|
HC ECHO, 2D, DOPPLER, COLOR FLOW
|
Facility
|
IP
|
$2,048.55
|
|
|
Service Code
|
CPT 93306
|
| Hospital Charge Code |
48300001
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,425.79 |
| Max. Negotiated Rate |
$1,843.69 |
| Rate for Payer: Aetna Commercial |
$1,741.27
|
| Rate for Payer: BCBS Trust/PPO |
$1,691.90
|
| Rate for Payer: BCN Commercial |
$1,691.90
|
| Rate for Payer: Cash Price |
$1,638.84
|
| Rate for Payer: Cofinity Commercial |
$1,761.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,638.84
|
| Rate for Payer: Healthscope Commercial |
$1,843.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,536.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,741.27
|
| Rate for Payer: Nomi Health Commercial |
$1,679.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,536.41
|
| Rate for Payer: PHP Commercial |
$1,741.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,782.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,425.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,802.72
|
| Rate for Payer: UHC Core |
$1,710.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,536.41
|
|
|
HC ECHO, 2D, DOPPLER, COLOR FLOW
|
Facility
|
OP
|
$2,048.55
|
|
|
Service Code
|
CPT 93306
|
| Hospital Charge Code |
48300001
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$361.16 |
| Max. Negotiated Rate |
$1,843.69 |
| Rate for Payer: Aetna Commercial |
$1,741.27
|
| Rate for Payer: Aetna Medicare |
$532.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$640.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$640.17
|
| Rate for Payer: BCBS Complete |
$379.19
|
| Rate for Payer: BCBS MAPPO |
$512.14
|
| Rate for Payer: BCBS Trust/PPO |
$1,684.11
|
| Rate for Payer: BCN Commercial |
$1,684.11
|
| Rate for Payer: BCN Medicare Advantage |
$512.14
|
| Rate for Payer: Cash Price |
$1,638.84
|
| Rate for Payer: Cofinity Commercial |
$1,761.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,638.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$512.14
|
| Rate for Payer: Healthscope Commercial |
$1,843.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,536.41
|
| Rate for Payer: Mclaren Medicaid |
$361.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$537.74
|
| Rate for Payer: Meridian Medicaid |
$379.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$588.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$563.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,741.27
|
| Rate for Payer: Nomi Health Commercial |
$1,679.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,536.41
|
| Rate for Payer: PACE Senior Care Partners |
$486.53
|
| Rate for Payer: PACE SWMI |
$512.14
|
| Rate for Payer: PHP Commercial |
$1,741.27
|
| Rate for Payer: PHP Medicare Advantage |
$512.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$361.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,782.24
|
| Rate for Payer: Priority Health Medicare |
$517.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,425.79
|
| Rate for Payer: Railroad Medicare Medicare |
$512.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,802.72
|
| Rate for Payer: UHC Core |
$1,710.54
|
| Rate for Payer: UHC Exchange |
$512.14
|
| Rate for Payer: UHC Medicaid |
$361.16
|
| Rate for Payer: UHC Medicare Advantage |
$512.14
|
| Rate for Payer: UHCCP Medicaid |
$361.16
|
| Rate for Payer: VA VA |
$512.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,536.41
|
|
|
HC ECHO COMPLETE W/DEFINITY
|
Facility
|
IP
|
$2,048.55
|
|
|
Service Code
|
HCPCS C8929
|
| Hospital Charge Code |
48300003
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,425.79 |
| Max. Negotiated Rate |
$1,843.69 |
| Rate for Payer: Aetna Commercial |
$1,741.27
|
| Rate for Payer: BCBS Trust/PPO |
$1,691.90
|
| Rate for Payer: BCN Commercial |
$1,691.90
|
| Rate for Payer: Cash Price |
$1,638.84
|
| Rate for Payer: Cofinity Commercial |
$1,761.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,638.84
|
| Rate for Payer: Healthscope Commercial |
$1,843.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,536.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,741.27
|
| Rate for Payer: Nomi Health Commercial |
$1,679.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,536.41
|
| Rate for Payer: PHP Commercial |
$1,741.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,782.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,425.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,802.72
|
| Rate for Payer: UHC Core |
$1,710.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,536.41
|
|
|
HC ECHO COMPLETE W/DEFINITY
|
Facility
|
OP
|
$2,048.55
|
|
|
Service Code
|
HCPCS C8929
|
| Hospital Charge Code |
48300003
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$361.16 |
| Max. Negotiated Rate |
$1,843.69 |
| Rate for Payer: Aetna Commercial |
$1,741.27
|
| Rate for Payer: Aetna Medicare |
$532.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$640.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$640.17
|
| Rate for Payer: BCBS Complete |
$379.19
|
| Rate for Payer: BCBS MAPPO |
