|
HC ECHO, 2D, DOPPLER, COLOR FLOW
|
Facility
|
IP
|
$2,008.38
|
|
|
Service Code
|
CPT 93306
|
| Hospital Charge Code |
48300001
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,305.45 |
| Max. Negotiated Rate |
$1,807.54 |
| Rate for Payer: Aetna Commercial |
$1,707.12
|
| Rate for Payer: BCBS Trust/PPO |
$1,639.44
|
| Rate for Payer: BCN Commercial |
$1,552.08
|
| Rate for Payer: Cash Price |
$1,606.70
|
| Rate for Payer: Cofinity Commercial |
$1,727.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,606.70
|
| Rate for Payer: Healthscope Commercial |
$1,807.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,506.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,707.12
|
| Rate for Payer: Nomi Health Commercial |
$1,646.87
|
| Rate for Payer: PHP Commercial |
$1,707.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,305.45
|
| Rate for Payer: Priority Health HMO/PPO |
$1,747.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,345.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,767.37
|
| Rate for Payer: UHC Core |
$1,677.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,506.29
|
|
|
HC ECHO, 2D, DOPPLER, COLOR FLOW
|
Facility
|
OP
|
$2,008.38
|
|
|
Service Code
|
CPT 93306
|
| Hospital Charge Code |
48300001
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$396.42 |
| Max. Negotiated Rate |
$1,807.54 |
| Rate for Payer: Aetna Commercial |
$1,707.12
|
| Rate for Payer: Aetna Medicare |
$522.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$627.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$627.62
|
| Rate for Payer: BCBS Complete |
$416.27
|
| Rate for Payer: BCBS MAPPO |
$502.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,651.09
|
| Rate for Payer: BCN Commercial |
$1,561.52
|
| Rate for Payer: BCN Medicare Advantage |
$502.10
|
| Rate for Payer: Cash Price |
$1,606.70
|
| Rate for Payer: Cash Price |
$1,606.70
|
| Rate for Payer: Cofinity Commercial |
$1,727.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,606.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$502.10
|
| Rate for Payer: Healthscope Commercial |
$1,807.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,506.29
|
| Rate for Payer: Mclaren Medicaid |
$396.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$527.20
|
| Rate for Payer: Meridian Medicaid |
$416.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$577.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,707.12
|
| Rate for Payer: Nomi Health Commercial |
$1,646.87
|
| Rate for Payer: PACE Senior Care Partners |
$476.99
|
| Rate for Payer: PACE SWMI |
$502.10
|
| Rate for Payer: PHP Commercial |
$1,707.12
|
| Rate for Payer: PHP Medicare Advantage |
$502.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$396.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,305.45
|
| Rate for Payer: Priority Health HMO/PPO |
$1,747.29
|
| Rate for Payer: Priority Health Medicare |
$507.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,345.61
|
| Rate for Payer: Railroad Medicare Medicare |
$502.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,767.37
|
| Rate for Payer: UHC Core |
$1,677.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$502.10
|
| Rate for Payer: UHC Exchange |
$502.10
|
| Rate for Payer: UHC Medicare Advantage |
$502.10
|
| Rate for Payer: UHCCP Medicaid |
$396.42
|
| Rate for Payer: VA VA |
$502.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,506.29
|
|
|
HC ECHO COMPLETE W/DEFINITY
|
Facility
|
IP
|
$2,008.38
|
|
|
Service Code
|
HCPCS C8929
|
| Hospital Charge Code |
48300003
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,305.45 |
| Max. Negotiated Rate |
$1,807.54 |
| Rate for Payer: Aetna Commercial |
$1,707.12
|
| Rate for Payer: BCBS Trust/PPO |
$1,639.44
|
| Rate for Payer: BCN Commercial |
$1,552.08
|
| Rate for Payer: Cash Price |
$1,606.70
|
| Rate for Payer: Cofinity Commercial |
$1,727.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,606.70
|
| Rate for Payer: Healthscope Commercial |
$1,807.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,506.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,707.12
|
| Rate for Payer: Nomi Health Commercial |
$1,646.87
|
| Rate for Payer: PHP Commercial |
$1,707.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,305.45
|
| Rate for Payer: Priority Health HMO/PPO |
$1,747.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,345.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,767.37
|
| Rate for Payer: UHC Core |
$1,677.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,506.29
|
|
|
HC ECHO COMPLETE W/DEFINITY
|
Facility
|
OP
|
$2,008.38
|
|
|
Service Code
|
HCPCS C8929
|
| Hospital Charge Code |
48300003
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$476.99 |
| Max. Negotiated Rate |
$1,807.54 |
| Rate for Payer: Aetna Commercial |
$1,707.12
|
| Rate for Payer: Aetna Medicare |
$522.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$627.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$627.62
|
| Rate for Payer: BCBS Complete |
$599.81
|
| Rate for Payer: BCBS MAPPO |
$502.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,651.09
|
| Rate for Payer: BCN Commercial |
$1,561.52
|
| Rate for Payer: BCN Medicare Advantage |
$502.10
|
