|
HC EGD W EUS EXAM ESOPH ONLY
|
Facility
|
OP
|
$2,909.09
|
|
| Hospital Charge Code |
36000035
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$512.87 |
| Max. Negotiated Rate |
$2,618.18 |
| Rate for Payer: Aetna Commercial |
$2,472.73
|
| Rate for Payer: Aetna Medicare |
$756.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$909.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$909.09
|
| Rate for Payer: BCBS Complete |
$538.47
|
| Rate for Payer: BCBS MAPPO |
$727.27
|
| Rate for Payer: BCBS Trust/PPO |
$2,391.56
|
| Rate for Payer: BCN Commercial |
$2,391.56
|
| Rate for Payer: BCN Medicare Advantage |
$727.27
|
| Rate for Payer: Cash Price |
$2,327.27
|
| Rate for Payer: Cofinity Commercial |
$2,501.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,327.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$727.27
|
| Rate for Payer: Healthscope Commercial |
$2,618.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,181.82
|
| Rate for Payer: Mclaren Medicaid |
$512.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$763.64
|
| Rate for Payer: Meridian Medicaid |
$538.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$836.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$800.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,472.73
|
| Rate for Payer: Nomi Health Commercial |
$2,385.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,181.82
|
| Rate for Payer: PACE Senior Care Partners |
$690.91
|
| Rate for Payer: PACE SWMI |
$727.27
|
| Rate for Payer: PHP Commercial |
$2,472.73
|
| Rate for Payer: PHP Medicare Advantage |
$727.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$512.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,530.91
|
| Rate for Payer: Priority Health Medicare |
$734.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,024.73
|
| Rate for Payer: Railroad Medicare Medicare |
$727.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,560.00
|
| Rate for Payer: UHC Core |
$2,429.09
|
| Rate for Payer: UHC Exchange |
$727.27
|
| Rate for Payer: UHC Medicaid |
$512.87
|
| Rate for Payer: UHC Medicare Advantage |
$727.27
|
| Rate for Payer: UHCCP Medicaid |
$512.87
|
| Rate for Payer: VA VA |
$727.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,181.82
|
|
|
HC EGD W EUS EXAM ESOPH ONLY
|
Facility
|
IP
|
$2,909.09
|
|
| Hospital Charge Code |
36000035
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,024.73 |
| Max. Negotiated Rate |
$2,618.18 |
| Rate for Payer: Aetna Commercial |
$2,472.73
|
| Rate for Payer: BCBS Trust/PPO |
$2,402.62
|
| Rate for Payer: BCN Commercial |
$2,402.62
|
| Rate for Payer: Cash Price |
$2,327.27
|
| Rate for Payer: Cofinity Commercial |
$2,501.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,327.27
|
| Rate for Payer: Healthscope Commercial |
$2,618.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,181.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,472.73
|
| Rate for Payer: Nomi Health Commercial |
$2,385.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,181.82
|
| Rate for Payer: PHP Commercial |
$2,472.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,530.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,024.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,560.00
|
| Rate for Payer: UHC Core |
$2,429.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,181.82
|
|
|
HC EGD W EUS EXAM ESOPH,STOM,DUO,
|
Facility
|
OP
|
$3,038.67
|
|
| Hospital Charge Code |
36000036
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$535.72 |
| Max. Negotiated Rate |
$2,734.80 |
| Rate for Payer: Aetna Commercial |
$2,582.87
|
| Rate for Payer: Aetna Medicare |
$790.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$949.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$949.58
|
| Rate for Payer: BCBS Complete |
$562.46
|
| Rate for Payer: BCBS MAPPO |
$759.67
|
| Rate for Payer: BCBS Trust/PPO |
$2,498.09
|
| Rate for Payer: BCN Commercial |
$2,498.09
|
| Rate for Payer: BCN Medicare Advantage |
$759.67
|
| Rate for Payer: Cash Price |
$2,430.94
|
| Rate for Payer: Cofinity Commercial |
$2,613.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,430.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$759.67
|
| Rate for Payer: Healthscope Commercial |
$2,734.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,279.00
|
| Rate for Payer: Mclaren Medicaid |
$535.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$797.65
|
| Rate for Payer: Meridian Medicaid |
$562.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$873.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$835.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,582.87
|
| Rate for Payer: Nomi Health Commercial |