$512.14
|
| Rate for Payer: BCBS Trust/PPO |
$1,684.11
|
| Rate for Payer: BCN Commercial |
$1,684.11
|
| Rate for Payer: BCN Medicare Advantage |
$512.14
|
| Rate for Payer: Cash Price |
$1,638.84
|
| Rate for Payer: Cofinity Commercial |
$1,761.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,638.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$512.14
|
| Rate for Payer: Healthscope Commercial |
$1,843.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,536.41
|
| Rate for Payer: Mclaren Medicaid |
$361.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$537.74
|
| Rate for Payer: Meridian Medicaid |
$379.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$588.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$563.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,741.27
|
| Rate for Payer: Nomi Health Commercial |
$1,679.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,536.41
|
| Rate for Payer: PACE Senior Care Partners |
$486.53
|
| Rate for Payer: PACE SWMI |
$512.14
|
| Rate for Payer: PHP Commercial |
$1,741.27
|
| Rate for Payer: PHP Medicare Advantage |
$512.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$361.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,782.24
|
| Rate for Payer: Priority Health Medicare |
$517.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,425.79
|
| Rate for Payer: Railroad Medicare Medicare |
$512.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,802.72
|
| Rate for Payer: UHC Core |
$1,710.54
|
| Rate for Payer: UHC Exchange |
$512.14
|
| Rate for Payer: UHC Medicaid |
$361.16
|
| Rate for Payer: UHC Medicare Advantage |
$512.14
|
| Rate for Payer: UHCCP Medicaid |
$361.16
|
| Rate for Payer: VA VA |
$512.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,536.41
|
|
|
HC ECHO CONGENITAL
|
Facility
|
OP
|
$1,671.72
|
|
|
Service Code
|
CPT 93303
|
| Hospital Charge Code |
48000004
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$294.72 |
| Max. Negotiated Rate |
$1,504.55 |
| Rate for Payer: Aetna Commercial |
$1,420.96
|
| Rate for Payer: Aetna Medicare |
$434.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$522.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$522.41
|
| Rate for Payer: BCBS Complete |
$309.44
|
| Rate for Payer: BCBS MAPPO |
$417.93
|
| Rate for Payer: BCBS Trust/PPO |
$1,374.32
|
| Rate for Payer: BCN Commercial |
$1,374.32
|
| Rate for Payer: BCN Medicare Advantage |
$417.93
|
| Rate for Payer: Cash Price |
$1,337.38
|
| Rate for Payer: Cofinity Commercial |
$1,437.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,337.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$417.93
|
| Rate for Payer: Healthscope Commercial |
$1,504.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,253.79
|
| Rate for Payer: Mclaren Medicaid |
$294.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$438.83
|
| Rate for Payer: Meridian Medicaid |
$309.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$480.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$459.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,420.96
|
| Rate for Payer: Nomi Health Commercial |
$1,370.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,253.79
|
| Rate for Payer: PACE Senior Care Partners |
$397.03
|
| Rate for Payer: PACE SWMI |
$417.93
|
| Rate for Payer: PHP Commercial |
$1,420.96
|
| Rate for Payer: PHP Medicare Advantage |
$417.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$294.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,454.40
|
| Rate for Payer: Priority Health Medicare |
$422.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,163.52
|
| Rate for Payer: Railroad Medicare Medicare |
$417.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,471.11
|
| Rate for Payer: UHC Core |
$1,395.89
|
| Rate for Payer: UHC Exchange |
$417.93
|
| Rate for Payer: UHC Medicaid |
$294.72
|
| Rate for Payer: UHC Medicare Advantage |
$417.93
|
| Rate for Payer: UHCCP Medicaid |
$294.72
|
| Rate for Payer: VA VA |
$417.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,253.79
|
|
|
HC ECHO CONGENITAL
|
Facility
|
IP
|
$1,671.72
|
|
|
Service Code
|
CPT 93303
|
| Hospital Charge Code |
48000004
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,163.52 |
| Max. Negotiated Rate |
$1,504.55 |
| Rate for Payer: Aetna Commercial |
$1,420.96
|
| Rate for Payer: BCBS Trust/PPO |
$1,380.67
|
| Rate for Payer: BCN Commercial |
$1,380.67
|
| Rate for Payer: Cash Price |
$1,337.38
|
| Rate for Payer: Cofinity Commercial |
$1,437.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,337.38
|
| Rate for Payer: Healthscope Commercial |
$1,504.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,253.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,420.96
|
| Rate for Payer: Nomi Health Commercial |
$1,370.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,253.79
|
| Rate for Payer: PHP Commercial |
$1,420.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,454.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,163.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,471.11
