|
HC EGD W EUS EXAM ESOPH ONLY
|
Facility
|
OP
|
$2,852.05
|
|
| Hospital Charge Code |
36000035
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$677.36 |
| Max. Negotiated Rate |
$2,566.84 |
| Rate for Payer: Aetna Commercial |
$2,424.24
|
| Rate for Payer: Aetna Medicare |
$741.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$891.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$891.27
|
| Rate for Payer: BCBS Complete |
$1,140.82
|
| Rate for Payer: BCBS MAPPO |
$713.01
|
| Rate for Payer: BCBS Trust/PPO |
$2,344.67
|
| Rate for Payer: BCN Commercial |
$2,217.47
|
| Rate for Payer: BCN Medicare Advantage |
$713.01
|
| Rate for Payer: Cash Price |
$2,281.64
|
| Rate for Payer: Cofinity Commercial |
$2,452.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,281.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$713.01
|
| Rate for Payer: Healthscope Commercial |
$2,566.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,139.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$748.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$819.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,424.24
|
| Rate for Payer: Nomi Health Commercial |
$2,338.68
|
| Rate for Payer: PACE Senior Care Partners |
$677.36
|
| Rate for Payer: PACE SWMI |
$713.01
|
| Rate for Payer: PHP Commercial |
$2,424.24
|
| Rate for Payer: PHP Medicare Advantage |
$713.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,853.83
|
| Rate for Payer: Priority Health HMO/PPO |
$2,481.28
|
| Rate for Payer: Priority Health Medicare |
$720.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,910.87
|
| Rate for Payer: Railroad Medicare Medicare |
$713.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,509.80
|
| Rate for Payer: UHC Core |
$2,381.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$713.01
|
| Rate for Payer: UHC Exchange |
$713.01
|
| Rate for Payer: UHC Medicare Advantage |
$713.01
|
| Rate for Payer: VA VA |
$713.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,139.04
|
|
|
HC EGD W EUS EXAM ESOPH ONLY
|
Facility
|
IP
|
$2,852.05
|
|
| Hospital Charge Code |
36000035
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,853.83 |
| Max. Negotiated Rate |
$2,566.84 |
| Rate for Payer: Aetna Commercial |
$2,424.24
|
| Rate for Payer: BCBS Trust/PPO |
$2,328.13
|
| Rate for Payer: BCN Commercial |
$2,204.06
|
| Rate for Payer: Cash Price |
$2,281.64
|
| Rate for Payer: Cofinity Commercial |
$2,452.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,281.64
|
| Rate for Payer: Healthscope Commercial |
$2,566.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,139.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,424.24
|
| Rate for Payer: Nomi Health Commercial |
$2,338.68
|
| Rate for Payer: PHP Commercial |
$2,424.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,853.83
|
| Rate for Payer: Priority Health HMO/PPO |
$2,481.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,910.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,509.80
|
| Rate for Payer: UHC Core |
$2,381.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,139.04
|
|
|
HC EGD W EUS EXAM ESOPH,STOM,DUO,
|
Facility
|
IP
|
$2,979.09
|
|
| Hospital Charge Code |
36000036
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,936.41 |
| Max. Negotiated Rate |
$2,681.18 |
| Rate for Payer: Aetna Commercial |
$2,532.23
|
| Rate for Payer: BCBS Trust/PPO |
$2,431.83
|
| Rate for Payer: BCN Commercial |
$2,302.24
|
| Rate for Payer: Cash Price |
$2,383.27
|
| Rate for Payer: Cofinity Commercial |
$2,562.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,383.27
|
| Rate for Payer: Healthscope Commercial |
$2,681.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,234.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,532.23
|
| Rate for Payer: Nomi Health Commercial |
$2,442.85
|
| Rate for Payer: PHP Commercial |
$2,532.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,936.41
|
| Rate for Payer: Priority Health HMO/PPO |
$2,591.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,995.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,621.60