| Rate for Payer: Cash Price |
$1,606.70
|
| Rate for Payer: Cash Price |
$1,606.70
|
| Rate for Payer: Cofinity Commercial |
$1,727.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,606.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$502.10
|
| Rate for Payer: Healthscope Commercial |
$1,807.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,506.29
|
| Rate for Payer: Mclaren Medicaid |
$571.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$527.20
|
| Rate for Payer: Meridian Medicaid |
$599.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$577.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,707.12
|
| Rate for Payer: Nomi Health Commercial |
$1,646.87
|
| Rate for Payer: PACE Senior Care Partners |
$476.99
|
| Rate for Payer: PACE SWMI |
$502.10
|
| Rate for Payer: PHP Commercial |
$1,707.12
|
| Rate for Payer: PHP Medicare Advantage |
$502.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$571.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,305.45
|
| Rate for Payer: Priority Health HMO/PPO |
$1,747.29
|
| Rate for Payer: Priority Health Medicare |
$507.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,345.61
|
| Rate for Payer: Railroad Medicare Medicare |
$502.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,767.37
|
| Rate for Payer: UHC Core |
$1,677.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$502.10
|
| Rate for Payer: UHC Exchange |
$502.10
|
| Rate for Payer: UHC Medicare Advantage |
$502.10
|
| Rate for Payer: UHCCP Medicaid |
$571.21
|
| Rate for Payer: VA VA |
$502.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,506.29
|
|
|
HC ECHO CONGENITAL
|
Facility
|
OP
|
$1,638.94
|
|
|
Service Code
|
CPT 93303
|
| Hospital Charge Code |
48000004
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$389.25 |
| Max. Negotiated Rate |
$1,475.05 |
| Rate for Payer: Aetna Commercial |
$1,393.10
|
| Rate for Payer: Aetna Medicare |
$426.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$512.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$512.17
|
| Rate for Payer: BCBS Complete |
$416.27
|
| Rate for Payer: BCBS MAPPO |
$409.74
|
| Rate for Payer: BCBS Trust/PPO |
$1,347.37
|
| Rate for Payer: BCN Commercial |
$1,274.28
|
| Rate for Payer: BCN Medicare Advantage |
$409.74
|
| Rate for Payer: Cash Price |
$1,311.15
|
| Rate for Payer: Cash Price |
$1,311.15
|
| Rate for Payer: Cofinity Commercial |
$1,409.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,311.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$409.74
|
| Rate for Payer: Healthscope Commercial |
$1,475.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,229.20
|
| Rate for Payer: Mclaren Medicaid |
$396.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$430.22
|
| Rate for Payer: Meridian Medicaid |
$416.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$471.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,393.10
|
| Rate for Payer: Nomi Health Commercial |
$1,343.93
|
| Rate for Payer: PACE Senior Care Partners |
$389.25
|
| Rate for Payer: PACE SWMI |
$409.74
|
| Rate for Payer: PHP Commercial |
$1,393.10
|
| Rate for Payer: PHP Medicare Advantage |
$409.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$396.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,065.31
|
| Rate for Payer: Priority Health HMO/PPO |
$1,425.88
|
| Rate for Payer: Priority Health Medicare |
$413.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,098.09
|
| Rate for Payer: Railroad Medicare Medicare |
$409.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,442.27
|
| Rate for Payer: UHC Core |
$1,368.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$409.74
|
| Rate for Payer: UHC Exchange |
$409.74
|
| Rate for Payer: UHC Medicare Advantage |
$409.74
|
| Rate for Payer: UHCCP Medicaid |
$396.42
|
| Rate for Payer: VA VA |
$409.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,229.20
|
|
|
HC ECHO CONGENITAL
|
Facility
|
IP
|
$1,638.94
|
|
|
Service Code
|
CPT 93303
|
| Hospital Charge Code |
48000004
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,065.31 |
| Max. Negotiated Rate |
$1,475.05 |
| Rate for Payer: Aetna Commercial |
$1,393.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,337.87
|
| Rate for Payer: BCN Commercial |
$1,266.57
|
| Rate for Payer: Cash Price |
$1,311.15
|
| Rate for Payer: Cofinity Commercial |
$1,409.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,311.15
|
| Rate for Payer: Healthscope Commercial |
$1,475.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,229.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,393.10
|
| Rate for Payer: Nomi Health Commercial |
$1,343.93
|
| Rate for Payer: PHP Commercial |
$1,393.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,065.31
|
| Rate for Payer: Priority Health HMO/PPO |
$1,425.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,098.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,442.27
|
| Rate for Payer: UHC Core |
$1,368.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,229.20
|
|
|
HC ECHO CONGENITAL LMTD
|
Facility
|
IP
|
$1,144.66
|
|
|
Service Code
|
CPT 93304
|
| Hospital Charge Code |
48000005
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$744.03 |
| Max. Negotiated Rate |
$1,030.19 |
