|
HC ABSCESS DRAINAGE SIMPLE
|
Facility
|
IP
|
$391.99
|
|
|
Service Code
|
CPT 10060
|
| Hospital Charge Code |
36100002
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$239.07 |
| Max. Negotiated Rate |
$352.79 |
| Rate for Payer: Aetna Commercial |
$333.19
|
| Rate for Payer: BCBS Trust/PPO |
$302.93
|
| Rate for Payer: BCN Commercial |
$302.93
|
| Rate for Payer: Cash Price |
$313.59
|
| Rate for Payer: Cofinity Commercial |
$337.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$313.59
|
| Rate for Payer: Healthscope Commercial |
$352.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$293.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$333.19
|
| Rate for Payer: PHP Commercial |
$333.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$274.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$341.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$239.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$344.95
|
| Rate for Payer: UHC Core |
$327.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$293.99
|
|
|
HC ABSCESS ISHIO/PERIRECTAL
|
Facility
|
OP
|
$1,754.30
|
|
|
Service Code
|
CPT 46040
|
| Hospital Charge Code |
36100196
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$416.65 |
| Max. Negotiated Rate |
$1,578.87 |
| Rate for Payer: Aetna Commercial |
$1,491.16
|
| Rate for Payer: Aetna Medicare |
$456.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$548.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$548.22
|
| Rate for Payer: BCBS Complete |
$812.82
|
| Rate for Payer: BCBS MAPPO |
$438.58
|
| Rate for Payer: BCBS Trust/PPO |
$1,363.97
|
| Rate for Payer: BCN Commercial |
$1,363.97
|
| Rate for Payer: BCN Medicare Advantage |
$438.58
|
| Rate for Payer: Cash Price |
$1,403.44
|
| Rate for Payer: Cash Price |
$1,403.44
|
| Rate for Payer: Cofinity Commercial |
$1,508.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,403.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$438.58
|
| Rate for Payer: Healthscope Commercial |
$1,578.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,315.72
|
| Rate for Payer: Mclaren Medicaid |
$774.12
|
| Rate for Payer: Meridian Medicaid |
$812.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$460.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$504.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,491.16
|
| Rate for Payer: PACE Senior Care Partners |
$416.65
|
| Rate for Payer: PACE SWMI |
$438.58
|
| Rate for Payer: PHP Commercial |
$1,491.16
|
| Rate for Payer: PHP Medicare Advantage |
$438.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$774.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,228.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,526.24
|
| Rate for Payer: Priority Health Medicare |
$438.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,069.95
|
| Rate for Payer: Railroad Medicare Medicare |
$438.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,543.78
|
| Rate for Payer: UHC Core |
$1,464.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$438.58
|
| Rate for Payer: UHC Medicare Advantage |
$451.73
|
| Rate for Payer: VA VA |
$438.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,315.72
|
|
|
HC ABSCESS ISHIO/PERIRECTAL
|
Facility
|
IP
|
$1,754.30
|
|
|
Service Code
|
CPT 46040
|
| Hospital Charge Code |
36100196
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,069.95 |
| Max. Negotiated Rate |
$1,578.87 |
| Rate for Payer: Aetna Commercial |
$1,491.16
|
| Rate for Payer: BCBS Trust/PPO |
$1,355.72
|
| Rate for Payer: BCN Commercial |
$1,355.72
|
| Rate for Payer: Cash Price |
$1,403.44
|
| Rate for Payer: Cofinity Commercial |
$1,508.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,403.44
|
| Rate for Payer: Healthscope Commercial |
$1,578.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,315.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,491.16
|
| Rate for Payer: PHP Commercial |
$1,491.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,228.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,526.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,069.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,543.78
|
| Rate for Payer: UHC Core |
$1,464.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,315.72
|
|
|
HC ACAPELLA SUPPLY
|
Facility
|
OP
|
$192.14
|
|
| Hospital Charge Code |
27000025
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$45.63 |
| Max. Negotiated Rate |
$172.93 |
| Rate for Payer: Aetna Commercial |
$163.32
|
| Rate for Payer: Aetna Medicare |
