Payer: BCBS Complete |
$37.04
|
| Rate for Payer: BCBS MAPPO |
$23.15
|
| Rate for Payer: BCBS Trust/PPO |
$76.13
|
| Rate for Payer: BCN Commercial |
$72.00
|
| Rate for Payer: BCN Medicare Advantage |
$23.15
|
| Rate for Payer: Cash Price |
$74.08
|
| Rate for Payer: Cofinity Commercial |
$79.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.15
|
| Rate for Payer: Healthscope Commercial |
$83.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.71
|
| Rate for Payer: Nomi Health Commercial |
$75.93
|
| Rate for Payer: PACE Senior Care Partners |
$21.99
|
| Rate for Payer: PACE SWMI |
$23.15
|
| Rate for Payer: PHP Commercial |
$78.71
|
| Rate for Payer: PHP Medicare Advantage |
$23.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.19
|
| Rate for Payer: Priority Health HMO/PPO |
$80.56
|
| Rate for Payer: Priority Health Medicare |
$23.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$62.04
|
| Rate for Payer: Railroad Medicare Medicare |
$23.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$81.49
|
| Rate for Payer: UHC Core |
$77.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.15
|
| Rate for Payer: UHC Exchange |
$23.15
|
| Rate for Payer: UHC Medicare Advantage |
$23.15
|
| Rate for Payer: VA VA |
$23.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.45
|
|
|
HC WHIRLPOOL
|
Facility
|
IP
|
$92.60
|
|
|
Service Code
|
CPT 97022
|
| Hospital Charge Code |
42000012
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$60.19 |
| Max. Negotiated Rate |
$83.34 |
| Rate for Payer: Aetna Commercial |
$78.71
|
| Rate for Payer: BCBS Trust/PPO |
$75.59
|
| Rate for Payer: BCN Commercial |
$71.56
|
| Rate for Payer: Cash Price |
$74.08
|
| Rate for Payer: Cofinity Commercial |
$79.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.08
|
| Rate for Payer: Healthscope Commercial |
$83.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.71
|
| Rate for Payer: Nomi Health Commercial |
$75.93
|
| Rate for Payer: PHP Commercial |
$78.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.19
|
| Rate for Payer: Priority Health HMO/PPO |
$80.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$62.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$81.49
|
| Rate for Payer: UHC Core |
$77.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.45
|
|
|
HC WHITE ASH IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200106
|
|
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 WHITE ASH IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200106
|
|
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 WHITE FACED HORNET IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200107
|
|
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 WHITE FACED HORNET IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200107
|
|
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 WHITE HICKORY IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200108
|
|
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 WHITE HICKORY IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200108
|
|
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 WHITE PINE IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200109
|
|
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 WHITE PINE IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200109
|
|
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 WHOLE BLOOD DIRECT
|
Facility
|
OP
|
$892.19
|
|
|
Service Code
|
CPT P9010
|
| Hospital Charge Code |
39000074
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$162.76 |
| Max. Negotiated Rate |
$802.97 |
| Rate for Payer: Aetna Commercial |
$758.36
|
| Rate for Payer: Aetna Medicare |
$231.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$278.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$278.81
|
| Rate for Payer: BCBS Complete |
$170.91
|
| Rate for Payer: BCBS MAPPO |
$223.05
|
| Rate for Payer: BCBS Trust/PPO |
$733.47
|
| Rate for Payer: BCN Commercial |
$693.68
|
| Rate for Payer: BCN Medicare Advantage |
$223.05
|
| Rate for Payer: Cash Price |
$713.75
|
| Rate for Payer: Cash Price |
$713.75
|
| Rate for Payer: Cofinity Commercial |
$767.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$713.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$223.05
|
| Rate for Payer: Healthscope Commercial |
$802.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$669.14
|
| Rate for Payer: Mclaren Medicaid |
$162.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$234.20
|
| Rate for Payer: Meridian Medicaid |
$170.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$256.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$758.36
|
| Rate for Payer: Nomi Health Commercial |
$731.60
|
| Rate for Payer: PACE Senior Care Partners |
$211.90
|
| Rate for Payer: PACE SWMI |
$223.05
|
| Rate for Payer: PHP Commercial |
$758.36
|
| Rate for Payer: PHP Medicare Advantage |