| Rate for Payer: Aetna Commercial |
$972.96
|
| Rate for Payer: BCBS Trust/PPO |
$934.39
|
| Rate for Payer: BCN Commercial |
$884.59
|
| Rate for Payer: Cash Price |
$915.73
|
| Rate for Payer: Cofinity Commercial |
$984.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$915.73
|
| Rate for Payer: Healthscope Commercial |
$1,030.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$858.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$972.96
|
| Rate for Payer: Nomi Health Commercial |
$938.62
|
| Rate for Payer: PHP Commercial |
$972.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$744.03
|
| Rate for Payer: Priority Health HMO/PPO |
$995.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$766.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,007.30
|
| Rate for Payer: UHC Core |
$955.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$858.50
|
|
|
HC ECHO CONGENITAL LMTD
|
Facility
|
OP
|
$1,144.66
|
|
|
Service Code
|
CPT 93304
|
| Hospital Charge Code |
48000005
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$271.86 |
| Max. Negotiated Rate |
$1,030.19 |
| Rate for Payer: Aetna Commercial |
$972.96
|
| Rate for Payer: Aetna Medicare |
$297.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$357.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$357.71
|
| Rate for Payer: BCBS Complete |
$416.27
|
| Rate for Payer: BCBS MAPPO |
$286.17
|
| Rate for Payer: BCBS Trust/PPO |
$941.02
|
| Rate for Payer: BCN Commercial |
$889.97
|
| Rate for Payer: BCN Medicare Advantage |
$286.17
|
| Rate for Payer: Cash Price |
$915.73
|
| Rate for Payer: Cash Price |
$915.73
|
| Rate for Payer: Cofinity Commercial |
$984.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$915.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$286.17
|
| Rate for Payer: Healthscope Commercial |
$1,030.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$858.50
|
| Rate for Payer: Mclaren Medicaid |
$396.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$300.47
|
| Rate for Payer: Meridian Medicaid |
$416.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$329.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$972.96
|
| Rate for Payer: Nomi Health Commercial |
$938.62
|
| Rate for Payer: PACE Senior Care Partners |
$271.86
|
| Rate for Payer: PACE SWMI |
$286.17
|
| Rate for Payer: PHP Commercial |
$972.96
|
| Rate for Payer: PHP Medicare Advantage |
$286.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$396.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$744.03
|
| Rate for Payer: Priority Health HMO/PPO |
$995.85
|
| Rate for Payer: Priority Health Medicare |
$289.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$766.92
|
| Rate for Payer: Railroad Medicare Medicare |
$286.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,007.30
|
| Rate for Payer: UHC Core |
$955.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$286.17
|
| Rate for Payer: UHC Exchange |
$286.17
|
| Rate for Payer: UHC Medicare Advantage |
$286.17
|
| Rate for Payer: UHCCP Medicaid |
$396.42
|
| Rate for Payer: VA VA |
$286.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$858.50
|
|
|
HC ECHO FETAL COMPLETE
|
Facility
|
IP
|
$966.85
|
|
|
Service Code
|
CPT 76825
|
| Hospital Charge Code |
40200030
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$628.45 |
| Max. Negotiated Rate |
$870.16 |
| Rate for Payer: Aetna Commercial |
$821.82
|
| Rate for Payer: BCBS Trust/PPO |
$789.24
|
| Rate for Payer: BCN Commercial |
$747.18
|
| Rate for Payer: Cash Price |
$773.48
|
| Rate for Payer: Cofinity Commercial |
$831.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$773.48
|
| Rate for Payer: Healthscope Commercial |
$870.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$725.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$821.82
|
| Rate for Payer: Nomi Health Commercial |
$792.82
|
| Rate for Payer: PHP Commercial |
$821.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$628.45
|
| Rate for Payer: Priority Health HMO/PPO |
$841.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$647.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$850.83
|
| Rate for Payer: UHC Core |
$807.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$725.14
|
|
|
HC ECHO FETAL COMPLETE
|
Facility
|
OP
|
$966.85
|
|
|
Service Code
|
CPT 76825
|
| Hospital Charge Code |
40200030
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$229.63 |
| Max. Negotiated Rate |
$870.16 |
| Rate for Payer: Aetna Commercial |
$821.82
|
| Rate for Payer: Aetna Medicare |
$251.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$302.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$302.14
|
| Rate for Payer: BCBS Complete |
$416.27
|
| Rate for Payer: BCBS MAPPO |
$241.71
|
| Rate for Payer: BCBS Trust/PPO |
$794.85
|
| Rate for Payer: BCN Commercial |
$751.73
|
| Rate for Payer: BCN Medicare Advantage |
$241.71
|
| Rate for Payer: Cash Price |
$773.48
|
| Rate for Payer: Cash Price |
$773.48
|
| Rate for Payer: Cofinity Commercial |
$831.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$773.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$241.71
|
| Rate for Payer: Healthscope Commercial |
$870.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$725.14
|