$49.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$60.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$60.04
|
| Rate for Payer: BCBS Complete |
$76.86
|
| Rate for Payer: BCBS MAPPO |
$48.04
|
| Rate for Payer: BCBS Trust/PPO |
$149.39
|
| Rate for Payer: BCN Commercial |
$149.39
|
| Rate for Payer: BCN Medicare Advantage |
$48.04
|
| Rate for Payer: Cash Price |
$153.71
|
| Rate for Payer: Cofinity Commercial |
$165.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$153.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.04
|
| Rate for Payer: Healthscope Commercial |
$172.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$144.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$50.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$163.32
|
| Rate for Payer: PACE Senior Care Partners |
$45.63
|
| Rate for Payer: PACE SWMI |
$48.04
|
| Rate for Payer: PHP Commercial |
$163.32
|
| Rate for Payer: PHP Medicare Advantage |
$48.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$167.16
|
| Rate for Payer: Priority Health Medicare |
$48.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$117.19
|
| Rate for Payer: Railroad Medicare Medicare |
$48.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$169.08
|
| Rate for Payer: UHC Core |
$160.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$48.04
|
| Rate for Payer: UHC Medicare Advantage |
$49.48
|
| Rate for Payer: VA VA |
$48.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$144.10
|
|
|
HC ACAPELLA SUPPLY
|
Facility
|
IP
|
$192.14
|
|
| Hospital Charge Code |
27000025
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$117.19 |
| Max. Negotiated Rate |
$172.93 |
| Rate for Payer: Aetna Commercial |
$163.32
|
| Rate for Payer: BCBS Trust/PPO |
$148.49
|
| Rate for Payer: BCN Commercial |
$148.49
|
| Rate for Payer: Cash Price |
$153.71
|
| Rate for Payer: Cofinity Commercial |
$165.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$153.71
|
| Rate for Payer: Healthscope Commercial |
$172.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$144.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$163.32
|
| Rate for Payer: PHP Commercial |
$163.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$167.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$117.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$169.08
|
| Rate for Payer: UHC Core |
$160.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$144.10
|
|
|
HC ACB APLIGRAF PER SQ CM
|
Facility
|
OP
|
$92.44
|
|
|
Service Code
|
HCPCS Q4101
|
| Hospital Charge Code |
63600031
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.95 |
| Max. Negotiated Rate |
$83.20 |
| Rate for Payer: Aetna Commercial |
$78.57
|
| Rate for Payer: Aetna Medicare |
$24.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.89
|
| Rate for Payer: BCBS Complete |
$36.98
|
| Rate for Payer: BCBS MAPPO |
$23.11
|
| Rate for Payer: BCBS Trust/PPO |
$71.87
|
| Rate for Payer: BCN Commercial |
$71.87
|
| Rate for Payer: BCN Medicare Advantage |
$23.11
|
| Rate for Payer: Cash Price |
$73.95
|
| Rate for Payer: Cofinity Commercial |
$79.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.11
|
| Rate for Payer: Healthscope Commercial |
$83.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.33
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$24.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$78.57
|
| Rate for Payer: PACE Senior Care Partners |
$21.95
|
| Rate for Payer: PACE SWMI |
$23.11
|
| Rate for Payer: PHP Commercial |
$78.57
|
| Rate for Payer: PHP Medicare Advantage |
$23.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$80.42
|
| Rate for Payer: Priority Health Medicare |
$23.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$56.38
|
| Rate for Payer: Railroad Medicare Medicare |
$23.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$81.35
|
| Rate for Payer: UHC Core |
$77.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.11
|
| Rate for Payer: UHC Medicare Advantage |
$23.80
|
| Rate for Payer: VA VA |
$23.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.33
|
|
|
HC ACB APLIGRAF PER SQ CM
|
Facility
|
IP
|
$92.44
|
|
|
Service Code
|
HCPCS Q4101
|
| Hospital Charge Code |
63600031
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$56.38 |
| Max. Negotiated Rate |
$83.20 |
| Rate for Payer: Aetna Commercial |
$78.57
|
| Rate for Payer: BCBS Trust/PPO |
$71.44
|
| Rate for Payer: BCN Commercial |
$71.44
|
| Rate for Payer: Cash Price |
$73.95
|
| Rate for Payer: Cofinity Commercial |
$79.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.95