|
| Rate for Payer: UHC Core |
$1,395.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,253.79
|
|
|
HC ECHO CONGENITAL LMTD
|
Facility
|
IP
|
$1,167.55
|
|
|
Service Code
|
CPT 93304
|
| Hospital Charge Code |
48000005
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$812.61 |
| Max. Negotiated Rate |
$1,050.80 |
| Rate for Payer: Aetna Commercial |
$992.42
|
| Rate for Payer: BCBS Trust/PPO |
$964.28
|
| Rate for Payer: BCN Commercial |
$964.28
|
| Rate for Payer: Cash Price |
$934.04
|
| Rate for Payer: Cofinity Commercial |
$1,004.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$934.04
|
| Rate for Payer: Healthscope Commercial |
$1,050.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$875.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$992.42
|
| Rate for Payer: Nomi Health Commercial |
$957.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$875.66
|
| Rate for Payer: PHP Commercial |
$992.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,015.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$812.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,027.44
|
| Rate for Payer: UHC Core |
$974.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$875.66
|
|
|
HC ECHO CONGENITAL LMTD
|
Facility
|
OP
|
$1,167.55
|
|
|
Service Code
|
CPT 93304
|
| Hospital Charge Code |
48000005
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$205.84 |
| Max. Negotiated Rate |
$1,050.80 |
| Rate for Payer: Aetna Commercial |
$992.42
|
| Rate for Payer: Aetna Medicare |
$303.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$364.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$364.86
|
| Rate for Payer: BCBS Complete |
$216.11
|
| Rate for Payer: BCBS MAPPO |
$291.89
|
| Rate for Payer: BCBS Trust/PPO |
$959.84
|
| Rate for Payer: BCN Commercial |
$959.84
|
| Rate for Payer: BCN Medicare Advantage |
$291.89
|
| Rate for Payer: Cash Price |
$934.04
|
| Rate for Payer: Cofinity Commercial |
$1,004.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$934.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$291.89
|
| Rate for Payer: Healthscope Commercial |
$1,050.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$875.66
|
| Rate for Payer: Mclaren Medicaid |
$205.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$306.48
|
| Rate for Payer: Meridian Medicaid |
$216.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$335.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$321.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$992.42
|
| Rate for Payer: Nomi Health Commercial |
$957.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$875.66
|
| Rate for Payer: PACE Senior Care Partners |
$277.29
|
| Rate for Payer: PACE SWMI |
$291.89
|
| Rate for Payer: PHP Commercial |
$992.42
|
| Rate for Payer: PHP Medicare Advantage |
$291.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$205.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,015.77
|
| Rate for Payer: Priority Health Medicare |
$294.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$812.61
|
| Rate for Payer: Railroad Medicare Medicare |
$291.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,027.44
|
| Rate for Payer: UHC Core |
$974.90
|
| Rate for Payer: UHC Exchange |
$291.89
|
| Rate for Payer: UHC Medicaid |
$205.84
|
| Rate for Payer: UHC Medicare Advantage |
$291.89
|
| Rate for Payer: UHCCP Medicaid |
$205.84
|
| Rate for Payer: VA VA |
$291.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$875.66
|
|
|
HC ECHO FETAL COMPLETE
|
Facility
|
IP
|
$986.19
|
|
|
Service Code
|
CPT 76825
|
| Hospital Charge Code |
40200030
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$686.39 |
| Max. Negotiated Rate |
$887.57 |
| Rate for Payer: Aetna Commercial |
$838.26
|
| Rate for Payer: BCBS Trust/PPO |
$814.49
|
| Rate for Payer: BCN Commercial |
$814.49
|
| Rate for Payer: Cash Price |
$788.95
|
| Rate for Payer: Cofinity Commercial |
$848.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$788.95
|
| Rate for Payer: Healthscope Commercial |
$887.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$739.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$838.26
|
| Rate for Payer: Nomi Health Commercial |
$808.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$739.64
|
| Rate for Payer: PHP Commercial |
$838.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$857.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$686.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$867.85
|
| Rate for Payer: UHC Core |
$823.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$739.64
|
|
|
HC ECHO FETAL COMPLETE
|
Facility
|
OP
|
$986.19
|
|
|
Service Code
|
CPT 76825
|
| Hospital Charge Code |
40200030
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$173.87 |
| Max. Negotiated Rate |
$887.57 |
| Rate for Payer: Aetna Commercial |
$838.26
|
| Rate for Payer: Aetna Medicare |
$256.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$308.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$308.18
|
| Rate for Payer: BCBS Complete |
$182.54
|