|
| Rate for Payer: UHC Core |
$2,487.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,234.32
|
|
|
HC EGD W EUS EXAM ESOPH,STOM,DUO,
|
Facility
|
OP
|
$2,979.09
|
|
| Hospital Charge Code |
36000036
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$707.53 |
| Max. Negotiated Rate |
$2,681.18 |
| Rate for Payer: Aetna Commercial |
$2,532.23
|
| Rate for Payer: Aetna Medicare |
$774.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$930.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$930.97
|
| Rate for Payer: BCBS Complete |
$1,191.64
|
| Rate for Payer: BCBS MAPPO |
$744.77
|
| Rate for Payer: BCBS Trust/PPO |
$2,449.11
|
| Rate for Payer: BCN Commercial |
$2,316.24
|
| Rate for Payer: BCN Medicare Advantage |
$744.77
|
| Rate for Payer: Cash Price |
$2,383.27
|
| Rate for Payer: Cofinity Commercial |
$2,562.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,383.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$744.77
|
| Rate for Payer: Healthscope Commercial |
$2,681.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,234.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$782.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$856.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,532.23
|
| Rate for Payer: Nomi Health Commercial |
$2,442.85
|
| Rate for Payer: PACE Senior Care Partners |
$707.53
|
| Rate for Payer: PACE SWMI |
$744.77
|
| Rate for Payer: PHP Commercial |
$2,532.23
|
| Rate for Payer: PHP Medicare Advantage |
$744.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,936.41
|
| Rate for Payer: Priority Health HMO/PPO |
$2,591.81
|
| Rate for Payer: Priority Health Medicare |
$752.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,995.99
|
| Rate for Payer: Railroad Medicare Medicare |
$744.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,621.60
|
| Rate for Payer: UHC Core |
$2,487.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$744.77
|
| Rate for Payer: UHC Exchange |
$744.77
|
| Rate for Payer: UHC Medicare Advantage |
$744.77
|
| Rate for Payer: VA VA |
$744.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,234.32
|
|
|
HC EGG WHITE IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200041
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: BCBS Trust/PPO |
$20.73
|
| Rate for Payer: BCN Commercial |
$19.62
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO |
$22.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.34
|
| Rate for Payer: UHC Core |
$21.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.04
|
|
|
HC EGG WHITE IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200041
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.77 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna Medicare |
$6.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.93
|
| Rate for Payer: BCBS Complete |
$3.96
|
| Rate for Payer: BCBS MAPPO |
$6.35
|
| Rate for Payer: BCBS Trust/PPO |
$20.87
|
| Rate for Payer: BCN Commercial |
$19.74
|
| Rate for Payer: BCN Medicare Advantage |
$6.35
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.35
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.04
|
| Rate for Payer: Mclaren Medicaid |
$3.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.66
|
| Rate for Payer: Meridian Medicaid |
$3.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: PACE Senior Care Partners |
$6.03
|
| Rate for Payer: PACE SWMI |
$6.35
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: PHP Medicare Advantage |
$6.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO |
$22.09
|
| Rate for Payer: Priority Health Medicare |
$6.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.01
|
| Rate for Payer: Railroad Medicare Medicare |
$6.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.34
|
| Rate for Payer: UHC Core |
$21.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.35
|
| Rate for Payer: UHC Exchange |
$6.35
|
| Rate for Payer: UHC Medicare Advantage |
$6.35
|
| Rate for Payer: UHCCP Medicaid |
$3.77
|
| Rate for Payer: VA VA |