|
| Rate for Payer: Healthscope Commercial |
$83.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$78.57
|
| Rate for Payer: PHP Commercial |
$78.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$80.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$56.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$81.35
|
| Rate for Payer: UHC Core |
$77.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.33
|
|
|
HC ACB ESTABLISHED PT LEVEL 1
|
Facility
|
OP
|
$355.31
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000072
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$319.78 |
| Rate for Payer: Aetna Commercial |
$302.01
|
| Rate for Payer: Aetna Medicare |
$92.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$111.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$111.03
|
| Rate for Payer: BCBS Complete |
$142.12
|
| Rate for Payer: BCBS MAPPO |
$88.83
|
| Rate for Payer: BCBS Trust/PPO |
$276.25
|
| Rate for Payer: BCCCP Commercial |
$22.00
|
| Rate for Payer: BCN Commercial |
$276.25
|
| Rate for Payer: BCN Medicare Advantage |
$88.83
|
| Rate for Payer: Cash Price |
$284.25
|
| Rate for Payer: Cash Price |
$284.25
|
| Rate for Payer: Cofinity Commercial |
$305.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$284.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$88.83
|
| Rate for Payer: Healthscope Commercial |
$319.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$266.48
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$93.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$102.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$302.01
|
| Rate for Payer: PACE Senior Care Partners |
$84.39
|
| Rate for Payer: PACE SWMI |
$88.83
|
| Rate for Payer: PHP Commercial |
$302.01
|
| Rate for Payer: PHP Medicare Advantage |
$88.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$248.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$309.12
|
| Rate for Payer: Priority Health Medicare |
$88.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$216.70
|
| Rate for Payer: Railroad Medicare Medicare |
$88.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$312.67
|
| Rate for Payer: UHC Core |
$296.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$88.83
|
| Rate for Payer: UHC Medicare Advantage |
$91.49
|
| Rate for Payer: VA VA |
$88.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$266.48
|
|
|
HC ACB ESTABLISHED PT LEVEL 1
|
Facility
|
IP
|
$355.31
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000072
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$216.70 |
| Max. Negotiated Rate |
$319.78 |
| Rate for Payer: Aetna Commercial |
$302.01
|
| Rate for Payer: BCBS Trust/PPO |
$274.58
|
| Rate for Payer: BCN Commercial |
$274.58
|
| Rate for Payer: Cash Price |
$284.25
|
| Rate for Payer: Cofinity Commercial |
$305.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$284.25
|
| Rate for Payer: Healthscope Commercial |
$319.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$266.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$302.01
|
| Rate for Payer: PHP Commercial |
$302.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$248.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$309.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$216.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$312.67
|
| Rate for Payer: UHC Core |
$296.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$266.48
|
|
|
HC ACB ESTABLISHED PT LEVEL 2
|
Facility
|
OP
|
$494.43
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
51000073
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$444.99 |
| Rate for Payer: Aetna Commercial |
$420.27
|
| Rate for Payer: Aetna Medicare |
$128.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$154.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$154.51
|
| Rate for Payer: BCBS Complete |
$197.77
|
| Rate for Payer: BCBS MAPPO |
$123.61
|
| Rate for Payer: BCBS Trust/PPO |
$384.42
|
| Rate for Payer: BCCCP Commercial |
$22.00
|
| Rate for Payer: BCN Commercial |
$384.42
|
| Rate for Payer: BCN Medicare Advantage |
$123.61
|
| Rate for Payer: Cash Price |
$395.54
|
| Rate for Payer: Cash Price |
$395.54
|
| Rate for Payer: Cofinity Commercial |
$425.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$395.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$123.61
|
| Rate for Payer: Healthscope Commercial |
$444.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$370.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$129.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$420.27