$2,491.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,279.00
|
| Rate for Payer: PACE Senior Care Partners |
$721.68
|
| Rate for Payer: PACE SWMI |
$759.67
|
| Rate for Payer: PHP Commercial |
$2,582.87
|
| Rate for Payer: PHP Medicare Advantage |
$759.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$535.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,643.64
|
| Rate for Payer: Priority Health Medicare |
$767.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,114.91
|
| Rate for Payer: Railroad Medicare Medicare |
$759.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,674.03
|
| Rate for Payer: UHC Core |
$2,537.29
|
| Rate for Payer: UHC Exchange |
$759.67
|
| Rate for Payer: UHC Medicaid |
$535.72
|
| Rate for Payer: UHC Medicare Advantage |
$759.67
|
| Rate for Payer: UHCCP Medicaid |
$535.72
|
| Rate for Payer: VA VA |
$759.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,279.00
|
|
|
HC EGD W EUS EXAM ESOPH,STOM,DUO,
|
Facility
|
IP
|
$3,038.67
|
|
| Hospital Charge Code |
36000036
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,114.91 |
| Max. Negotiated Rate |
$2,734.80 |
| Rate for Payer: Aetna Commercial |
$2,582.87
|
| Rate for Payer: BCBS Trust/PPO |
$2,509.64
|
| Rate for Payer: BCN Commercial |
$2,509.64
|
| Rate for Payer: Cash Price |
$2,430.94
|
| Rate for Payer: Cofinity Commercial |
$2,613.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,430.94
|
| Rate for Payer: Healthscope Commercial |
$2,734.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,279.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,582.87
|
| Rate for Payer: Nomi Health Commercial |
$2,491.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,279.00
|
| Rate for Payer: PHP Commercial |
$2,582.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,643.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,114.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,674.03
|
| Rate for Payer: UHC Core |
$2,537.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,279.00
|
|
|
HC EGG WHITE IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200041
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.57 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna Medicare |
$6.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.09
|
| Rate for Payer: BCBS Complete |
$4.79
|
| Rate for Payer: BCBS MAPPO |
$6.47
|
| Rate for Payer: BCBS Trust/PPO |
$21.29
|
| Rate for Payer: BCN Commercial |
$21.29
|
| Rate for Payer: BCN Medicare Advantage |
$6.47
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.47
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.43
|
| Rate for Payer: Mclaren Medicaid |
$4.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.80
|
| Rate for Payer: Meridian Medicaid |
$4.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PACE Senior Care Partners |
$6.15
|
| Rate for Payer: PACE SWMI |
$6.47
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: PHP Medicare Advantage |
$6.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.53
|
| Rate for Payer: Priority Health Medicare |
$6.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.03
|
| Rate for Payer: Railroad Medicare Medicare |
$6.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.79
|
| Rate for Payer: UHC Core |
$21.63
|
| Rate for Payer: UHC Exchange |
$6.47
|
| Rate for Payer: UHC Medicaid |
$4.57
|
| Rate for Payer: UHC Medicare Advantage |
$6.47
|
| Rate for Payer: UHCCP Medicaid |
$4.57
|
| Rate for Payer: VA VA |
$6.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.43
|
|
|
HC EGG WHITE IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200041
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.03 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: BCBS Trust/PPO |
$21.39
|
| Rate for Payer: BCN Commercial |
$21.39
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.79
|
| Rate for Payer: UHC Core |
$21.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.43
|
|
|
HC EGG YOLK, IGE
|
Facility
|
IP
|
$31.83
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200482
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.15 |
| Max. Negotiated Rate |
$28.65 |
| Rate for Payer: Aetna Commercial |
$27.06
|
| Rate for Payer: BCBS Trust/PPO |
$26.29
|
| Rate for Payer: BCN Commercial |
$26.29
|
| Rate for Payer: Cash Price |
$25.46
|
| Rate for Payer: Cofinity Commercial |
$27.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.46
|
| Rate for Payer: Healthscope Commercial |
$28.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.06
|
| Rate for Payer: Nomi Health Commercial |
$26.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.87
|