| Rate for Payer: Mclaren Medicaid |
$396.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$253.80
|
| Rate for Payer: Meridian Medicaid |
$416.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$277.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$821.82
|
| Rate for Payer: Nomi Health Commercial |
$792.82
|
| Rate for Payer: PACE Senior Care Partners |
$229.63
|
| Rate for Payer: PACE SWMI |
$241.71
|
| Rate for Payer: PHP Commercial |
$821.82
|
| Rate for Payer: PHP Medicare Advantage |
$241.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$396.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$628.45
|
| Rate for Payer: Priority Health HMO/PPO |
$841.16
|
| Rate for Payer: Priority Health Medicare |
$244.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$647.79
|
| Rate for Payer: Railroad Medicare Medicare |
$241.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$850.83
|
| Rate for Payer: UHC Core |
$807.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$241.71
|
| Rate for Payer: UHC Exchange |
$241.71
|
| Rate for Payer: UHC Medicare Advantage |
$241.71
|
| Rate for Payer: UHCCP Medicaid |
$396.42
|
| Rate for Payer: VA VA |
$241.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$725.14
|
|
|
HC ECHO FETAL FOLLOWUP/REPEAT
|
Facility
|
IP
|
$736.60
|
|
|
Service Code
|
CPT 76826
|
| Hospital Charge Code |
40200077
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$478.79 |
| Max. Negotiated Rate |
$662.94 |
| Rate for Payer: Aetna Commercial |
$626.11
|
| Rate for Payer: BCBS Trust/PPO |
$601.29
|
| Rate for Payer: BCN Commercial |
$569.24
|
| Rate for Payer: Cash Price |
$589.28
|
| Rate for Payer: Cofinity Commercial |
$633.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$589.28
|
| Rate for Payer: Healthscope Commercial |
$662.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$552.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$626.11
|
| Rate for Payer: Nomi Health Commercial |
$604.01
|
| Rate for Payer: PHP Commercial |
$626.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$478.79
|
| Rate for Payer: Priority Health HMO/PPO |
$640.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$493.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$648.21
|
| Rate for Payer: UHC Core |
$615.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$552.45
|
|
|
HC ECHO FETAL FOLLOWUP/REPEAT
|
Facility
|
OP
|
$736.60
|
|
|
Service Code
|
CPT 76826
|
| Hospital Charge Code |
40200077
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$174.76 |
| Max. Negotiated Rate |
$662.94 |
| Rate for Payer: Aetna Commercial |
$626.11
|
| Rate for Payer: Aetna Medicare |
$191.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$230.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$230.19
|
| Rate for Payer: BCBS Complete |
$183.51
|
| Rate for Payer: BCBS MAPPO |
$184.15
|
| Rate for Payer: BCBS Trust/PPO |
$605.56
|
| Rate for Payer: BCN Commercial |
$572.71
|
| Rate for Payer: BCN Medicare Advantage |
$184.15
|
| Rate for Payer: Cash Price |
$589.28
|
| Rate for Payer: Cash Price |
$589.28
|
| Rate for Payer: Cofinity Commercial |
$633.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$589.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$184.15
|
| Rate for Payer: Healthscope Commercial |
$662.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$552.45
|
| Rate for Payer: Mclaren Medicaid |
$174.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$193.36
|
| Rate for Payer: Meridian Medicaid |
$183.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$211.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$626.11
|
| Rate for Payer: Nomi Health Commercial |
$604.01
|
| Rate for Payer: PACE Senior Care Partners |
$174.94
|
| Rate for Payer: PACE SWMI |
$184.15
|
| Rate for Payer: PHP Commercial |
$626.11
|
| Rate for Payer: PHP Medicare Advantage |
$184.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$174.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$478.79
|
| Rate for Payer: Priority Health HMO/PPO |
$640.84
|
| Rate for Payer: Priority Health Medicare |
$185.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$493.52
|
| Rate for Payer: Railroad Medicare Medicare |
$184.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$648.21
|
| Rate for Payer: UHC Core |
$615.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$184.15
|
| Rate for Payer: UHC Exchange |
$184.15
|
| Rate for Payer: UHC Medicare Advantage |
$184.15
|
| Rate for Payer: UHCCP Medicaid |
$174.76
|
| Rate for Payer: VA VA |
$184.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$552.45
|
|
|
HC ECHO FETAL FOLLOW UP SPECTRAL
|
Facility
|
IP
|
$425.52
|
|
|
Service Code
|
CPT 76828
|
| Hospital Charge Code |
40200079
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$276.59 |
| Max. Negotiated Rate |
$382.97 |
| Rate for Payer: Aetna Commercial |
$361.69
|
| Rate for Payer: BCBS Trust/PPO |
$347.35
|
| Rate for Payer: BCN Commercial |
$328.84
|
| Rate for Payer: Cash Price |
$340.42
|
| Rate for Payer: Cofinity Commercial |
$365.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$340.42
|
| Rate for Payer: Healthscope Commercial |
$382.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$319.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$361.69