|
| Rate for Payer: PACE Senior Care Partners |
$117.43
|
| Rate for Payer: PACE SWMI |
$123.61
|
| Rate for Payer: PHP Commercial |
$420.27
|
| Rate for Payer: PHP Medicare Advantage |
$123.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$346.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$430.15
|
| Rate for Payer: Priority Health Medicare |
$123.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$301.55
|
| Rate for Payer: Railroad Medicare Medicare |
$123.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$435.10
|
| Rate for Payer: UHC Core |
$412.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$123.61
|
| Rate for Payer: UHC Medicare Advantage |
$127.32
|
| Rate for Payer: VA VA |
$123.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$370.82
|
|
|
HC ACB ESTABLISHED PT LEVEL 2
|
Facility
|
IP
|
$494.43
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
51000073
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$301.55 |
| Max. Negotiated Rate |
$444.99 |
| Rate for Payer: Aetna Commercial |
$420.27
|
| Rate for Payer: BCBS Trust/PPO |
$382.10
|
| Rate for Payer: BCN Commercial |
$382.10
|
| Rate for Payer: Cash Price |
$395.54
|
| Rate for Payer: Cofinity Commercial |
$425.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$395.54
|
| Rate for Payer: Healthscope Commercial |
$444.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$370.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$420.27
|
| Rate for Payer: PHP Commercial |
$420.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$346.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$430.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$301.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$435.10
|
| Rate for Payer: UHC Core |
$412.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$370.82
|
|
|
HC ACB ESTABLISHED PT LEVEL 3
|
Facility
|
IP
|
$688.85
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
51000074
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$420.13 |
| Max. Negotiated Rate |
$619.96 |
| Rate for Payer: Aetna Commercial |
$585.52
|
| Rate for Payer: BCBS Trust/PPO |
$532.34
|
| Rate for Payer: BCN Commercial |
$532.34
|
| Rate for Payer: Cash Price |
$551.08
|
| Rate for Payer: Cofinity Commercial |
$592.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$551.08
|
| Rate for Payer: Healthscope Commercial |
$619.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$516.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$585.52
|
| Rate for Payer: PHP Commercial |
$585.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$482.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$599.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$420.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$606.19
|
| Rate for Payer: UHC Core |
$575.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$516.64
|
|
|
HC ACB ESTABLISHED PT LEVEL 3
|
Facility
|
OP
|
$688.85
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
51000074
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$72.85 |
| Max. Negotiated Rate |
$619.96 |
| Rate for Payer: Aetna Commercial |
$585.52
|
| Rate for Payer: Aetna Medicare |
$179.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$215.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$215.27
|
| Rate for Payer: BCBS Complete |
$275.54
|
| Rate for Payer: BCBS MAPPO |
$172.21
|
| Rate for Payer: BCBS Trust/PPO |
$535.58
|
| Rate for Payer: BCCCP Commercial |
$72.85
|
| Rate for Payer: BCN Commercial |
$535.58
|
| Rate for Payer: BCN Medicare Advantage |
$172.21
|
| Rate for Payer: Cash Price |
$551.08
|
| Rate for Payer: Cash Price |
$551.08
|
| Rate for Payer: Cofinity Commercial |
$592.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$551.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$172.21
|
| Rate for Payer: Healthscope Commercial |
$619.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$516.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$180.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$198.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$585.52
|
| Rate for Payer: PACE Senior Care Partners |
$163.60
|
| Rate for Payer: PACE SWMI |
$172.21
|
| Rate for Payer: PHP Commercial |
$585.52
|
| Rate for Payer: PHP Medicare Advantage |
$172.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$482.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$599.30
|
| Rate for Payer: Priority Health Medicare |