$223.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$162.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$579.92
|
| Rate for Payer: Priority Health HMO/PPO |
$776.21
|
| Rate for Payer: Priority Health Medicare |
$225.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$597.77
|
| Rate for Payer: Railroad Medicare Medicare |
$223.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$785.13
|
| Rate for Payer: UHC Core |
$744.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$223.05
|
| Rate for Payer: UHC Exchange |
$223.05
|
| Rate for Payer: UHC Medicare Advantage |
$223.05
|
| Rate for Payer: UHCCP Medicaid |
$162.76
|
| Rate for Payer: VA VA |
$223.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$669.14
|
|
|
HC WHOLE BLOOD DIRECT
|
Facility
|
IP
|
$892.19
|
|
|
Service Code
|
CPT P9010
|
| Hospital Charge Code |
39000074
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$579.92 |
| Max. Negotiated Rate |
$802.97 |
| Rate for Payer: Aetna Commercial |
$758.36
|
| Rate for Payer: BCBS Trust/PPO |
$728.29
|
| Rate for Payer: BCN Commercial |
$689.48
|
| Rate for Payer: Cash Price |
$713.75
|
| Rate for Payer: Cofinity Commercial |
$767.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$713.75
|
| Rate for Payer: Healthscope Commercial |
$802.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$669.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$758.36
|
| Rate for Payer: Nomi Health Commercial |
$731.60
|
| Rate for Payer: PHP Commercial |
$758.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$579.92
|
| Rate for Payer: Priority Health HMO/PPO |
$776.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$597.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$785.13
|
| Rate for Payer: UHC Core |
$744.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$669.14
|
|
|
HC WHOLEY EXCHANGE
|
Facility
|
OP
|
$509.35
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200081
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$120.97 |
| Max. Negotiated Rate |
$458.42 |
| Rate for Payer: Aetna Commercial |
$432.95
|
| Rate for Payer: Aetna Medicare |
$132.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$159.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$159.17
|
| Rate for Payer: BCBS Complete |
$203.74
|
| Rate for Payer: BCBS MAPPO |
$127.34
|
| Rate for Payer: BCBS Trust/PPO |
$418.74
|
| Rate for Payer: BCN Commercial |
$396.02
|
| Rate for Payer: BCN Medicare Advantage |
$127.34
|
| Rate for Payer: Cash Price |
$407.48
|
| Rate for Payer: Cofinity Commercial |
$438.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$407.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$127.34
|
| Rate for Payer: Healthscope Commercial |
$458.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$382.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$133.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$146.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$432.95
|
| Rate for Payer: Nomi Health Commercial |
$417.67
|
| Rate for Payer: PACE Senior Care Partners |
$120.97
|
| Rate for Payer: PACE SWMI |
$127.34
|
| Rate for Payer: PHP Commercial |
$432.95
|
| Rate for Payer: PHP Medicare Advantage |
$127.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.08
|
| Rate for Payer: Priority Health HMO/PPO |
$443.13
|
| Rate for Payer: Priority Health Medicare |
$128.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$341.26
|
| Rate for Payer: Railroad Medicare Medicare |
$127.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$448.23
|
| Rate for Payer: UHC Core |
$425.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$127.34
|
| Rate for Payer: UHC Exchange |
$127.34
|
| Rate for Payer: UHC Medicare Advantage |
$127.34
|
| Rate for Payer: VA VA |
$127.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$382.01
|
|
|
HC WHOLEY EXCHANGE
|
Facility
|
IP
|
$509.35
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200081
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$331.08 |
| Max. Negotiated Rate |
$458.42 |
| Rate for Payer: Aetna Commercial |
$432.95
|
| Rate for Payer: BCBS Trust/PPO |
$415.78
|
| Rate for Payer: BCN Commercial |
$393.63
|
| Rate for Payer: Cash Price |
$407.48
|
| Rate for Payer: Cofinity Commercial |
$438.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$407.48
|
| Rate for Payer: Healthscope Commercial |
$458.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$382.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$432.95
|
| Rate for Payer: Nomi Health Commercial |
$417.67
|
| Rate for Payer: PHP Commercial |
$432.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.08
|
| Rate for Payer: Priority Health HMO/PPO |
$443.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$341.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$448.23
|
| Rate for Payer: UHC Core |
$425.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$382.01
|
|
|