$6.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.04
|
|
|
HC EGG YOLK, IGE
|
Facility
|
IP
|
$31.21
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200482
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.29 |
| Max. Negotiated Rate |
$28.09 |
| Rate for Payer: Aetna Commercial |
$26.53
|
| Rate for Payer: BCBS Trust/PPO |
$25.48
|
| Rate for Payer: BCN Commercial |
$24.12
|
| Rate for Payer: Cash Price |
$24.97
|
| Rate for Payer: Cofinity Commercial |
$26.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.97
|
| Rate for Payer: Healthscope Commercial |
$28.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.53
|
| Rate for Payer: Nomi Health Commercial |
$25.59
|
| Rate for Payer: PHP Commercial |
$26.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.29
|
| Rate for Payer: Priority Health HMO/PPO |
$27.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.46
|
| Rate for Payer: UHC Core |
$26.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.41
|
|
|
HC EGG YOLK, IGE
|
Facility
|
OP
|
$31.21
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200482
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.77 |
| Max. Negotiated Rate |
$28.09 |
| Rate for Payer: Aetna Commercial |
$26.53
|
| Rate for Payer: Aetna Medicare |
$8.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.75
|
| Rate for Payer: BCBS Complete |
$3.96
|
| Rate for Payer: BCBS MAPPO |
$7.80
|
| Rate for Payer: BCBS Trust/PPO |
$25.66
|
| Rate for Payer: BCN Commercial |
$24.27
|
| Rate for Payer: BCN Medicare Advantage |
$7.80
|
| Rate for Payer: Cash Price |
$24.97
|
| Rate for Payer: Cash Price |
$24.97
|
| Rate for Payer: Cofinity Commercial |
$26.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.80
|
| Rate for Payer: Healthscope Commercial |
$28.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.41
|
| Rate for Payer: Mclaren Medicaid |
$3.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.19
|
| Rate for Payer: Meridian Medicaid |
$3.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.53
|
| Rate for Payer: Nomi Health Commercial |
$25.59
|
| Rate for Payer: PACE Senior Care Partners |
$7.41
|
| Rate for Payer: PACE SWMI |
$7.80
|
| Rate for Payer: PHP Commercial |
$26.53
|
| Rate for Payer: PHP Medicare Advantage |
$7.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.29
|
| Rate for Payer: Priority Health HMO/PPO |
$27.15
|
| Rate for Payer: Priority Health Medicare |
$7.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.91
|
| Rate for Payer: Railroad Medicare Medicare |
$7.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.46
|
| Rate for Payer: UHC Core |
$26.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.80
|
| Rate for Payer: UHC Exchange |
$7.80
|
| Rate for Payer: UHC Medicare Advantage |
$7.80
|
| Rate for Payer: UHCCP Medicaid |
$3.77
|
| Rate for Payer: VA VA |
$7.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.41
|
|
|
HC EKG RHYTHM STRIP
|
Facility
|
OP
|
$73.86
|
|
|
Service Code
|
CPT 93041
|
| Hospital Charge Code |
73000002
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$17.54 |
| Max. Negotiated Rate |
$66.47 |
| Rate for Payer: Aetna Commercial |
$62.78
|
| Rate for Payer: Aetna Medicare |
$19.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.08
|
| Rate for Payer: BCBS Complete |
$45.10
|
| Rate for Payer: BCBS MAPPO |
$18.46
|
| Rate for Payer: BCBS Trust/PPO |
$60.72
|
| Rate for Payer: BCN Commercial |
$57.43
|
| Rate for Payer: BCN Medicare Advantage |
$18.46
|
| Rate for Payer: Cash Price |
$59.09
|
| Rate for Payer: Cash Price |
$59.09
|
| Rate for Payer: Cofinity Commercial |
$63.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.46
|
| Rate for Payer: Healthscope Commercial |
$66.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.40
|
| Rate for Payer: Mclaren Medicaid |
$42.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.39
|
| Rate for Payer: Meridian Medicaid |
$45.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.78
|
| Rate for Payer: Nomi Health Commercial |
$60.57
|
| Rate for Payer: PACE Senior Care Partners |