$172.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$420.13
|
| Rate for Payer: Railroad Medicare Medicare |
$172.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$606.19
|
| Rate for Payer: UHC Core |
$575.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$172.21
|
| Rate for Payer: UHC Medicare Advantage |
$177.38
|
| Rate for Payer: VA VA |
$172.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$516.64
|
|
|
HC ACB ESTABLISHED PT LEVEL 4
|
Facility
|
IP
|
$874.52
|
|
|
Service Code
|
CPT 99214
|
| Hospital Charge Code |
51000075
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$533.37 |
| Max. Negotiated Rate |
$787.07 |
| Rate for Payer: Aetna Commercial |
$743.34
|
| Rate for Payer: BCBS Trust/PPO |
$675.83
|
| Rate for Payer: BCN Commercial |
$675.83
|
| Rate for Payer: Cash Price |
$699.62
|
| Rate for Payer: Cofinity Commercial |
$752.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$699.62
|
| Rate for Payer: Healthscope Commercial |
$787.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$655.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$743.34
|
| Rate for Payer: PHP Commercial |
$743.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$612.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$760.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$533.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$769.58
|
| Rate for Payer: UHC Core |
$730.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$655.89
|
|
|
HC ACB ESTABLISHED PT LEVEL 4
|
Facility
|
OP
|
$874.52
|
|
|
Service Code
|
CPT 99214
|
| Hospital Charge Code |
51000075
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$72.85 |
| Max. Negotiated Rate |
$787.07 |
| Rate for Payer: Aetna Commercial |
$743.34
|
| Rate for Payer: Aetna Medicare |
$227.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$273.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$273.29
|
| Rate for Payer: BCBS Complete |
$349.81
|
| Rate for Payer: BCBS MAPPO |
$218.63
|
| Rate for Payer: BCBS Trust/PPO |
$679.94
|
| Rate for Payer: BCCCP Commercial |
$72.85
|
| Rate for Payer: BCN Commercial |
$679.94
|
| Rate for Payer: BCN Medicare Advantage |
$218.63
|
| Rate for Payer: Cash Price |
$699.62
|
| Rate for Payer: Cash Price |
$699.62
|
| Rate for Payer: Cofinity Commercial |
$752.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$699.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$218.63
|
| Rate for Payer: Healthscope Commercial |
$787.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$655.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$229.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$251.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$743.34
|
| Rate for Payer: PACE Senior Care Partners |
$207.70
|
| Rate for Payer: PACE SWMI |
$218.63
|
| Rate for Payer: PHP Commercial |
$743.34
|
| Rate for Payer: PHP Medicare Advantage |
$218.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$612.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$760.83
|
| Rate for Payer: Priority Health Medicare |
$218.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$533.37
|
| Rate for Payer: Railroad Medicare Medicare |
$218.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$769.58
|
| Rate for Payer: UHC Core |
$730.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$218.63
|
| Rate for Payer: UHC Medicare Advantage |
$225.19
|
| Rate for Payer: VA VA |
$218.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$655.89
|
|
|
HC ACB ESTABLISHED PT LEVEL 5
|
Facility
|
OP
|
$1,042.88
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
51000076
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$247.68 |
| Max. Negotiated Rate |
$938.59 |
| Rate for Payer: Aetna Commercial |
$886.45
|
| Rate for Payer: Aetna Medicare |
$271.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$325.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$325.90
|
| Rate for Payer: BCBS Complete |
$417.15
|
| Rate for Payer: BCBS MAPPO |
$260.72
|
| Rate for Payer: BCBS Trust/PPO |
$810.84
|
| Rate for Payer: BCN Commercial |
$810.84
|
| Rate for Payer: BCN Medicare Advantage |
$260.72
|
| Rate for Payer: Cash Price |
$834.30
|
| Rate for Payer: Cofinity Commercial |
$896.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$834.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$260.72
|
| Rate for Payer: Healthscope Commercial |
$938.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$782.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$273.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$299.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$886.45