HC WILLOW IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200110
|
|
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 WILLOW IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200110
|
|
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 WMC FDG PER DOSE
|
Facility
|
IP
|
$374.82
|
|
|
Service Code
|
HCPCS A9552
|
| Hospital Charge Code |
34300026
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$243.63 |
| Max. Negotiated Rate |
$337.34 |
| Rate for Payer: Aetna Commercial |
$318.60
|
| Rate for Payer: BCBS Trust/PPO |
$305.97
|
| Rate for Payer: BCN Commercial |
$289.66
|
| Rate for Payer: Cash Price |
$299.86
|
| Rate for Payer: Cofinity Commercial |
$322.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$299.86
|
| Rate for Payer: Healthscope Commercial |
$337.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$281.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$318.60
|
| Rate for Payer: Nomi Health Commercial |
$307.35
|
| Rate for Payer: PHP Commercial |
$318.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$243.63
|
| Rate for Payer: Priority Health HMO/PPO |
$326.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$251.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$329.84
|
| Rate for Payer: UHC Core |
$312.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$281.12
|
|
|
HC WMC FDG PER DOSE
|
Facility
|
OP
|
$374.82
|
|
|
Service Code
|
HCPCS A9552
|
| Hospital Charge Code |
34300026
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$89.02 |
| Max. Negotiated Rate |
$337.34 |
| Rate for Payer: Aetna Commercial |
$318.60
|
| Rate for Payer: Aetna Medicare |
$97.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$117.13
|
| Rate for Payer: Amish Plain Church Group Commercial |
$117.13
|
| Rate for Payer: BCBS Complete |
$149.93
|
| Rate for Payer: BCBS MAPPO |
$93.70
|
| Rate for Payer: BCBS Trust/PPO |
$308.14
|
| Rate for Payer: BCN Commercial |
$291.42
|
| Rate for Payer: BCN Medicare Advantage |
$93.70
|
| Rate for Payer: Cash Price |
$299.86
|
| Rate for Payer: Cofinity Commercial |
$322.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$299.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$93.70
|
| Rate for Payer: Healthscope Commercial |
$337.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$281.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$98.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$107.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$318.60
|
| Rate for Payer: Nomi Health Commercial |
$307.35
|
| Rate for Payer: PACE Senior Care Partners |
$89.02
|
| Rate for Payer: PACE SWMI |
$93.70
|
| Rate for Payer: PHP Commercial |
$318.60
|
| Rate for Payer: PHP Medicare Advantage |
$93.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$243.63
|
| Rate for Payer: Priority Health HMO/PPO |
$326.09
|
| Rate for Payer: Priority Health Medicare |
$94.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$251.13
|
| Rate for Payer: Railroad Medicare Medicare |
$93.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$329.84
|
| Rate for Payer: UHC Core |
$312.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$93.70
|
| Rate for Payer: UHC Exchange |
$93.70
|
| Rate for Payer: UHC Medicare Advantage |
$93.70
|
| Rate for Payer: VA VA |
$93.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$281.12
|
|
|
HC WMC PET SKULL TO THIGH
|
Facility
|
OP
|
$7,746.90
|
|
|
Service Code
|
CPT 78815
|
| Hospital Charge Code |
40400006
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,054.56 |
| Max. Negotiated Rate |
$6,972.21 |
| Rate for Payer: Aetna Commercial |
$6,584.86
|
| Rate for Payer: Aetna Medicare |
$2,014.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,420.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,420.91
|
| Rate for Payer: BCBS Complete |
$1,107.36
|
| Rate for Payer: BCBS MAPPO |
$1,936.72
|
| Rate for Payer: BCBS Trust/PPO |
$6,368.73
|
| Rate for Payer: BCN Commercial |
$6,023.21
|
| Rate for Payer: BCN Medicare Advantage |
$1,936.72
|
| Rate for Payer: Cash Price |
$6,197.52
|
| Rate for Payer: Cash Price |
$6,197.52
|
| Rate for Payer: Cofinity Commercial |
$6,662.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,197.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,936.72
|
| Rate for Payer: Healthscope Commercial |
$6,972.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,810.18
|
| Rate for Payer: Mclaren Medicaid |
$1,054.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,033.56
|
| Rate for Payer: Meridian Medicaid |
$1,107.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,227.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,584.86
|
| Rate for Payer: Nomi Health Commercial |
$6,352.46
|
| Rate for Payer: PACE Senior Care Partners |
$1,839.89
|
| Rate for Payer: PACE SWMI |
$1,936.72
|
| Rate for Payer: PHP Commercial |
$6,584.86
|
| Rate for Payer: PHP Medicare Advantage |