|
| Rate for Payer: Nomi Health Commercial |
$348.93
|
| Rate for Payer: PHP Commercial |
$361.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$276.59
|
| Rate for Payer: Priority Health HMO/PPO |
$370.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$285.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$374.46
|
| Rate for Payer: UHC Core |
$355.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$319.14
|
|
|
HC ECHO FETAL FOLLOW UP SPECTRAL
|
Facility
|
OP
|
$425.52
|
|
|
Service Code
|
CPT 76828
|
| Hospital Charge Code |
40200079
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$76.88 |
| Max. Negotiated Rate |
$382.97 |
| Rate for Payer: Aetna Commercial |
$361.69
|
| Rate for Payer: Aetna Medicare |
$110.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$132.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$132.97
|
| Rate for Payer: BCBS Complete |
$80.73
|
| Rate for Payer: BCBS MAPPO |
$106.38
|
| Rate for Payer: BCBS Trust/PPO |
$349.82
|
| Rate for Payer: BCN Commercial |
$330.84
|
| Rate for Payer: BCN Medicare Advantage |
$106.38
|
| Rate for Payer: Cash Price |
$340.42
|
| Rate for Payer: Cash Price |
$340.42
|
| Rate for Payer: Cofinity Commercial |
$365.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$340.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$106.38
|
| Rate for Payer: Healthscope Commercial |
$382.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$319.14
|
| Rate for Payer: Mclaren Medicaid |
$76.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$111.70
|
| Rate for Payer: Meridian Medicaid |
$80.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$122.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$361.69
|
| Rate for Payer: Nomi Health Commercial |
$348.93
|
| Rate for Payer: PACE Senior Care Partners |
$101.06
|
| Rate for Payer: PACE SWMI |
$106.38
|
| Rate for Payer: PHP Commercial |
$361.69
|
| Rate for Payer: PHP Medicare Advantage |
$106.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$276.59
|
| Rate for Payer: Priority Health HMO/PPO |
$370.20
|
| Rate for Payer: Priority Health Medicare |
$107.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$285.10
|
| Rate for Payer: Railroad Medicare Medicare |
$106.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$374.46
|
| Rate for Payer: UHC Core |
$355.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$106.38
|
| Rate for Payer: UHC Exchange |
$106.38
|
| Rate for Payer: UHC Medicare Advantage |
$106.38
|
| Rate for Payer: UHCCP Medicaid |
$76.88
|
| Rate for Payer: VA VA |
$106.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$319.14
|
|
|
HC ECHO FETAL SPECTRAL
|
Facility
|
OP
|
$701.23
|
|
|
Service Code
|
CPT 76827
|
| Hospital Charge Code |
40200078
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$76.88 |
| Max. Negotiated Rate |
$631.11 |
| Rate for Payer: Aetna Commercial |
$596.05
|
| Rate for Payer: Aetna Medicare |
$182.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$219.13
|
| Rate for Payer: Amish Plain Church Group Commercial |
$219.13
|
| Rate for Payer: BCBS Complete |
$80.73
|
| Rate for Payer: BCBS MAPPO |
$175.31
|
| Rate for Payer: BCBS Trust/PPO |
$576.48
|
| Rate for Payer: BCN Commercial |
$545.21
|
| Rate for Payer: BCN Medicare Advantage |
$175.31
|
| Rate for Payer: Cash Price |
$560.98
|
| Rate for Payer: Cash Price |
$560.98
|
| Rate for Payer: Cofinity Commercial |
$603.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$560.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$175.31
|
| Rate for Payer: Healthscope Commercial |
$631.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$525.92
|
| Rate for Payer: Mclaren Medicaid |
$76.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$184.07
|
| Rate for Payer: Meridian Medicaid |
$80.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$201.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$596.05
|
| Rate for Payer: Nomi Health Commercial |
$575.01
|
| Rate for Payer: PACE Senior Care Partners |
$166.54
|
| Rate for Payer: PACE SWMI |
$175.31
|
| Rate for Payer: PHP Commercial |
$596.05
|
| Rate for Payer: PHP Medicare Advantage |
$175.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$455.80
|
| Rate for Payer: Priority Health HMO/PPO |
$610.07
|
| Rate for Payer: Priority Health Medicare |
$177.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$469.82
|
| Rate for Payer: Railroad Medicare Medicare |
$175.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$617.08
|
| Rate for Payer: UHC Core |
$585.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$175.31
|
| Rate for Payer: UHC Exchange |
$175.31
|
| Rate for Payer: UHC Medicare Advantage |
$175.31
|
| Rate for Payer: UHCCP Medicaid |
$76.88
|
| Rate for Payer: VA VA |
$175.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$525.92
|
|
|
HC ECHO FETAL SPECTRAL
|
Facility
|
IP
|
$701.23
|
|
|
Service Code
|
CPT 76827
|
| Hospital Charge Code |
40200078
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$455.80 |
| Max. Negotiated Rate |
$631.11 |
| Rate for Payer: Aetna Commercial |
$596.05
|
| Rate for Payer: BCBS Trust/PPO |
$572.41
|
| Rate for Payer: BCN Commercial |
$541.91
|