|
| Rate for Payer: PACE Senior Care Partners |
$247.68
|
| Rate for Payer: PACE SWMI |
$260.72
|
| Rate for Payer: PHP Commercial |
$886.45
|
| Rate for Payer: PHP Medicare Advantage |
$260.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$730.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$907.31
|
| Rate for Payer: Priority Health Medicare |
$260.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$636.05
|
| Rate for Payer: Railroad Medicare Medicare |
$260.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$917.73
|
| Rate for Payer: UHC Core |
$870.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$260.72
|
| Rate for Payer: UHC Medicare Advantage |
$268.54
|
| Rate for Payer: VA VA |
$260.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$782.16
|
|
|
HC ACB ESTABLISHED PT LEVEL 5
|
Facility
|
IP
|
$1,042.88
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
51000076
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$636.05 |
| Max. Negotiated Rate |
$938.59 |
| Rate for Payer: Aetna Commercial |
$886.45
|
| Rate for Payer: BCBS Trust/PPO |
$805.94
|
| Rate for Payer: BCN Commercial |
$805.94
|
| Rate for Payer: Cash Price |
$834.30
|
| Rate for Payer: Cofinity Commercial |
$896.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$834.30
|
| Rate for Payer: Healthscope Commercial |
$938.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$782.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$886.45
|
| Rate for Payer: PHP Commercial |
$886.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$730.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$907.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$636.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$917.73
|
| Rate for Payer: UHC Core |
$870.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$782.16
|
|
|
HC ACB GARMENT MEASURE VISIT
|
Facility
|
IP
|
$372.74
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000048
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$227.33 |
| Max. Negotiated Rate |
$335.47 |
| Rate for Payer: Aetna Commercial |
$316.83
|
| Rate for Payer: BCBS Trust/PPO |
$288.05
|
| Rate for Payer: BCN Commercial |
$288.05
|
| Rate for Payer: Cash Price |
$298.19
|
| Rate for Payer: Cofinity Commercial |
$320.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$298.19
|
| Rate for Payer: Healthscope Commercial |
$335.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$279.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$316.83
|
| Rate for Payer: PHP Commercial |
$316.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$260.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$324.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$227.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$328.01
|
| Rate for Payer: UHC Core |
$311.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$279.56
|
|
|
HC ACB GARMENT MEASURE VISIT
|
Facility
|
OP
|
$372.74
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000048
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$335.47 |
| Rate for Payer: Aetna Commercial |
$316.83
|
| Rate for Payer: Aetna Medicare |
$96.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$116.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$116.48
|
| Rate for Payer: BCBS Complete |
$149.10
|
| Rate for Payer: BCBS MAPPO |
$93.18
|
| Rate for Payer: BCBS Trust/PPO |
$289.81
|
| Rate for Payer: BCCCP Commercial |
$22.00
|
| Rate for Payer: BCN Commercial |
$289.81
|
| Rate for Payer: BCN Medicare Advantage |
$93.18
|
| Rate for Payer: Cash Price |
$298.19
|
| Rate for Payer: Cash Price |
$298.19
|
| Rate for Payer: Cofinity Commercial |
$320.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$298.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$93.18
|
| Rate for Payer: Healthscope Commercial |
$335.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$279.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$97.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$107.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$316.83
|
| Rate for Payer: PACE Senior Care Partners |
$88.53
|
| Rate for Payer: PACE SWMI |
$93.18
|
| Rate for Payer: PHP Commercial |
$316.83
|
| Rate for Payer: PHP Medicare Advantage |
$93.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$260.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$324.28
|
| Rate for Payer: Priority Health Medicare |
$93.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$227.33