| Rate for Payer: BCBS MAPPO |
$246.55
|
| Rate for Payer: BCBS Trust/PPO |
$810.75
|
| Rate for Payer: BCN Commercial |
$810.75
|
| Rate for Payer: BCN Medicare Advantage |
$246.55
|
| Rate for Payer: Cash Price |
$788.95
|
| Rate for Payer: Cofinity Commercial |
$848.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$788.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$246.55
|
| Rate for Payer: Healthscope Commercial |
$887.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$739.64
|
| Rate for Payer: Mclaren Medicaid |
$173.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$258.87
|
| Rate for Payer: Meridian Medicaid |
$182.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$283.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$271.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$838.26
|
| Rate for Payer: Nomi Health Commercial |
$808.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$739.64
|
| Rate for Payer: PACE Senior Care Partners |
$234.22
|
| Rate for Payer: PACE SWMI |
$246.55
|
| Rate for Payer: PHP Commercial |
$838.26
|
| Rate for Payer: PHP Medicare Advantage |
$246.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$173.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$857.99
|
| Rate for Payer: Priority Health Medicare |
$249.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$686.39
|
| Rate for Payer: Railroad Medicare Medicare |
$246.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$867.85
|
| Rate for Payer: UHC Core |
$823.47
|
| Rate for Payer: UHC Exchange |
$246.55
|
| Rate for Payer: UHC Medicaid |
$173.87
|
| Rate for Payer: UHC Medicare Advantage |
$246.55
|
| Rate for Payer: UHCCP Medicaid |
$173.87
|
| Rate for Payer: VA VA |
$246.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$739.64
|
|
|
HC ECHO FETAL FOLLOWUP/REPEAT
|
Facility
|
OP
|
$751.33
|
|
|
Service Code
|
CPT 76826
|
| Hospital Charge Code |
40200077
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$132.46 |
| Max. Negotiated Rate |
$676.20 |
| Rate for Payer: Aetna Commercial |
$638.63
|
| Rate for Payer: Aetna Medicare |
$195.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$234.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$234.79
|
| Rate for Payer: BCBS Complete |
$139.07
|
| Rate for Payer: BCBS MAPPO |
$187.83
|
| Rate for Payer: BCBS Trust/PPO |
$617.67
|
| Rate for Payer: BCN Commercial |
$617.67
|
| Rate for Payer: BCN Medicare Advantage |
$187.83
|
| Rate for Payer: Cash Price |
$601.06
|
| Rate for Payer: Cofinity Commercial |
$646.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$601.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$187.83
|
| Rate for Payer: Healthscope Commercial |
$676.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$563.50
|
| Rate for Payer: Mclaren Medicaid |
$132.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$197.22
|
| Rate for Payer: Meridian Medicaid |
$139.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$216.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$206.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$638.63
|
| Rate for Payer: Nomi Health Commercial |
$616.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$563.50
|
| Rate for Payer: PACE Senior Care Partners |
$178.44
|
| Rate for Payer: PACE SWMI |
$187.83
|
| Rate for Payer: PHP Commercial |
$638.63
|
| Rate for Payer: PHP Medicare Advantage |
$187.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$132.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$653.66
|
| Rate for Payer: Priority Health Medicare |
$189.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$522.93
|
| Rate for Payer: Railroad Medicare Medicare |
$187.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$661.17
|
| Rate for Payer: UHC Core |
$627.36
|
| Rate for Payer: UHC Exchange |
$187.83
|
| Rate for Payer: UHC Medicaid |
$132.46
|
| Rate for Payer: UHC Medicare Advantage |
$187.83
|
| Rate for Payer: UHCCP Medicaid |
$132.46
|
| Rate for Payer: VA VA |
$187.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$563.50
|
|
|
HC ECHO FETAL FOLLOWUP/REPEAT
|
Facility
|
IP
|
$751.33
|
|
|
Service Code
|
CPT 76826
|
| Hospital Charge Code |
40200077
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$522.93 |
| Max. Negotiated Rate |
$676.20 |
| Rate for Payer: Aetna Commercial |
$638.63
|
| Rate for Payer: BCBS Trust/PPO |
$620.52
|
| Rate for Payer: BCN Commercial |
$620.52
|
| Rate for Payer: Cash Price |
$601.06
|
| Rate for Payer: Cofinity Commercial |
$646.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$601.06
|
| Rate for Payer: Healthscope Commercial |
$676.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$563.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$638.63
|
| Rate for Payer: Nomi Health Commercial |
$616.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$563.50
|
| Rate for Payer: PHP Commercial |
$638.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$653.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$522.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$661.17