| Rate for Payer: Cash Price |
$560.98
|
| Rate for Payer: Cofinity Commercial |
$603.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$560.98
|
| Rate for Payer: Healthscope Commercial |
$631.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$525.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$596.05
|
| Rate for Payer: Nomi Health Commercial |
$575.01
|
| Rate for Payer: PHP Commercial |
$596.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$455.80
|
| Rate for Payer: Priority Health HMO/PPO |
$610.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$469.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$617.08
|
| Rate for Payer: UHC Core |
$585.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$525.92
|
|
|
HC ECHO LIMITED W/DEFINITY
|
Facility
|
IP
|
$921.85
|
|
|
Service Code
|
HCPCS C8924
|
| Hospital Charge Code |
48300007
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$599.20 |
| Max. Negotiated Rate |
$829.66 |
| Rate for Payer: Aetna Commercial |
$783.57
|
| Rate for Payer: BCBS Trust/PPO |
$752.51
|
| Rate for Payer: BCN Commercial |
$712.41
|
| Rate for Payer: Cash Price |
$737.48
|
| Rate for Payer: Cofinity Commercial |
$792.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$737.48
|
| Rate for Payer: Healthscope Commercial |
$829.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$691.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$783.57
|
| Rate for Payer: Nomi Health Commercial |
$755.92
|
| Rate for Payer: PHP Commercial |
$783.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$599.20
|
| Rate for Payer: Priority Health HMO/PPO |
$802.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$617.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$811.23
|
| Rate for Payer: UHC Core |
$769.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$691.39
|
|
|
HC ECHO LIMITED W/DEFINITY
|
Facility
|
OP
|
$921.85
|
|
|
Service Code
|
HCPCS C8924
|
| Hospital Charge Code |
48300007
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$218.94 |
| Max. Negotiated Rate |
$829.66 |
| Rate for Payer: Aetna Commercial |
$783.57
|
| Rate for Payer: Aetna Medicare |
$239.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$288.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$288.08
|
| Rate for Payer: BCBS Complete |
$271.13
|
| Rate for Payer: BCBS MAPPO |
$230.46
|
| Rate for Payer: BCBS Trust/PPO |
$757.85
|
| Rate for Payer: BCN Commercial |
$716.74
|
| Rate for Payer: BCN Medicare Advantage |
$230.46
|
| Rate for Payer: Cash Price |
$737.48
|
| Rate for Payer: Cash Price |
$737.48
|
| Rate for Payer: Cofinity Commercial |
$792.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$737.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$230.46
|
| Rate for Payer: Healthscope Commercial |
$829.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$691.39
|
| Rate for Payer: Mclaren Medicaid |
$258.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$241.99
|
| Rate for Payer: Meridian Medicaid |
$271.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$265.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$783.57
|
| Rate for Payer: Nomi Health Commercial |
$755.92
|
| Rate for Payer: PACE Senior Care Partners |
$218.94
|
| Rate for Payer: PACE SWMI |
$230.46
|
| Rate for Payer: PHP Commercial |
$783.57
|
| Rate for Payer: PHP Medicare Advantage |
$230.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$258.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$599.20
|
| Rate for Payer: Priority Health HMO/PPO |
$802.01
|
| Rate for Payer: Priority Health Medicare |
$232.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$617.64
|
| Rate for Payer: Railroad Medicare Medicare |
$230.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$811.23
|
| Rate for Payer: UHC Core |
$769.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$230.46
|
| Rate for Payer: UHC Exchange |
$230.46
|
| Rate for Payer: UHC Medicare Advantage |
$230.46
|
| Rate for Payer: UHCCP Medicaid |
$258.20
|
| Rate for Payer: VA VA |
$230.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$691.39
|
|
|
HC ECHO/STRESS W DEFINITY.
|
Facility
|
IP
|
$1,488.15
|
|
|
Service Code
|
HCPCS C8928
|
| Hospital Charge Code |
48300008
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$967.30 |
| Max. Negotiated Rate |
$1,339.34 |
| Rate for Payer: Aetna Commercial |
$1,264.93
|
| Rate for Payer: BCBS Trust/PPO |
$1,214.78
|
| Rate for Payer: BCN Commercial |
$1,150.04
|
| Rate for Payer: Cash Price |
$1,190.52
|
| Rate for Payer: Cofinity Commercial |
$1,279.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,190.52
|
| Rate for Payer: Healthscope Commercial |
$1,339.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,116.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,264.93
|
| Rate for Payer: Nomi Health Commercial |
$1,220.28
|
| Rate for Payer: PHP Commercial |
$1,264.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$967.30
|
| Rate for Payer: Priority Health HMO/PPO |
$1,294.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$997.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,309.57
|
| Rate for Payer: UHC Core |
$1,242.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,116.11
|
|
|
HC ECHO/STRESS W DEFINITY.