|
| Rate for Payer: Railroad Medicare Medicare |
$93.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$328.01
|
| Rate for Payer: UHC Core |
$311.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$93.18
|
| Rate for Payer: UHC Medicare Advantage |
$95.98
|
| Rate for Payer: VA VA |
$93.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$279.56
|
|
|
HC ACB NEW PATIENT VISIT
|
Facility
|
IP
|
$165.16
|
|
|
Service Code
|
HCPCS 99211
|
| Hospital Charge Code |
51000100
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$100.73 |
| Max. Negotiated Rate |
$148.64 |
| Rate for Payer: Aetna Commercial |
$140.39
|
| Rate for Payer: BCBS Trust/PPO |
$127.64
|
| Rate for Payer: BCN Commercial |
$127.64
|
| Rate for Payer: Cash Price |
$132.13
|
| Rate for Payer: Cofinity Commercial |
$142.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.13
|
| Rate for Payer: Healthscope Commercial |
$148.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$140.39
|
| Rate for Payer: PHP Commercial |
$140.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$143.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$100.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$145.34
|
| Rate for Payer: UHC Core |
$137.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.87
|
|
|
HC ACB NEW PATIENT VISIT
|
Facility
|
OP
|
$165.16
|
|
|
Service Code
|
HCPCS 99211
|
| Hospital Charge Code |
51000100
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$148.64 |
| Rate for Payer: Aetna Commercial |
$140.39
|
| Rate for Payer: Aetna Medicare |
$42.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$51.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$51.61
|
| Rate for Payer: BCBS Complete |
$66.06
|
| Rate for Payer: BCBS MAPPO |
$41.29
|
| Rate for Payer: BCBS Trust/PPO |
$128.41
|
| Rate for Payer: BCCCP Commercial |
$22.00
|
| Rate for Payer: BCN Commercial |
$128.41
|
| Rate for Payer: BCN Medicare Advantage |
$41.29
|
| Rate for Payer: Cash Price |
$132.13
|
| Rate for Payer: Cash Price |
$132.13
|
| Rate for Payer: Cofinity Commercial |
$142.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.29
|
| Rate for Payer: Healthscope Commercial |
$148.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.87
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$43.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$140.39
|
| Rate for Payer: PACE Senior Care Partners |
$39.23
|
| Rate for Payer: PACE SWMI |
$41.29
|
| Rate for Payer: PHP Commercial |
$140.39
|
| Rate for Payer: PHP Medicare Advantage |
$41.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$143.69
|
| Rate for Payer: Priority Health Medicare |
$41.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$100.73
|
| Rate for Payer: Railroad Medicare Medicare |
$41.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$145.34
|
| Rate for Payer: UHC Core |
$137.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$41.29
|
| Rate for Payer: UHC Medicare Advantage |
$42.53
|
| Rate for Payer: VA VA |
$41.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.87
|
|
|
HC ACB NEW PT LEVEL 2
|
Facility
|
IP
|
$494.43
|
|
|
Service Code
|
CPT 99202
|
| Hospital Charge Code |
51000101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$301.55 |
| Max. Negotiated Rate |
$444.99 |
| Rate for Payer: Aetna Commercial |
$420.27
|
| Rate for Payer: BCBS Trust/PPO |
$382.10
|
| Rate for Payer: BCN Commercial |
$382.10
|
| Rate for Payer: Cash Price |
$395.54
|
| Rate for Payer: Cofinity Commercial |
$425.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$395.54
|
| Rate for Payer: Healthscope Commercial |
$444.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$370.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$420.27
|
| Rate for Payer: PHP Commercial |
$420.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$346.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$430.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$301.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$435.10
|
| Rate for Payer: UHC Core |
$412.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$370.82
|
|
|
HC ACB NEW PT LEVEL 2
|
Facility
|
OP
|
$494.43
|
|
|
Service Code
|
CPT 99202
|
| Hospital Charge Code |
51000101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$444.99 |
| Rate for Payer: Aetna Commercial |
$420.27
|
| Rate for Payer: Aetna Medicare |
$128.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$154.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$154.51
|
| Rate for Payer: BCBS Complete |
$197.77