| Rate for Payer: PHP Commercial |
$27.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$27.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.01
|
| Rate for Payer: UHC Core |
$26.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.87
|
|
|
HC EGG YOLK, IGE
|
Facility
|
OP
|
$31.83
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200482
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.61 |
| Max. Negotiated Rate |
$28.65 |
| Rate for Payer: Aetna Commercial |
$27.06
|
| Rate for Payer: Aetna Medicare |
$8.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.95
|
| Rate for Payer: BCBS Complete |
$5.89
|
| Rate for Payer: BCBS MAPPO |
$7.96
|
| Rate for Payer: BCBS Trust/PPO |
$26.17
|
| Rate for Payer: BCN Commercial |
$26.17
|
| Rate for Payer: BCN Medicare Advantage |
$7.96
|
| Rate for Payer: Cash Price |
$25.46
|
| Rate for Payer: Cofinity Commercial |
$27.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.96
|
| Rate for Payer: Healthscope Commercial |
$28.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.87
|
| Rate for Payer: Mclaren Medicaid |
$5.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.36
|
| Rate for Payer: Meridian Medicaid |
$5.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.15
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.06
|
| Rate for Payer: Nomi Health Commercial |
$26.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.87
|
| Rate for Payer: PACE Senior Care Partners |
$7.56
|
| Rate for Payer: PACE SWMI |
$7.96
|
| Rate for Payer: PHP Commercial |
$27.06
|
| Rate for Payer: PHP Medicare Advantage |
$7.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$27.69
|
| Rate for Payer: Priority Health Medicare |
$8.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.15
|
| Rate for Payer: Railroad Medicare Medicare |
$7.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.01
|
| Rate for Payer: UHC Core |
$26.58
|
| Rate for Payer: UHC Exchange |
$7.96
|
| Rate for Payer: UHC Medicaid |
$5.61
|
| Rate for Payer: UHC Medicare Advantage |
$7.96
|
| Rate for Payer: UHCCP Medicaid |
$5.61
|
| Rate for Payer: VA VA |
$7.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.87
|
|
|
HC EKG RHYTHM STRIP
|
Facility
|
IP
|
$75.34
|
|
|
Service Code
|
CPT 93041
|
| Hospital Charge Code |
73000002
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$52.44 |
| Max. Negotiated Rate |
$67.81 |
| Rate for Payer: Aetna Commercial |
$64.04
|
| Rate for Payer: BCBS Trust/PPO |
$62.22
|
| Rate for Payer: BCN Commercial |
$62.22
|
| Rate for Payer: Cash Price |
$60.27
|
| Rate for Payer: Cofinity Commercial |
$64.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.27
|
| Rate for Payer: Healthscope Commercial |
$67.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.04
|
| Rate for Payer: Nomi Health Commercial |
$61.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.51
|
| Rate for Payer: PHP Commercial |
$64.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$65.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.30
|
| Rate for Payer: UHC Core |
$62.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.51
|
|
|
HC EKG RHYTHM STRIP
|
Facility
|
OP
|
$75.34
|
|
|
Service Code
|
CPT 93041
|
| Hospital Charge Code |
73000002
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$13.28 |
| Max. Negotiated Rate |
$67.81 |
| Rate for Payer: Aetna Commercial |
$64.04
|
| Rate for Payer: Aetna Medicare |
$19.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.54
|
| Rate for Payer: BCBS Complete |
$13.95
|
| Rate for Payer: BCBS MAPPO |
$18.84
|
| Rate for Payer: BCBS Trust/PPO |
$61.94
|
| Rate for Payer: BCN Commercial |
$61.94
|
| Rate for Payer: BCN Medicare Advantage |
$18.84
|
| Rate for Payer: Cash Price |
$60.27
|
| Rate for Payer: Cofinity Commercial |
$64.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.84
|
| Rate for Payer: Healthscope Commercial |
$67.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.51
|
| Rate for Payer: Mclaren Medicaid |
$13.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.78
|
| Rate for Payer: Meridian Medicaid |
$13.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.04
|
| Rate for Payer: Nomi Health Commercial |
$61.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.51
|
| Rate for Payer: PACE Senior Care Partners |
$17.89
|
| Rate for Payer: PACE SWMI |
$18.84
|
| Rate for Payer: PHP Commercial |
$64.04
|
| Rate for Payer: PHP Medicare Advantage |
$18.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$65.55
|
| Rate for Payer: Priority Health Medicare |
$19.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.44
|
| Rate for Payer: Railroad Medicare Medicare |