|
| Rate for Payer: UHC Core |
$627.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$563.50
|
|
|
HC ECHO FETAL FOLLOW UP SPECTRAL
|
Facility
|
IP
|
$434.03
|
|
|
Service Code
|
CPT 76828
|
| Hospital Charge Code |
40200079
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$302.08 |
| Max. Negotiated Rate |
$390.63 |
| Rate for Payer: Aetna Commercial |
$368.93
|
| Rate for Payer: BCBS Trust/PPO |
$358.47
|
| Rate for Payer: BCN Commercial |
$358.47
|
| Rate for Payer: Cash Price |
$347.22
|
| Rate for Payer: Cofinity Commercial |
$373.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$347.22
|
| Rate for Payer: Healthscope Commercial |
$390.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$325.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$368.93
|
| Rate for Payer: Nomi Health Commercial |
$355.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$325.52
|
| Rate for Payer: PHP Commercial |
$368.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$377.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$302.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$381.95
|
| Rate for Payer: UHC Core |
$362.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$325.52
|
|
|
HC ECHO FETAL FOLLOW UP SPECTRAL
|
Facility
|
OP
|
$434.03
|
|
|
Service Code
|
CPT 76828
|
| Hospital Charge Code |
40200079
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$76.52 |
| Max. Negotiated Rate |
$390.63 |
| Rate for Payer: Aetna Commercial |
$368.93
|
| Rate for Payer: Aetna Medicare |
$112.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$135.63
|
| Rate for Payer: Amish Plain Church Group Commercial |
$135.63
|
| Rate for Payer: BCBS Complete |
$80.34
|
| Rate for Payer: BCBS MAPPO |
$108.51
|
| Rate for Payer: BCBS Trust/PPO |
$356.82
|
| Rate for Payer: BCN Commercial |
$356.82
|
| Rate for Payer: BCN Medicare Advantage |
$108.51
|
| Rate for Payer: Cash Price |
$347.22
|
| Rate for Payer: Cofinity Commercial |
$373.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$347.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$108.51
|
| Rate for Payer: Healthscope Commercial |
$390.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$325.52
|
| Rate for Payer: Mclaren Medicaid |
$76.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$113.93
|
| Rate for Payer: Meridian Medicaid |
$80.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$124.78
|
| Rate for Payer: Molina Medicare/Medicaid |
$119.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$368.93
|
| Rate for Payer: Nomi Health Commercial |
$355.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$325.52
|
| Rate for Payer: PACE Senior Care Partners |
$103.08
|
| Rate for Payer: PACE SWMI |
$108.51
|
| Rate for Payer: PHP Commercial |
$368.93
|
| Rate for Payer: PHP Medicare Advantage |
$108.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$377.61
|
| Rate for Payer: Priority Health Medicare |
$109.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$302.08
|
| Rate for Payer: Railroad Medicare Medicare |
$108.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$381.95
|
| Rate for Payer: UHC Core |
$362.42
|
| Rate for Payer: UHC Exchange |
$108.51
|
| Rate for Payer: UHC Medicaid |
$76.52
|
| Rate for Payer: UHC Medicare Advantage |
$108.51
|
| Rate for Payer: UHCCP Medicaid |
$76.52
|
| Rate for Payer: VA VA |
$108.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$325.52
|
|
|
HC ECHO FETAL SPECTRAL
|
Facility
|
OP
|
$715.25
|
|
|
Service Code
|
CPT 76827
|
| Hospital Charge Code |
40200078
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$126.10 |
| Max. Negotiated Rate |
$643.73 |
| Rate for Payer: Aetna Commercial |
$607.96
|
| Rate for Payer: Aetna Medicare |
$185.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$223.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$223.52
|
| Rate for Payer: BCBS Complete |
$132.39
|
| Rate for Payer: BCBS MAPPO |
$178.81
|
| Rate for Payer: BCBS Trust/PPO |
$588.01
|
| Rate for Payer: BCN Commercial |
$588.01
|
| Rate for Payer: BCN Medicare Advantage |
$178.81
|
| Rate for Payer: Cash Price |
$572.20
|
| Rate for Payer: Cofinity Commercial |
$615.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$572.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$178.81
|
| Rate for Payer: Healthscope Commercial |
$643.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$536.44
|
| Rate for Payer: Mclaren Medicaid |
$126.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$187.75
|
| Rate for Payer: Meridian Medicaid |
$132.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$205.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$196.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$607.96
|
| Rate for Payer: Nomi Health Commercial |
$586.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$536.44
|
| Rate for Payer: PACE Senior Care Partners |
$169.87
|
| Rate for Payer: PACE SWMI |
$178.81
|
| Rate for Payer: PHP Commercial |
$607.96
|
| Rate for Payer: PHP Medicare Advantage |
$178.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$622.27