$17.54
|
| Rate for Payer: PACE SWMI |
$18.46
|
| Rate for Payer: PHP Commercial |
$62.78
|
| Rate for Payer: PHP Medicare Advantage |
$18.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$42.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.01
|
| Rate for Payer: Priority Health HMO/PPO |
$64.26
|
| Rate for Payer: Priority Health Medicare |
$18.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.49
|
| Rate for Payer: Railroad Medicare Medicare |
$18.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.00
|
| Rate for Payer: UHC Core |
$61.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.46
|
| Rate for Payer: UHC Exchange |
$18.46
|
| Rate for Payer: UHC Medicare Advantage |
$18.46
|
| Rate for Payer: UHCCP Medicaid |
$42.95
|
| Rate for Payer: VA VA |
$18.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.40
|
|
|
HC EKG RHYTHM STRIP
|
Facility
|
IP
|
$73.86
|
|
|
Service Code
|
CPT 93041
|
| Hospital Charge Code |
73000002
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$48.01 |
| Max. Negotiated Rate |
$66.47 |
| Rate for Payer: Aetna Commercial |
$62.78
|
| Rate for Payer: BCBS Trust/PPO |
$60.29
|
| Rate for Payer: BCN Commercial |
$57.08
|
| Rate for Payer: Cash Price |
$59.09
|
| Rate for Payer: Cofinity Commercial |
$63.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.09
|
| Rate for Payer: Healthscope Commercial |
$66.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.78
|
| Rate for Payer: Nomi Health Commercial |
$60.57
|
| Rate for Payer: PHP Commercial |
$62.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.01
|
| Rate for Payer: Priority Health HMO/PPO |
$64.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.00
|
| Rate for Payer: UHC Core |
$61.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.40
|
|
|
HC EKG TRACING FOR INITIAL PREV
|
Facility
|
IP
|
$36.39
|
|
|
Service Code
|
HCPCS G0404
|
| Hospital Charge Code |
73000004
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$23.65 |
| Max. Negotiated Rate |
$32.75 |
| Rate for Payer: Aetna Commercial |
$30.93
|
| Rate for Payer: BCBS Trust/PPO |
$29.71
|
| Rate for Payer: BCN Commercial |
$28.12
|
| Rate for Payer: Cash Price |
$29.11
|
| Rate for Payer: Cofinity Commercial |
$31.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.11
|
| Rate for Payer: Healthscope Commercial |
$32.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.93
|
| Rate for Payer: Nomi Health Commercial |
$29.84
|
| Rate for Payer: PHP Commercial |
$30.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.65
|
| Rate for Payer: Priority Health HMO/PPO |
$31.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.02
|
| Rate for Payer: UHC Core |
$30.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.29
|
|
|
HC EKG TRACING FOR INITIAL PREV
|
Facility
|
OP
|
$36.39
|
|
|
Service Code
|
HCPCS G0404
|
| Hospital Charge Code |
73000004
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$8.64 |
| Max. Negotiated Rate |
$32.75 |
| Rate for Payer: Aetna Commercial |
$30.93
|
| Rate for Payer: Aetna Medicare |
$9.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.37
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.37
|
| Rate for Payer: BCBS Complete |
$18.59
|
| Rate for Payer: BCBS MAPPO |
$9.10
|
| Rate for Payer: BCBS Trust/PPO |
$29.92
|
| Rate for Payer: BCN Commercial |
$28.29
|
| Rate for Payer: BCN Medicare Advantage |
$9.10
|
| Rate for Payer: Cash Price |
$29.11
|
| Rate for Payer: Cash Price |
$29.11
|
| Rate for Payer: Cofinity Commercial |
$31.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.10
|
| Rate for Payer: Healthscope Commercial |
$32.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.29
|
| Rate for Payer: Mclaren Medicaid |
$17.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.55
|
| Rate for Payer: Meridian Medicaid |
$18.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.93
|
| Rate for Payer: Nomi Health Commercial |
$29.84
|
| Rate for Payer: PACE Senior Care Partners |
$8.64
|
| Rate for Payer: PACE SWMI |
$9.10
|
| Rate for Payer: PHP Commercial |