$18.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.30
|
| Rate for Payer: UHC Core |
$62.91
|
| Rate for Payer: UHC Exchange |
$18.84
|
| Rate for Payer: UHC Medicaid |
$13.28
|
| Rate for Payer: UHC Medicare Advantage |
$18.84
|
| Rate for Payer: UHCCP Medicaid |
$13.28
|
| Rate for Payer: VA VA |
$18.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.51
|
|
|
HC EKG TRACING FOR INITIAL PREV
|
Facility
|
IP
|
$37.12
|
|
|
Service Code
|
HCPCS G0404
|
| Hospital Charge Code |
73000004
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$25.84 |
| Max. Negotiated Rate |
$33.41 |
| Rate for Payer: Aetna Commercial |
$31.55
|
| Rate for Payer: BCBS Trust/PPO |
$30.66
|
| Rate for Payer: BCN Commercial |
$30.66
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Cofinity Commercial |
$31.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.70
|
| Rate for Payer: Healthscope Commercial |
$33.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.55
|
| Rate for Payer: Nomi Health Commercial |
$30.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.84
|
| Rate for Payer: PHP Commercial |
$31.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$32.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.67
|
| Rate for Payer: UHC Core |
$31.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.84
|
|
|
HC EKG TRACING FOR INITIAL PREV
|
Facility
|
OP
|
$37.12
|
|
|
Service Code
|
HCPCS G0404
|
| Hospital Charge Code |
73000004
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$6.54 |
| Max. Negotiated Rate |
$33.41 |
| Rate for Payer: Aetna Commercial |
$31.55
|
| Rate for Payer: Aetna Medicare |
$9.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.60
|
| Rate for Payer: BCBS Complete |
$6.87
|
| Rate for Payer: BCBS MAPPO |
$9.28
|
| Rate for Payer: BCBS Trust/PPO |
$30.52
|
| Rate for Payer: BCN Commercial |
$30.52
|
| Rate for Payer: BCN Medicare Advantage |
$9.28
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Cofinity Commercial |
$31.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.28
|
| Rate for Payer: Healthscope Commercial |
$33.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.84
|
| Rate for Payer: Mclaren Medicaid |
$6.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.74
|
| Rate for Payer: Meridian Medicaid |
$6.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$10.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.55
|
| Rate for Payer: Nomi Health Commercial |
$30.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.84
|
| Rate for Payer: PACE Senior Care Partners |
$8.82
|
| Rate for Payer: PACE SWMI |
$9.28
|
| Rate for Payer: PHP Commercial |
$31.55
|
| Rate for Payer: PHP Medicare Advantage |
$9.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$32.29
|
| Rate for Payer: Priority Health Medicare |
$9.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.84
|
| Rate for Payer: Railroad Medicare Medicare |
$9.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.67
|
| Rate for Payer: UHC Core |
$31.00
|
| Rate for Payer: UHC Exchange |
$9.28
|
| Rate for Payer: UHC Medicaid |
$6.54
|
| Rate for Payer: UHC Medicare Advantage |
$9.28
|
| Rate for Payer: UHCCP Medicaid |
$6.54
|
| Rate for Payer: VA VA |
$9.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.84
|
|
|
HC EKO INFUSION SYSTEM
|
Facility
|
OP
|
$7,849.99
|
|
| Hospital Charge Code |
27200279
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,383.95 |
| Max. Negotiated Rate |
$7,064.99 |
| Rate for Payer: Aetna Commercial |
$6,672.49
|
| Rate for Payer: Aetna Medicare |
$2,041.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,453.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,453.12
|
| Rate for Payer: BCBS Complete |
$1,453.03
|
| Rate for Payer: BCBS MAPPO |
$1,962.50
|
| Rate for Payer: BCBS Trust/PPO |
$6,453.48
|
| Rate for Payer: BCN Commercial |
$6,453.48
|
| Rate for Payer: BCN Medicare Advantage |
$1,962.50
|
| Rate for Payer: Cash Price |
$6,279.99
|
| Rate for Payer: Cofinity Commercial |
$6,750.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,279.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,962.50
|
| Rate for Payer: Healthscope Commercial |
$7,064.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,887.49
|
| Rate for Payer: Mclaren Medicaid |
$1,383.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,060.62
|
| Rate for Payer: Meridian Medicaid |
$1,453.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,256.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,158.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,672.49
|
| Rate for Payer: Nomi Health Commercial |
$6,436.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,887.49
|