|
| Rate for Payer: Priority Health Medicare |
$180.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$497.81
|
| Rate for Payer: Railroad Medicare Medicare |
$178.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$629.42
|
| Rate for Payer: UHC Core |
$597.23
|
| Rate for Payer: UHC Exchange |
$178.81
|
| Rate for Payer: UHC Medicaid |
$126.10
|
| Rate for Payer: UHC Medicare Advantage |
$178.81
|
| Rate for Payer: UHCCP Medicaid |
$126.10
|
| Rate for Payer: VA VA |
$178.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$536.44
|
|
|
HC ECHO FETAL SPECTRAL
|
Facility
|
IP
|
$715.25
|
|
|
Service Code
|
CPT 76827
|
| Hospital Charge Code |
40200078
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$497.81 |
| Max. Negotiated Rate |
$643.73 |
| Rate for Payer: Aetna Commercial |
$607.96
|
| Rate for Payer: BCBS Trust/PPO |
$590.72
|
| Rate for Payer: BCN Commercial |
$590.72
|
| Rate for Payer: Cash Price |
$572.20
|
| Rate for Payer: Cofinity Commercial |
$615.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$572.20
|
| Rate for Payer: Healthscope Commercial |
$643.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$536.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$607.96
|
| Rate for Payer: Nomi Health Commercial |
$586.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$536.44
|
| Rate for Payer: PHP Commercial |
$607.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$622.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$497.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$629.42
|
| Rate for Payer: UHC Core |
$597.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$536.44
|
|
|
HC ECHO LIMITED W/DEFINITY
|
Facility
|
IP
|
$940.29
|
|
|
Service Code
|
HCPCS C8924
|
| Hospital Charge Code |
48300007
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$654.44 |
| Max. Negotiated Rate |
$846.26 |
| Rate for Payer: Aetna Commercial |
$799.25
|
| Rate for Payer: BCBS Trust/PPO |
$776.59
|
| Rate for Payer: BCN Commercial |
$776.59
|
| Rate for Payer: Cash Price |
$752.23
|
| Rate for Payer: Cofinity Commercial |
$808.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$752.23
|
| Rate for Payer: Healthscope Commercial |
$846.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$705.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$799.25
|
| Rate for Payer: Nomi Health Commercial |
$771.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$705.22
|
| Rate for Payer: PHP Commercial |
$799.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$818.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$654.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$827.46
|
| Rate for Payer: UHC Core |
$785.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$705.22
|
|
|
HC ECHO LIMITED W/DEFINITY
|
Facility
|
OP
|
$940.29
|
|
|
Service Code
|
HCPCS C8924
|
| Hospital Charge Code |
48300007
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$165.77 |
| Max. Negotiated Rate |
$846.26 |
| Rate for Payer: Aetna Commercial |
$799.25
|
| Rate for Payer: Aetna Medicare |
$244.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$293.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$293.84
|
| Rate for Payer: BCBS Complete |
$174.05
|
| Rate for Payer: BCBS MAPPO |
$235.07
|
| Rate for Payer: BCBS Trust/PPO |
$773.01
|
| Rate for Payer: BCN Commercial |
$773.01
|
| Rate for Payer: BCN Medicare Advantage |
$235.07
|
| Rate for Payer: Cash Price |
$752.23
|
| Rate for Payer: Cofinity Commercial |
$808.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$752.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.07
|
| Rate for Payer: Healthscope Commercial |
$846.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$705.22
|
| Rate for Payer: Mclaren Medicaid |
$165.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$246.83
|
| Rate for Payer: Meridian Medicaid |
$174.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$270.33
|
| Rate for Payer: Molina Medicare/Medicaid |
$258.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$799.25
|
| Rate for Payer: Nomi Health Commercial |
$771.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$705.22
|
| Rate for Payer: PACE Senior Care Partners |
$223.32
|
| Rate for Payer: PACE SWMI |
$235.07
|
| Rate for Payer: PHP Commercial |
$799.25
|
| Rate for Payer: PHP Medicare Advantage |
$235.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$165.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$818.05
|
| Rate for Payer: Priority Health Medicare |
$237.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$654.44
|
| Rate for Payer: Railroad Medicare Medicare |
$235.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$827.46
|
| Rate for Payer: UHC Core |
$785.14
|
| Rate for Payer: UHC Exchange |
$235.07
|
| Rate for Payer: UHC Medicaid |
$165.77
|
| Rate for Payer: UHC Medicare Advantage |
$235.07
|
| Rate for Payer: UHCCP Medicaid |
$165.77
|
| Rate for Payer: VA VA |
$235.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$705.22
|
|
|
HC ECHO/STRESS W DEFINITY.