|
| Rate for Payer: BCBS MAPPO |
$123.61
|
| Rate for Payer: BCBS Trust/PPO |
$384.42
|
| Rate for Payer: BCCCP Commercial |
$45.00
|
| Rate for Payer: BCN Commercial |
$384.42
|
| Rate for Payer: BCN Medicare Advantage |
$123.61
|
| Rate for Payer: Cash Price |
$395.54
|
| Rate for Payer: Cash Price |
$395.54
|
| Rate for Payer: Cofinity Commercial |
$425.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$395.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$123.61
|
| Rate for Payer: Healthscope Commercial |
$444.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$370.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$129.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$420.27
|
| Rate for Payer: PACE Senior Care Partners |
$117.43
|
| Rate for Payer: PACE SWMI |
$123.61
|
| Rate for Payer: PHP Commercial |
$420.27
|
| Rate for Payer: PHP Medicare Advantage |
$123.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$346.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$430.15
|
| Rate for Payer: Priority Health Medicare |
$123.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$301.55
|
| Rate for Payer: Railroad Medicare Medicare |
$123.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$435.10
|
| Rate for Payer: UHC Core |
$412.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$123.61
|
| Rate for Payer: UHC Medicare Advantage |
$127.32
|
| Rate for Payer: VA VA |
$123.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$370.82
|
|
|
HC ACB NEW PT LEVEL 3
|
Facility
|
OP
|
$688.85
|
|
|
Service Code
|
CPT 99203
|
| Hospital Charge Code |
51000102
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$107.15 |
| Max. Negotiated Rate |
$619.96 |
| Rate for Payer: Aetna Commercial |
$585.52
|
| Rate for Payer: Aetna Medicare |
$179.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$215.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$215.27
|
| Rate for Payer: BCBS Complete |
$275.54
|
| Rate for Payer: BCBS MAPPO |
$172.21
|
| Rate for Payer: BCBS Trust/PPO |
$535.58
|
| Rate for Payer: BCCCP Commercial |
$107.15
|
| Rate for Payer: BCN Commercial |
$535.58
|
| Rate for Payer: BCN Medicare Advantage |
$172.21
|
| Rate for Payer: Cash Price |
$551.08
|
| Rate for Payer: Cash Price |
$551.08
|
| Rate for Payer: Cofinity Commercial |
$592.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$551.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$172.21
|
| Rate for Payer: Healthscope Commercial |
$619.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$516.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$180.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$198.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$585.52
|
| Rate for Payer: PACE Senior Care Partners |
$163.60
|
| Rate for Payer: PACE SWMI |
$172.21
|
| Rate for Payer: PHP Commercial |
$585.52
|
| Rate for Payer: PHP Medicare Advantage |
$172.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$482.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$599.30
|
| Rate for Payer: Priority Health Medicare |
$172.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$420.13
|
| Rate for Payer: Railroad Medicare Medicare |
$172.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$606.19
|
| Rate for Payer: UHC Core |
$575.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$172.21
|
| Rate for Payer: UHC Medicare Advantage |
$177.38
|
| Rate for Payer: VA VA |
$172.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$516.64
|
|
|
HC ACB NEW PT LEVEL 3
|
Facility
|
IP
|
$688.85
|
|
|
Service Code
|
CPT 99203
|
| Hospital Charge Code |
51000102
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$420.13 |
| Max. Negotiated Rate |
$619.96 |
| Rate for Payer: Aetna Commercial |
$585.52
|
| Rate for Payer: BCBS Trust/PPO |
$532.34
|
| Rate for Payer: BCN Commercial |
$532.34
|
| Rate for Payer: Cash Price |
$551.08
|
| Rate for Payer: Cofinity Commercial |
$592.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$551.08
|
| Rate for Payer: Healthscope Commercial |
$619.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$516.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$585.52
|
| Rate for Payer: PHP Commercial |
$585.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$482.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$599.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$420.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$606.19
|
| Rate for Payer: UHC Core |
$575.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$516.64
|
|