| Rate for Payer: PACE Senior Care Partners |
$1,864.37
|
| Rate for Payer: PACE SWMI |
$1,962.50
|
| Rate for Payer: PHP Commercial |
$6,672.49
|
| Rate for Payer: PHP Medicare Advantage |
$1,962.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,383.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$6,829.49
|
| Rate for Payer: Priority Health Medicare |
$1,982.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,463.59
|
| Rate for Payer: Railroad Medicare Medicare |
$1,962.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,907.99
|
| Rate for Payer: UHC Core |
$6,554.74
|
| Rate for Payer: UHC Exchange |
$1,962.50
|
| Rate for Payer: UHC Medicaid |
$1,383.95
|
| Rate for Payer: UHC Medicare Advantage |
$1,962.50
|
| Rate for Payer: UHCCP Medicaid |
$1,383.95
|
| Rate for Payer: VA VA |
$1,962.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,887.49
|
|
|
HC EKO INFUSION SYSTEM
|
Facility
|
IP
|
$7,849.99
|
|
| Hospital Charge Code |
27200279
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5,463.59 |
| Max. Negotiated Rate |
$7,064.99 |
| Rate for Payer: Aetna Commercial |
$6,672.49
|
| Rate for Payer: BCBS Trust/PPO |
$6,483.31
|
| Rate for Payer: BCN Commercial |
$6,483.31
|
| Rate for Payer: Cash Price |
$6,279.99
|
| Rate for Payer: Cofinity Commercial |
$6,750.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,279.99
|
| Rate for Payer: Healthscope Commercial |
$7,064.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,887.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,672.49
|
| Rate for Payer: Nomi Health Commercial |
$6,436.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,887.49
|
| Rate for Payer: PHP Commercial |
$6,672.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$6,829.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,463.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,907.99
|
| Rate for Payer: UHC Core |
$6,554.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,887.49
|
|
|
HC ELEC ALYS IMPLT BRN NPGT PRGRMG EA ADDL 15 MIN
|
Facility
|
OP
|
$71.00
|
|
|
Service Code
|
CPT 95984
|
| Hospital Charge Code |
76100548
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$12.52 |
| Max. Negotiated Rate |
$63.90 |
| Rate for Payer: Aetna Commercial |
$60.35
|
| Rate for Payer: Aetna Medicare |
$18.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.19
|
| Rate for Payer: BCBS Complete |
$13.14
|
| Rate for Payer: BCBS MAPPO |
$17.75
|
| Rate for Payer: BCBS Trust/PPO |
$58.37
|
| Rate for Payer: BCN Commercial |
$58.37
|
| Rate for Payer: BCN Medicare Advantage |
$17.75
|
| Rate for Payer: Cash Price |
$56.80
|
| Rate for Payer: Cofinity Commercial |
$61.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.75
|
| Rate for Payer: Healthscope Commercial |
$63.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.25
|
| Rate for Payer: Mclaren Medicaid |
$12.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.64
|
| Rate for Payer: Meridian Medicaid |
$13.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.35
|
| Rate for Payer: Nomi Health Commercial |
$58.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.25
|
| Rate for Payer: PACE Senior Care Partners |
$16.86
|
| Rate for Payer: PACE SWMI |
$17.75
|
| Rate for Payer: PHP Commercial |
$60.35
|
| Rate for Payer: PHP Medicare Advantage |
$17.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$61.77
|
| Rate for Payer: Priority Health Medicare |
$17.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.42
|
| Rate for Payer: Railroad Medicare Medicare |
$17.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.48
|
| Rate for Payer: UHC Core |
$59.28
|
| Rate for Payer: UHC Exchange |
$17.75
|
| Rate for Payer: UHC Medicaid |
$12.52
|
| Rate for Payer: UHC Medicare Advantage |
$17.75
|
| Rate for Payer: UHCCP Medicaid |
$12.52
|
| Rate for Payer: VA VA |
$17.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.25
|
|
|
HC ELEC ALYS IMPLT BRN NPGT PRGRMG EA ADDL 15 MIN
|
Facility
|
IP
|
$71.00
|
|
|
Service Code
|
CPT 95984
|
| Hospital Charge Code |
76100548
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$49.42 |
| Max. Negotiated Rate |
$63.90 |
| Rate for Payer: Aetna Commercial |
$60.35
|
| Rate for Payer: BCBS Trust/PPO |
$58.64
|
| Rate for Payer: BCN Commercial |
$58.64
|
| Rate for Payer: Cash Price |
$56.80
|
| Rate for Payer: Cofinity Commercial |
$61.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.80
|
| Rate for Payer: Healthscope Commercial |
$63.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.35
|
| Rate for Payer: Nomi Health Commercial |
$58.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.25
|
| Rate for Payer: PHP Commercial |