|
Facility
|
IP
|
$1,517.91
|
|
|
Service Code
|
HCPCS C8928
|
| Hospital Charge Code |
48300008
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,056.47 |
| Max. Negotiated Rate |
$1,366.12 |
| Rate for Payer: Aetna Commercial |
$1,290.22
|
| Rate for Payer: BCBS Trust/PPO |
$1,253.64
|
| Rate for Payer: BCN Commercial |
$1,253.64
|
| Rate for Payer: Cash Price |
$1,214.33
|
| Rate for Payer: Cofinity Commercial |
$1,305.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,214.33
|
| Rate for Payer: Healthscope Commercial |
$1,366.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,138.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,290.22
|
| Rate for Payer: Nomi Health Commercial |
$1,244.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,138.43
|
| Rate for Payer: PHP Commercial |
$1,290.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,320.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,056.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,335.76
|
| Rate for Payer: UHC Core |
$1,267.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,138.43
|
|
|
HC ECHO/STRESS W DEFINITY.
|
Facility
|
OP
|
$1,517.91
|
|
|
Service Code
|
HCPCS C8928
|
| Hospital Charge Code |
48300008
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$267.61 |
| Max. Negotiated Rate |
$1,366.12 |
| Rate for Payer: Aetna Commercial |
$1,290.22
|
| Rate for Payer: Aetna Medicare |
$394.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$474.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$474.35
|
| Rate for Payer: BCBS Complete |
$280.97
|
| Rate for Payer: BCBS MAPPO |
$379.48
|
| Rate for Payer: BCBS Trust/PPO |
$1,247.87
|
| Rate for Payer: BCN Commercial |
$1,247.87
|
| Rate for Payer: BCN Medicare Advantage |
$379.48
|
| Rate for Payer: Cash Price |
$1,214.33
|
| Rate for Payer: Cofinity Commercial |
$1,305.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,214.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$379.48
|
| Rate for Payer: Healthscope Commercial |
$1,366.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,138.43
|
| Rate for Payer: Mclaren Medicaid |
$267.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$398.45
|
| Rate for Payer: Meridian Medicaid |
$280.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$436.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$417.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,290.22
|
| Rate for Payer: Nomi Health Commercial |
$1,244.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,138.43
|
| Rate for Payer: PACE Senior Care Partners |
$360.50
|
| Rate for Payer: PACE SWMI |
$379.48
|
| Rate for Payer: PHP Commercial |
$1,290.22
|
| Rate for Payer: PHP Medicare Advantage |
$379.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$267.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,320.58
|
| Rate for Payer: Priority Health Medicare |
$383.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,056.47
|
| Rate for Payer: Railroad Medicare Medicare |
$379.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,335.76
|
| Rate for Payer: UHC Core |
$1,267.45
|
| Rate for Payer: UHC Exchange |
$379.48
|
| Rate for Payer: UHC Medicaid |
$267.61
|
| Rate for Payer: UHC Medicare Advantage |
$379.48
|
| Rate for Payer: UHCCP Medicaid |
$267.61
|
| Rate for Payer: VA VA |
$379.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,138.43
|
|
|
HC ECMO OR VAD HOURLY CHRG
|
Facility
|
OP
|
$468.18
|
|
| Hospital Charge Code |
27000097
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$82.54 |
| Max. Negotiated Rate |
$421.36 |
| Rate for Payer: Aetna Commercial |
$397.95
|
| Rate for Payer: Aetna Medicare |
$121.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$146.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$146.31
|
| Rate for Payer: BCBS Complete |
$86.66
|
| Rate for Payer: BCBS MAPPO |
$117.05
|
| Rate for Payer: BCBS Trust/PPO |
$384.89
|
| Rate for Payer: BCN Commercial |
$384.89
|
| Rate for Payer: BCN Medicare Advantage |
$117.05
|
| Rate for Payer: Cash Price |
$374.54
|
| Rate for Payer: Cofinity Commercial |
$402.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$117.05
|
| Rate for Payer: Healthscope Commercial |
$421.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$351.13
|
| Rate for Payer: Mclaren Medicaid |
$82.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$122.90
|
| Rate for Payer: Meridian Medicaid |
$86.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$134.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$128.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$397.95
|
| Rate for Payer: Nomi Health Commercial |
$383.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$351.13
|
| Rate for Payer: PACE Senior Care Partners |
$111.19
|
| Rate for Payer: PACE SWMI |
$117.05
|
| Rate for Payer: PHP Commercial |
$397.95
|
| Rate for Payer: PHP Medicare Advantage |
$117.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$407.32
|
| Rate for Payer: Priority Health Medicare |
$118.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$325.85
|
| Rate for Payer: Railroad Medicare Medicare |
$117.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$412.00
|
| Rate for Payer: UHC Core |
$390.93
|
| Rate for Payer: UHC Exchange |
$117.05
|
| Rate for Payer: UHC Medicaid |
$82.54
|
| Rate for Payer: UHC Medicare Advantage |
$117.05
|
| Rate for Payer: UHCCP Medicaid |
$82.54
|
| Rate for Payer: VA VA |
$117.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$351.13