$30.93
|
| Rate for Payer: PHP Medicare Advantage |
$9.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.65
|
| Rate for Payer: Priority Health HMO/PPO |
$31.66
|
| Rate for Payer: Priority Health Medicare |
$9.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.38
|
| Rate for Payer: Railroad Medicare Medicare |
$9.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.02
|
| Rate for Payer: UHC Core |
$30.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.10
|
| Rate for Payer: UHC Exchange |
$9.10
|
| Rate for Payer: UHC Medicare Advantage |
$9.10
|
| Rate for Payer: UHCCP Medicaid |
$17.71
|
| Rate for Payer: VA VA |
$9.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.29
|
|
|
HC EKO INFUSION SYSTEM
|
Facility
|
IP
|
$7,696.07
|
|
| Hospital Charge Code |
27200279
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5,002.45 |
| Max. Negotiated Rate |
$6,926.46 |
| Rate for Payer: Aetna Commercial |
$6,541.66
|
| Rate for Payer: BCBS Trust/PPO |
$6,282.30
|
| Rate for Payer: BCN Commercial |
$5,947.52
|
| Rate for Payer: Cash Price |
$6,156.86
|
| Rate for Payer: Cofinity Commercial |
$6,618.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,156.86
|
| Rate for Payer: Healthscope Commercial |
$6,926.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,772.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,541.66
|
| Rate for Payer: Nomi Health Commercial |
$6,310.78
|
| Rate for Payer: PHP Commercial |
$6,541.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,002.45
|
| Rate for Payer: Priority Health HMO/PPO |
$6,695.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,156.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,772.54
|
| Rate for Payer: UHC Core |
$6,426.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,772.05
|
|
|
HC EKO INFUSION SYSTEM
|
Facility
|
OP
|
$7,696.07
|
|
| Hospital Charge Code |
27200279
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,827.82 |
| Max. Negotiated Rate |
$6,926.46 |
| Rate for Payer: Aetna Commercial |
$6,541.66
|
| Rate for Payer: Aetna Medicare |
$2,000.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,405.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,405.02
|
| Rate for Payer: BCBS Complete |
$3,078.43
|
| Rate for Payer: BCBS MAPPO |
$1,924.02
|
| Rate for Payer: BCBS Trust/PPO |
$6,326.94
|
| Rate for Payer: BCN Commercial |
$5,983.69
|
| Rate for Payer: BCN Medicare Advantage |
$1,924.02
|
| Rate for Payer: Cash Price |
$6,156.86
|
| Rate for Payer: Cofinity Commercial |
$6,618.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,156.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,924.02
|
| Rate for Payer: Healthscope Commercial |
$6,926.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,772.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,020.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,212.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,541.66
|
| Rate for Payer: Nomi Health Commercial |
$6,310.78
|
| Rate for Payer: PACE Senior Care Partners |
$1,827.82
|
| Rate for Payer: PACE SWMI |
$1,924.02
|
| Rate for Payer: PHP Commercial |
$6,541.66
|
| Rate for Payer: PHP Medicare Advantage |
$1,924.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,002.45
|
| Rate for Payer: Priority Health HMO/PPO |
$6,695.58
|
| Rate for Payer: Priority Health Medicare |
$1,943.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,156.37
|
| Rate for Payer: Railroad Medicare Medicare |
$1,924.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,772.54
|
| Rate for Payer: UHC Core |
$6,426.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,924.02
|
| Rate for Payer: UHC Exchange |
$1,924.02
|
| Rate for Payer: UHC Medicare Advantage |
$1,924.02
|
| Rate for Payer: VA VA |
$1,924.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,772.05
|
|
|
HC ELEC ALYS IMPLT NPGT CPLX SP/PN PRGM
|
Facility
|
OP
|
$194.55
|
|
|
Service Code
|
CPT 95972
|
| Hospital Charge Code |
92000029
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$46.21 |
| Max. Negotiated Rate |
$175.09 |