$60.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$61.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.48
|
| Rate for Payer: UHC Core |
$59.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.25
|
|
|
HC ELEC ALYS IMPLT COMPLEX CN NPGT PRGRMG
|
Facility
|
OP
|
$271.00
|
|
|
Service Code
|
CPT 95977
|
| Hospital Charge Code |
76100550
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$47.78 |
| Max. Negotiated Rate |
$243.90 |
| Rate for Payer: Aetna Commercial |
$230.35
|
| Rate for Payer: Aetna Medicare |
$70.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$84.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$84.69
|
| Rate for Payer: BCBS Complete |
$50.16
|
| Rate for Payer: BCBS MAPPO |
$67.75
|
| Rate for Payer: BCBS Trust/PPO |
$222.79
|
| Rate for Payer: BCN Commercial |
$222.79
|
| Rate for Payer: BCN Medicare Advantage |
$67.75
|
| Rate for Payer: Cash Price |
$216.80
|
| Rate for Payer: Cofinity Commercial |
$233.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$67.75
|
| Rate for Payer: Healthscope Commercial |
$243.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$203.25
|
| Rate for Payer: Mclaren Medicaid |
$47.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$71.14
|
| Rate for Payer: Meridian Medicaid |
$50.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$77.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$74.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.35
|
| Rate for Payer: Nomi Health Commercial |
$222.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$203.25
|
| Rate for Payer: PACE Senior Care Partners |
$64.36
|
| Rate for Payer: PACE SWMI |
$67.75
|
| Rate for Payer: PHP Commercial |
$230.35
|
| Rate for Payer: PHP Medicare Advantage |
$67.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$47.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$235.77
|
| Rate for Payer: Priority Health Medicare |
$68.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$188.62
|
| Rate for Payer: Railroad Medicare Medicare |
$67.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$238.48
|
| Rate for Payer: UHC Core |
$226.28
|
| Rate for Payer: UHC Exchange |
$67.75
|
| Rate for Payer: UHC Medicaid |
$47.78
|
| Rate for Payer: UHC Medicare Advantage |
$67.75
|
| Rate for Payer: UHCCP Medicaid |
$47.78
|
| Rate for Payer: VA VA |
$67.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$203.25
|
|
|
HC ELEC ALYS IMPLT COMPLEX CN NPGT PRGRMG
|
Facility
|
IP
|
$271.00
|
|
|
Service Code
|
CPT 95977
|
| Hospital Charge Code |
76100550
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$188.62 |
| Max. Negotiated Rate |
$243.90 |
| Rate for Payer: Aetna Commercial |
$230.35
|
| Rate for Payer: BCBS Trust/PPO |
$223.82
|
| Rate for Payer: BCN Commercial |
$223.82
|
| Rate for Payer: Cash Price |
$216.80
|
| Rate for Payer: Cofinity Commercial |
$233.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.80
|
| Rate for Payer: Healthscope Commercial |
$243.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$203.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.35
|
| Rate for Payer: Nomi Health Commercial |
$222.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$203.25
|
| Rate for Payer: PHP Commercial |
$230.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$235.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$188.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$238.48
|
| Rate for Payer: UHC Core |
$226.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$203.25
|
|
|
HC ELEC ALYS IMPLT NPGT CPLX SP/PN PRGM
|
Facility
|
OP
|
$198.44
|
|
|
Service Code
|
CPT 95972
|
| Hospital Charge Code |
92000029
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$34.98 |
| Max. Negotiated Rate |
$178.60 |
| Rate for Payer: Aetna Commercial |
$168.67
|
| Rate for Payer: Aetna Medicare |
$51.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$62.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$62.01
|
| Rate for Payer: BCBS Complete |
$36.73
|
| Rate for Payer: BCBS MAPPO |
$49.61
|
| Rate for Payer: BCBS Trust/PPO |
$163.14
|
| Rate for Payer: BCN Commercial |
$163.14
|
| Rate for Payer: BCN Medicare Advantage |
$49.61
|
| Rate for Payer: Cash Price |
$158.75
|
| Rate for Payer: Cofinity Commercial |
$170.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.61
|
| Rate for Payer: Healthscope Commercial |
$178.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$148.83
|
| Rate for Payer: Mclaren Medicaid |
$34.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$52.09
|
| Rate for Payer: Meridian Medicaid |
$36.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$54.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.67