|
Facility
|
OP
|
$1,488.15
|
|
|
Service Code
|
HCPCS C8928
|
| Hospital Charge Code |
48300008
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$353.44 |
| Max. Negotiated Rate |
$1,339.34 |
| Rate for Payer: Aetna Commercial |
$1,264.93
|
| Rate for Payer: Aetna Medicare |
$386.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$465.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$465.05
|
| Rate for Payer: BCBS Complete |
$599.81
|
| Rate for Payer: BCBS MAPPO |
$372.04
|
| Rate for Payer: BCBS Trust/PPO |
$1,223.41
|
| Rate for Payer: BCN Commercial |
$1,157.04
|
| Rate for Payer: BCN Medicare Advantage |
$372.04
|
| Rate for Payer: Cash Price |
$1,190.52
|
| Rate for Payer: Cash Price |
$1,190.52
|
| Rate for Payer: Cofinity Commercial |
$1,279.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,190.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$372.04
|
| Rate for Payer: Healthscope Commercial |
$1,339.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,116.11
|
| Rate for Payer: Mclaren Medicaid |
$571.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$390.64
|
| Rate for Payer: Meridian Medicaid |
$599.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$427.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,264.93
|
| Rate for Payer: Nomi Health Commercial |
$1,220.28
|
| Rate for Payer: PACE Senior Care Partners |
$353.44
|
| Rate for Payer: PACE SWMI |
$372.04
|
| Rate for Payer: PHP Commercial |
$1,264.93
|
| Rate for Payer: PHP Medicare Advantage |
$372.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$571.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$967.30
|
| Rate for Payer: Priority Health HMO/PPO |
$1,294.69
|
| Rate for Payer: Priority Health Medicare |
$375.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$997.06
|
| Rate for Payer: Railroad Medicare Medicare |
$372.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,309.57
|
| Rate for Payer: UHC Core |
$1,242.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$372.04
|
| Rate for Payer: UHC Exchange |
$372.04
|
| Rate for Payer: UHC Medicare Advantage |
$372.04
|
| Rate for Payer: UHCCP Medicaid |
$571.21
|
| Rate for Payer: VA VA |
$372.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,116.11
|
|
|
HC ECMO OR VAD HOURLY CHRG
|
Facility
|
OP
|
$459.00
|
|
| Hospital Charge Code |
27000097
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$109.01 |
| Max. Negotiated Rate |
$413.10 |
| Rate for Payer: Aetna Commercial |
$390.15
|
| Rate for Payer: Aetna Medicare |
$119.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$143.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$143.44
|
| Rate for Payer: BCBS Complete |
$183.60
|
| Rate for Payer: BCBS MAPPO |
$114.75
|
| Rate for Payer: BCBS Trust/PPO |
$377.34
|
| Rate for Payer: BCN Commercial |
$356.87
|
| Rate for Payer: BCN Medicare Advantage |
$114.75
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Cofinity Commercial |
$394.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$367.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$114.75
|
| Rate for Payer: Healthscope Commercial |
$413.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$344.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$120.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$131.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$390.15
|
| Rate for Payer: Nomi Health Commercial |
$376.38
|
| Rate for Payer: PACE Senior Care Partners |
$109.01
|
| Rate for Payer: PACE SWMI |
$114.75
|
| Rate for Payer: PHP Commercial |
$390.15
|
| Rate for Payer: PHP Medicare Advantage |
$114.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$298.35
|
| Rate for Payer: Priority Health HMO/PPO |
$399.33
|
| Rate for Payer: Priority Health Medicare |
$115.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$307.53
|
| Rate for Payer: Railroad Medicare Medicare |
$114.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$403.92
|
| Rate for Payer: UHC Core |
$383.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$114.75
|
| Rate for Payer: UHC Exchange |
$114.75
|
| Rate for Payer: UHC Medicare Advantage |
$114.75
|
| Rate for Payer: VA VA |
$114.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$344.25
|
|
|
HC ECMO OR VAD HOURLY CHRG
|
Facility
|
IP
|
$459.00
|
|
| Hospital Charge Code |
27000097
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$298.35 |
| Max. Negotiated Rate |
$413.10 |
| Rate for Payer: Aetna Commercial |
$390.15
|
| Rate for Payer: BCBS Trust/PPO |
$374.68
|
| Rate for Payer: BCN Commercial |
$354.72
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Cofinity Commercial |
$394.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$367.20
|
| Rate for Payer: Healthscope Commercial |
$413.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$344.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$390.15
|
| Rate for Payer: Nomi Health Commercial |
$376.38
|
| Rate for Payer: PHP Commercial |
$390.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$298.35
|
| Rate for Payer: Priority Health HMO/PPO |
$399.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$307.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$403.92
|
| Rate for Payer: UHC Core |
$383.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$344.25
|
|
|