| Rate for Payer: Aetna Commercial |
$165.37
|
| Rate for Payer: Aetna Medicare |
$50.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$60.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$60.80
|
| Rate for Payer: BCBS Complete |
$69.69
|
| Rate for Payer: BCBS MAPPO |
$48.64
|
| Rate for Payer: BCBS Trust/PPO |
$159.94
|
| Rate for Payer: BCN Commercial |
$151.26
|
| Rate for Payer: BCN Medicare Advantage |
$48.64
|
| Rate for Payer: Cash Price |
$155.64
|
| Rate for Payer: Cash Price |
$155.64
|
| Rate for Payer: Cofinity Commercial |
$167.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.64
|
| Rate for Payer: Healthscope Commercial |
$175.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$145.91
|
| Rate for Payer: Mclaren Medicaid |
$66.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.07
|
| Rate for Payer: Meridian Medicaid |
$69.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.37
|
| Rate for Payer: Nomi Health Commercial |
$159.53
|
| Rate for Payer: PACE Senior Care Partners |
$46.21
|
| Rate for Payer: PACE SWMI |
$48.64
|
| Rate for Payer: PHP Commercial |
$165.37
|
| Rate for Payer: PHP Medicare Advantage |
$48.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$66.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.46
|
| Rate for Payer: Priority Health HMO/PPO |
$169.26
|
| Rate for Payer: Priority Health Medicare |
$49.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$130.35
|
| Rate for Payer: Railroad Medicare Medicare |
$48.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$171.20
|
| Rate for Payer: UHC Core |
$162.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$48.64
|
| Rate for Payer: UHC Exchange |
$48.64
|
| Rate for Payer: UHC Medicare Advantage |
$48.64
|
| Rate for Payer: UHCCP Medicaid |
$66.36
|
| Rate for Payer: VA VA |
$48.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$145.91
|
|
|
HC ELEC ALYS IMPLT NPGT CPLX SP/PN PRGM
|
Facility
|
IP
|
$194.55
|
|
|
Service Code
|
CPT 95972
|
| Hospital Charge Code |
92000029
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$126.46 |
| Max. Negotiated Rate |
$175.09 |
| Rate for Payer: Aetna Commercial |
$165.37
|
| Rate for Payer: BCBS Trust/PPO |
$158.81
|
| Rate for Payer: BCN Commercial |
$150.35
|
| Rate for Payer: Cash Price |
$155.64
|
| Rate for Payer: Cofinity Commercial |
$167.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.64
|
| Rate for Payer: Healthscope Commercial |
$175.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$145.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.37
|
| Rate for Payer: Nomi Health Commercial |
$159.53
|
| Rate for Payer: PHP Commercial |
$165.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.46
|
| Rate for Payer: Priority Health HMO/PPO |
$169.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$130.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$171.20
|
| Rate for Payer: UHC Core |
$162.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$145.91
|
|
|
HC ELEC ALYS IMPLT NPGT PHYS/QHP W/O PRGM
|
Facility
|
OP
|
$170.14
|
|
|
Service Code
|
CPT 95970
|
| Hospital Charge Code |
92000030
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$40.41 |
| Max. Negotiated Rate |
$153.13 |
| Rate for Payer: Aetna Commercial |
$144.62
|
| Rate for Payer: Aetna Medicare |
$44.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$53.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$53.17
|
| Rate for Payer: BCBS Complete |
$97.86
|
| Rate for Payer: BCBS MAPPO |
$42.53
|
| Rate for Payer: BCBS Trust/PPO |
$139.87
|
| Rate for Payer: BCN Commercial |
$132.28
|
| Rate for Payer: BCN Medicare Advantage |
$42.53
|
| Rate for Payer: Cash Price |
$136.11
|
| Rate for Payer: Cash Price |
$136.11
|
| Rate for Payer: Cofinity Commercial |
$146.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$136.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.53
|
| Rate for Payer: Healthscope Commercial |
$153.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$127.61
|
| Rate for Payer: Mclaren Medicaid |