|
| Rate for Payer: Nomi Health Commercial |
$162.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$148.83
|
| Rate for Payer: PACE Senior Care Partners |
$47.13
|
| Rate for Payer: PACE SWMI |
$49.61
|
| Rate for Payer: PHP Commercial |
$168.67
|
| Rate for Payer: PHP Medicare Advantage |
$49.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$172.64
|
| Rate for Payer: Priority Health Medicare |
$50.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$138.11
|
| Rate for Payer: Railroad Medicare Medicare |
$49.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$174.63
|
| Rate for Payer: UHC Core |
$165.70
|
| Rate for Payer: UHC Exchange |
$49.61
|
| Rate for Payer: UHC Medicaid |
$34.98
|
| Rate for Payer: UHC Medicare Advantage |
$49.61
|
| Rate for Payer: UHCCP Medicaid |
$34.98
|
| Rate for Payer: VA VA |
$49.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$148.83
|
|
|
HC ELEC ALYS IMPLT NPGT CPLX SP/PN PRGM
|
Facility
|
IP
|
$198.44
|
|
|
Service Code
|
CPT 95972
|
| Hospital Charge Code |
92000029
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$138.11 |
| Max. Negotiated Rate |
$178.60 |
| Rate for Payer: Aetna Commercial |
$168.67
|
| Rate for Payer: BCBS Trust/PPO |
$163.89
|
| Rate for Payer: BCN Commercial |
$163.89
|
| Rate for Payer: Cash Price |
$158.75
|
| Rate for Payer: Cofinity Commercial |
$170.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.75
|
| Rate for Payer: Healthscope Commercial |
$178.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$148.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.67
|
| Rate for Payer: Nomi Health Commercial |
$162.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$148.83
|
| Rate for Payer: PHP Commercial |
$168.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$172.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$138.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$174.63
|
| Rate for Payer: UHC Core |
$165.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$148.83
|
|
|
HC ELEC ALYS IMPLT NPGT PHYS/QHP W/O PRGM
|
Facility
|
OP
|
$173.54
|
|
|
Service Code
|
CPT 95970
|
| Hospital Charge Code |
92000030
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$30.60 |
| Max. Negotiated Rate |
$156.19 |
| Rate for Payer: Aetna Commercial |
$147.51
|
| Rate for Payer: Aetna Medicare |
$45.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$54.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$54.23
|
| Rate for Payer: BCBS Complete |
$32.12
|
| Rate for Payer: BCBS MAPPO |
$43.38
|
| Rate for Payer: BCBS Trust/PPO |
$142.67
|
| Rate for Payer: BCN Commercial |
$142.67
|
| Rate for Payer: BCN Medicare Advantage |
$43.38
|
| Rate for Payer: Cash Price |
$138.83
|
| Rate for Payer: Cofinity Commercial |
$149.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$43.38
|
| Rate for Payer: Healthscope Commercial |
$156.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$130.16
|
| Rate for Payer: Mclaren Medicaid |
$30.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$45.55
|
| Rate for Payer: Meridian Medicaid |
$32.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$49.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$47.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.51
|
| Rate for Payer: Nomi Health Commercial |
$142.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$130.16
|
| Rate for Payer: PACE Senior Care Partners |
$41.22
|
| Rate for Payer: PACE SWMI |
$43.38
|
| Rate for Payer: PHP Commercial |
$147.51
|
| Rate for Payer: PHP Medicare Advantage |
$43.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$150.98
|
| Rate for Payer: Priority Health Medicare |
$43.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$120.78
|
| Rate for Payer: Railroad Medicare Medicare |
$43.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$152.72
|
| Rate for Payer: UHC Core |
$144.91
|
| Rate for Payer: UHC Exchange |
$43.38
|
| Rate for Payer: UHC Medicaid |
$30.60
|
| Rate for Payer: UHC Medicare Advantage |
$43.38
|
| Rate for Payer: UHCCP Medicaid |
$30.60
|
| Rate for Payer: VA VA |
$43.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$130.16
|
|
|
HC ELEC ALYS IMPLT NPGT PHYS/QHP W/O PRGM
|
Facility
|
IP
|
$173.54
|
|
|
Service Code
|
CPT 95970
|
| Hospital Charge Code |
92000030
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$120.78 |
| Max. Negotiated Rate |
$156.19 |
| Rate for Payer: Aetna Commercial |
$147.51
|
| Rate for Payer: BCBS Trust/PPO |
$143.33
|
| Rate for Payer: BCN Commercial |
$143.33
|
| Rate for Payer: Cash Price |
$138.83
|
| Rate for Payer: Cofinity Commercial |
$149.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.83