$1,936.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,054.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,035.48
|
| Rate for Payer: Priority Health HMO/PPO |
$6,739.80
|
| Rate for Payer: Priority Health Medicare |
$1,956.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,190.42
|
| Rate for Payer: Railroad Medicare Medicare |
$1,936.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,817.27
|
| Rate for Payer: UHC Core |
$6,468.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,936.72
|
| Rate for Payer: UHC Exchange |
$1,936.72
|
| Rate for Payer: UHC Medicare Advantage |
$1,936.72
|
| Rate for Payer: UHCCP Medicaid |
$1,054.56
|
| Rate for Payer: VA VA |
$1,936.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,810.18
|
|
|
HC WMC PET SKULL TO THIGH
|
Facility
|
IP
|
$7,746.90
|
|
|
Service Code
|
CPT 78815
|
| Hospital Charge Code |
40400006
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$5,035.48 |
| Max. Negotiated Rate |
$6,972.21 |
| Rate for Payer: Aetna Commercial |
$6,584.86
|
| Rate for Payer: BCBS Trust/PPO |
$6,323.79
|
| Rate for Payer: BCN Commercial |
$5,986.80
|
| Rate for Payer: Cash Price |
$6,197.52
|
| Rate for Payer: Cofinity Commercial |
$6,662.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,197.52
|
| Rate for Payer: Healthscope Commercial |
$6,972.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,810.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,584.86
|
| Rate for Payer: Nomi Health Commercial |
$6,352.46
|
| Rate for Payer: PHP Commercial |
$6,584.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,035.48
|
| Rate for Payer: Priority Health HMO/PPO |
$6,739.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,190.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,817.27
|
| Rate for Payer: UHC Core |
$6,468.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,810.18
|
|
|
HC WORK CONDITIONING EACH ADD HR
|
Facility
|
IP
|
$260.48
|
|
|
Service Code
|
CPT 97546
|
| Hospital Charge Code |
42000034
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$169.31 |
| Max. Negotiated Rate |
$234.43 |
| Rate for Payer: Aetna Commercial |
$221.41
|
| Rate for Payer: BCBS Trust/PPO |
$212.63
|
| Rate for Payer: BCN Commercial |
$201.30
|
| Rate for Payer: Cash Price |
$208.38
|
| Rate for Payer: Cofinity Commercial |
$224.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.38
|
| Rate for Payer: Healthscope Commercial |
$234.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$195.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.41
|
| Rate for Payer: Nomi Health Commercial |
$213.59
|
| Rate for Payer: PHP Commercial |
$221.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.31
|
| Rate for Payer: Priority Health HMO/PPO |
$226.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$174.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$229.22
|
| Rate for Payer: UHC Core |
$217.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$195.36
|
|
|
HC WORK CONDITIONING EACH ADD HR
|
Facility
|
OP
|
$260.48
|
|
|
Service Code
|
CPT 97546
|
| Hospital Charge Code |
42000034
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$61.86 |
| Max. Negotiated Rate |
$234.43 |
| Rate for Payer: Aetna Commercial |
$221.41
|
| Rate for Payer: Aetna Medicare |
$67.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$81.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$81.40
|
| Rate for Payer: BCBS Complete |
$104.19
|
| Rate for Payer: BCBS MAPPO |
$65.12
|
| Rate for Payer: BCBS Trust/PPO |
$214.14
|
| Rate for Payer: BCN Commercial |
$202.52
|
| Rate for Payer: BCN Medicare Advantage |
$65.12
|
| Rate for Payer: Cash Price |
$208.38
|
| Rate for Payer: Cofinity Commercial |
$224.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$65.12
|
| Rate for Payer: Healthscope Commercial |
$234.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$195.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$68.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$74.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.41
|
| Rate for Payer: Nomi Health Commercial |
$213.59
|
| Rate for Payer: PACE Senior Care Partners |
$61.86
|
| Rate for Payer: PACE SWMI |
$65.12
|
| Rate for Payer: PHP Commercial |
$221.41
|
| Rate for Payer: PHP Medicare Advantage |
$65.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.31
|
| Rate for Payer: Priority Health HMO/PPO |
$226.62
|
| Rate for Payer: Priority Health Medicare |
$65.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$174.52
|
| Rate for Payer: Railroad Medicare Medicare |
$65.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$229.22
|
| Rate for Payer: UHC Core |
$217.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$65.12
|
| Rate for Payer: UHC Exchange |
$65.12
|
| Rate for Payer: UHC Medicare Advantage |
$65.12
|
| Rate for Payer: VA VA |
$65.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$195.36
|
|