$93.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44.66
|
| Rate for Payer: Meridian Medicaid |
$97.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$144.62
|
| Rate for Payer: Nomi Health Commercial |
$139.51
|
| Rate for Payer: PACE Senior Care Partners |
$40.41
|
| Rate for Payer: PACE SWMI |
$42.53
|
| Rate for Payer: PHP Commercial |
$144.62
|
| Rate for Payer: PHP Medicare Advantage |
$42.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.59
|
| Rate for Payer: Priority Health HMO/PPO |
$148.02
|
| Rate for Payer: Priority Health Medicare |
$42.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$113.99
|
| Rate for Payer: Railroad Medicare Medicare |
$42.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$149.72
|
| Rate for Payer: UHC Core |
$142.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$42.53
|
| Rate for Payer: UHC Exchange |
$42.53
|
| Rate for Payer: UHC Medicare Advantage |
$42.53
|
| Rate for Payer: UHCCP Medicaid |
$93.19
|
| Rate for Payer: VA VA |
$42.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$127.61
|
|
|
HC ELEC ALYS IMPLT NPGT PHYS/QHP W/O PRGM
|
Facility
|
IP
|
$170.14
|
|
|
Service Code
|
CPT 95970
|
| Hospital Charge Code |
92000030
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$110.59 |
| Max. Negotiated Rate |
$153.13 |
| Rate for Payer: Aetna Commercial |
$144.62
|
| Rate for Payer: BCBS Trust/PPO |
$138.89
|
| Rate for Payer: BCN Commercial |
$131.48
|
| Rate for Payer: Cash Price |
$136.11
|
| Rate for Payer: Cofinity Commercial |
$146.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$136.11
|
| Rate for Payer: Healthscope Commercial |
$153.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$127.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$144.62
|
| Rate for Payer: Nomi Health Commercial |
$139.51
|
| Rate for Payer: PHP Commercial |
$144.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.59
|
| Rate for Payer: Priority Health HMO/PPO |
$148.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$113.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$149.72
|
| Rate for Payer: UHC Core |
$142.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$127.61
|
|
|
HC ELEC ALYS IMPLT NPGT SMPL SP/PN NPGT PRGM
|
Facility
|
OP
|
$176.99
|
|
|
Service Code
|
CPT 95971
|
| Hospital Charge Code |
92000031
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$42.04 |
| Max. Negotiated Rate |
$159.29 |
| Rate for Payer: Aetna Commercial |
$150.44
|
| Rate for Payer: Aetna Medicare |
$46.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$55.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$55.31
|
| Rate for Payer: BCBS Complete |
$69.69
|
| Rate for Payer: BCBS MAPPO |
$44.25
|
| Rate for Payer: BCBS Trust/PPO |
$145.50
|
| Rate for Payer: BCN Commercial |
$137.61
|
| Rate for Payer: BCN Medicare Advantage |
$44.25
|
| Rate for Payer: Cash Price |
$141.59
|
| Rate for Payer: Cash Price |
$141.59
|
| Rate for Payer: Cofinity Commercial |
$152.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.25
|
| Rate for Payer: Healthscope Commercial |
$159.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.74
|
| Rate for Payer: Mclaren Medicaid |
$66.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$46.46
|
| Rate for Payer: Meridian Medicaid |
$69.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.44
|
| Rate for Payer: Nomi Health Commercial |
$145.13
|
| Rate for Payer: PACE Senior Care Partners |
$42.04
|
| Rate for Payer: PACE SWMI |
$44.25
|
| Rate for Payer: PHP Commercial |
$150.44
|
| Rate for Payer: PHP Medicare Advantage |
$44.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$66.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.04
|
| Rate for Payer: Priority Health HMO/PPO |
$153.98
|
| Rate for Payer: Priority Health Medicare |
$44.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$118.58
|
| Rate for Payer: Railroad Medicare Medicare |
$44.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$155.75
|
| Rate for Payer: UHC Core |
$147.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$44.25
|
| Rate for Payer: UHC Exchange |