|
| Rate for Payer: Healthscope Commercial |
$156.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$130.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.51
|
| Rate for Payer: Nomi Health Commercial |
$142.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$130.16
|
| Rate for Payer: PHP Commercial |
$147.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$150.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$120.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$152.72
|
| Rate for Payer: UHC Core |
$144.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$130.16
|
|
|
HC ELEC ALYS IMPLT NPGT SMPL SP/PN NPGT PRGM
|
Facility
|
IP
|
$180.53
|
|
|
Service Code
|
CPT 95971
|
| Hospital Charge Code |
92000031
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$125.65 |
| Max. Negotiated Rate |
$162.48 |
| Rate for Payer: Aetna Commercial |
$153.45
|
| Rate for Payer: BCBS Trust/PPO |
$149.10
|
| Rate for Payer: BCN Commercial |
$149.10
|
| Rate for Payer: Cash Price |
$144.42
|
| Rate for Payer: Cofinity Commercial |
$155.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.42
|
| Rate for Payer: Healthscope Commercial |
$162.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.45
|
| Rate for Payer: Nomi Health Commercial |
$148.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$135.40
|
| Rate for Payer: PHP Commercial |
$153.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$157.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$125.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$158.87
|
| Rate for Payer: UHC Core |
$150.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.40
|
|
|
HC ELEC ALYS IMPLT NPGT SMPL SP/PN NPGT PRGM
|
Facility
|
OP
|
$180.53
|
|
|
Service Code
|
CPT 95971
|
| Hospital Charge Code |
92000031
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$31.83 |
| Max. Negotiated Rate |
$162.48 |
| Rate for Payer: Aetna Commercial |
$153.45
|
| Rate for Payer: Aetna Medicare |
$46.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56.42
|
| Rate for Payer: BCBS Complete |
$33.42
|
| Rate for Payer: BCBS MAPPO |
$45.13
|
| Rate for Payer: BCBS Trust/PPO |
$148.41
|
| Rate for Payer: BCN Commercial |
$148.41
|
| Rate for Payer: BCN Medicare Advantage |
$45.13
|
| Rate for Payer: Cash Price |
$144.42
|
| Rate for Payer: Cofinity Commercial |
$155.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.13
|
| Rate for Payer: Healthscope Commercial |
$162.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.40
|
| Rate for Payer: Mclaren Medicaid |
$31.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$47.39
|
| Rate for Payer: Meridian Medicaid |
$33.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$49.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.45
|
| Rate for Payer: Nomi Health Commercial |
$148.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$135.40
|
| Rate for Payer: PACE Senior Care Partners |
$42.88
|
| Rate for Payer: PACE SWMI |
$45.13
|
| Rate for Payer: PHP Commercial |
$153.45
|
| Rate for Payer: PHP Medicare Advantage |
$45.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$157.06
|
| Rate for Payer: Priority Health Medicare |
$45.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$125.65
|
| Rate for Payer: Railroad Medicare Medicare |
$45.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$158.87
|
| Rate for Payer: UHC Core |
$150.74
|
| Rate for Payer: UHC Exchange |
$45.13
|
| Rate for Payer: UHC Medicaid |
$31.83
|
| Rate for Payer: UHC Medicare Advantage |
$45.13
|
| Rate for Payer: UHCCP Medicaid |
$31.83
|
| Rate for Payer: VA VA |
$45.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.40
|
|
|
HC ELEC BREAST PUMP KI (OB)
|
Facility
|
IP
|
$210.68
|
|
| Hospital Charge Code |
27000069
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$146.63 |
| Max. Negotiated Rate |
$189.61 |
| Rate for Payer: Aetna Commercial |
$179.08
|
| Rate for Payer: BCBS Trust/PPO |
$174.00
|
| Rate for Payer: BCN Commercial |
$174.00
|
| Rate for Payer: Cash Price |
$168.54
|
| Rate for Payer: Cofinity Commercial |
$181.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.54
|
| Rate for Payer: Healthscope Commercial |
$189.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$179.08
|
| Rate for Payer: Nomi Health Commercial |
$172.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$158.01
|
| Rate for Payer: PHP Commercial |
$179.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$183.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$146.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$185.40
|
| Rate for Payer: UHC Core |
$175.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$158.01
|
|