|
|
|
HC ECMO OR VAD HOURLY CHRG
|
Facility
|
IP
|
$468.18
|
|
| Hospital Charge Code |
27000097
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$325.85 |
| Max. Negotiated Rate |
$421.36 |
| Rate for Payer: Aetna Commercial |
$397.95
|
| Rate for Payer: BCBS Trust/PPO |
$386.67
|
| Rate for Payer: BCN Commercial |
$386.67
|
| Rate for Payer: Cash Price |
$374.54
|
| Rate for Payer: Cofinity Commercial |
$402.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.54
|
| Rate for Payer: Healthscope Commercial |
$421.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$351.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$397.95
|
| Rate for Payer: Nomi Health Commercial |
$383.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$351.13
|
| Rate for Payer: PHP Commercial |
$397.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$407.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$325.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$412.00
|
| Rate for Payer: UHC Core |
$390.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$351.13
|
|
|
HC ECMO OR VAD SUPPT SETUP
|
Facility
|
OP
|
$3,251.25
|
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$573.20 |
| Max. Negotiated Rate |
$2,926.12 |
| Rate for Payer: Aetna Commercial |
$2,763.56
|
| Rate for Payer: Aetna Medicare |
$845.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,016.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,016.02
|
| Rate for Payer: BCBS Complete |
$601.81
|
| Rate for Payer: BCBS MAPPO |
$812.81
|
| Rate for Payer: BCBS Trust/PPO |
$2,672.85
|
| Rate for Payer: BCN Commercial |
$2,672.85
|
| Rate for Payer: BCN Medicare Advantage |
$812.81
|
| Rate for Payer: Cash Price |
$2,601.00
|
| Rate for Payer: Cofinity Commercial |
$2,796.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,601.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$812.81
|
| Rate for Payer: Healthscope Commercial |
$2,926.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,438.44
|
| Rate for Payer: Mclaren Medicaid |
$573.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$853.45
|
| Rate for Payer: Meridian Medicaid |
$601.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$934.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$894.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,763.56
|
| Rate for Payer: Nomi Health Commercial |
$2,666.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,438.44
|
| Rate for Payer: PACE Senior Care Partners |
$772.17
|
| Rate for Payer: PACE SWMI |
$812.81
|
| Rate for Payer: PHP Commercial |
$2,763.56
|
| Rate for Payer: PHP Medicare Advantage |
$812.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$573.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,828.59
|
| Rate for Payer: Priority Health Medicare |
$820.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,262.87
|
| Rate for Payer: Railroad Medicare Medicare |
$812.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,861.10
|
| Rate for Payer: UHC Core |
$2,714.79
|
| Rate for Payer: UHC Exchange |
$812.81
|
| Rate for Payer: UHC Medicaid |
$573.20
|
| Rate for Payer: UHC Medicare Advantage |
$812.81
|
| Rate for Payer: UHCCP Medicaid |
$573.20
|
| Rate for Payer: VA VA |
$812.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,438.44
|
|
|
HC ECMO OR VAD SUPPT SETUP
|
Facility
|
IP
|
$3,251.25
|
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2,262.87 |
| Max. Negotiated Rate |
$2,926.12 |
| Rate for Payer: Aetna Commercial |
$2,763.56
|
| Rate for Payer: BCBS Trust/PPO |
$2,685.21
|
| Rate for Payer: BCN Commercial |
$2,685.21
|
| Rate for Payer: Cash Price |
$2,601.00
|
| Rate for Payer: Cofinity Commercial |
$2,796.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,601.00
|
| Rate for Payer: Healthscope Commercial |
$2,926.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,438.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,763.56
|
| Rate for Payer: Nomi Health Commercial |
$2,666.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,438.44
|
| Rate for Payer: PHP Commercial |
$2,763.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,828.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,262.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,861.10
|
| Rate for Payer: UHC Core |
$2,714.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,438.44
|
|
|
HC EEG AWAKE & ASLEEP
|
Facility
|
IP
|
$2,534.65
|
|
|
Service Code
|
CPT 95819
|
| Hospital Charge Code |
74000006
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,764.12 |
| Max. Negotiated Rate |
$2,281.18 |
| Rate for Payer: Aetna Commercial |
$2,154.45
|
| Rate for Payer: BCBS Trust/PPO |
$2,093.37
|
| Rate for Payer: BCN Commercial |
$2,093.37
|
| Rate for Payer: Cash Price |
$2,027.72
|
| Rate for Payer: Cofinity Commercial |
$2,179.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,027.72
|
| Rate for Payer: Healthscope Commercial |
$2,281.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,900.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,154.45
|
| Rate for Payer: Nomi Health Commercial |
$2,078.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,900.99
|
| Rate for Payer: PHP Commercial |
$2,154.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,205.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,764.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,230.49
|
| Rate for Payer: UHC Core |
$2,116.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,900.99
|
|