HC ECMO OR VAD SUPPT SETUP
|
Facility
|
IP
|
$3,187.50
|
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2,071.88 |
| Max. Negotiated Rate |
$2,868.75 |
| Rate for Payer: Aetna Commercial |
$2,709.38
|
| Rate for Payer: BCBS Trust/PPO |
$2,601.96
|
| Rate for Payer: BCN Commercial |
$2,463.30
|
| Rate for Payer: Cash Price |
$2,550.00
|
| Rate for Payer: Cofinity Commercial |
$2,741.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,550.00
|
| Rate for Payer: Healthscope Commercial |
$2,868.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,390.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,709.38
|
| Rate for Payer: Nomi Health Commercial |
$2,613.75
|
| Rate for Payer: PHP Commercial |
$2,709.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,071.88
|
| Rate for Payer: Priority Health HMO/PPO |
$2,773.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,135.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,805.00
|
| Rate for Payer: UHC Core |
$2,661.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,390.62
|
|
|
HC ECMO OR VAD SUPPT SETUP
|
Facility
|
OP
|
$3,187.50
|
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$757.03 |
| Max. Negotiated Rate |
$2,868.75 |
| Rate for Payer: Aetna Commercial |
$2,709.38
|
| Rate for Payer: Aetna Medicare |
$828.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$996.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$996.09
|
| Rate for Payer: BCBS Complete |
$1,275.00
|
| Rate for Payer: BCBS MAPPO |
$796.88
|
| Rate for Payer: BCBS Trust/PPO |
$2,620.44
|
| Rate for Payer: BCN Commercial |
$2,478.28
|
| Rate for Payer: BCN Medicare Advantage |
$796.88
|
| Rate for Payer: Cash Price |
$2,550.00
|
| Rate for Payer: Cofinity Commercial |
$2,741.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,550.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$796.88
|
| Rate for Payer: Healthscope Commercial |
$2,868.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,390.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$836.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$916.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,709.38
|
| Rate for Payer: Nomi Health Commercial |
$2,613.75
|
| Rate for Payer: PACE Senior Care Partners |
$757.03
|
| Rate for Payer: PACE SWMI |
$796.88
|
| Rate for Payer: PHP Commercial |
$2,709.38
|
| Rate for Payer: PHP Medicare Advantage |
$796.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,071.88
|
| Rate for Payer: Priority Health HMO/PPO |
$2,773.12
|
| Rate for Payer: Priority Health Medicare |
$804.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,135.62
|
| Rate for Payer: Railroad Medicare Medicare |
$796.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,805.00
|
| Rate for Payer: UHC Core |
$2,661.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$796.88
|
| Rate for Payer: UHC Exchange |
$796.88
|
| Rate for Payer: UHC Medicare Advantage |
$796.88
|
| Rate for Payer: VA VA |
$796.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,390.62
|
|
|
HC EEG AWAKE & ASLEEP
|
Facility
|
OP
|
$2,484.95
|
|
|
Service Code
|
CPT 95819
|
| Hospital Charge Code |
74000006
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$225.14 |
| Max. Negotiated Rate |
$2,236.45 |
| Rate for Payer: Aetna Commercial |
$2,112.21
|
| Rate for Payer: Aetna Medicare |
$646.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$776.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$776.55
|
| Rate for Payer: BCBS Complete |
$236.41
|
| Rate for Payer: BCBS MAPPO |
$621.24
|
| Rate for Payer: BCBS Trust/PPO |
$2,042.88
|
| Rate for Payer: BCN Commercial |
$1,932.05
|
| Rate for Payer: BCN Medicare Advantage |
$621.24
|
| Rate for Payer: Cash Price |
$1,987.96
|
| Rate for Payer: Cash Price |
$1,987.96
|
| Rate for Payer: Cofinity Commercial |
$2,137.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,987.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$621.24
|
| Rate for Payer: Healthscope Commercial |
$2,236.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,863.71
|
| Rate for Payer: Mclaren Medicaid |
$225.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$652.30
|
| Rate for Payer: Meridian Medicaid |
$236.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$714.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,112.21
|
| Rate for Payer: Nomi Health Commercial |
$2,037.66
|
| Rate for Payer: PACE Senior Care Partners |
$590.18
|
| Rate for Payer: PACE SWMI |
$621.24
|
| Rate for Payer: PHP Commercial |
$2,112.21
|
| Rate for Payer: PHP Medicare Advantage |
$621.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$225.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,615.22
|
| Rate for Payer: Priority Health HMO/PPO |
$2,161.91
|
| Rate for Payer: Priority Health Medicare |
$627.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,664.92
|
| Rate for Payer: Railroad Medicare Medicare |
$621.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,186.76
|
| Rate for Payer: UHC Core |
$2,074.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$621.24
|
| Rate for Payer: UHC Exchange |
$621.24
|
| Rate for Payer: UHC Medicare Advantage |
$621.24
|
| Rate for Payer: UHCCP Medicaid |
$225.14
|
| Rate for Payer: VA VA |
$621.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,863.71
|
|