$44.25
|
| Rate for Payer: UHC Medicare Advantage |
$44.25
|
| Rate for Payer: UHCCP Medicaid |
$66.36
|
| Rate for Payer: VA VA |
$44.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.74
|
|
|
HC ELEC ALYS IMPLT NPGT SMPL SP/PN NPGT PRGM
|
Facility
|
IP
|
$176.99
|
|
|
Service Code
|
CPT 95971
|
| Hospital Charge Code |
92000031
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$115.04 |
| Max. Negotiated Rate |
$159.29 |
| Rate for Payer: Aetna Commercial |
$150.44
|
| Rate for Payer: BCBS Trust/PPO |
$144.48
|
| Rate for Payer: BCN Commercial |
$136.78
|
| Rate for Payer: Cash Price |
$141.59
|
| Rate for Payer: Cofinity Commercial |
$152.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.59
|
| Rate for Payer: Healthscope Commercial |
$159.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.44
|
| Rate for Payer: Nomi Health Commercial |
$145.13
|
| Rate for Payer: PHP Commercial |
$150.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.04
|
| Rate for Payer: Priority Health HMO/PPO |
$153.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$118.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$155.75
|
| Rate for Payer: UHC Core |
$147.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.74
|
|
|
HC ELEC BREAST PUMP KI (OB)
|
Facility
|
OP
|
$206.55
|
|
| Hospital Charge Code |
27000069
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.06 |
| Max. Negotiated Rate |
$185.90 |
| Rate for Payer: Aetna Commercial |
$175.57
|
| Rate for Payer: Aetna Medicare |
$53.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$64.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$64.55
|
| Rate for Payer: BCBS Complete |
$82.62
|
| Rate for Payer: BCBS MAPPO |
$51.64
|
| Rate for Payer: BCBS Trust/PPO |
$169.80
|
| Rate for Payer: BCN Commercial |
$160.59
|
| Rate for Payer: BCN Medicare Advantage |
$51.64
|
| Rate for Payer: Cash Price |
$165.24
|
| Rate for Payer: Cofinity Commercial |
$177.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.64
|
| Rate for Payer: Healthscope Commercial |
$185.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$154.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$54.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.57
|
| Rate for Payer: Nomi Health Commercial |
$169.37
|
| Rate for Payer: PACE Senior Care Partners |
$49.06
|
| Rate for Payer: PACE SWMI |
$51.64
|
| Rate for Payer: PHP Commercial |
$175.57
|
| Rate for Payer: PHP Medicare Advantage |
$51.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.26
|
| Rate for Payer: Priority Health HMO/PPO |
$179.70
|
| Rate for Payer: Priority Health Medicare |
$52.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$138.39
|
| Rate for Payer: Railroad Medicare Medicare |
$51.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$181.76
|
| Rate for Payer: UHC Core |
$172.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.64
|
| Rate for Payer: UHC Exchange |
$51.64
|
| Rate for Payer: UHC Medicare Advantage |
$51.64
|
| Rate for Payer: VA VA |
$51.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$154.91
|
|
|
HC ELEC BREAST PUMP KI (OB)
|
Facility
|
IP
|
$206.55
|
|
| Hospital Charge Code |
27000069
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$134.26 |
| Max. Negotiated Rate |
$185.90 |
| Rate for Payer: Aetna Commercial |
$175.57
|
| Rate for Payer: BCBS Trust/PPO |
$168.61
|
| Rate for Payer: BCN Commercial |
$159.62
|
| Rate for Payer: Cash Price |
$165.24
|
| Rate for Payer: Cofinity Commercial |
$177.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.24
|
| Rate for Payer: Healthscope Commercial |
$185.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$154.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.57
|
| Rate for Payer: Nomi Health Commercial |
$169.37
|
| Rate for Payer: PHP Commercial |
$175.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.26
|
| Rate for Payer: Priority Health HMO/PPO |
$179.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$138.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$181.76
|
| Rate for Payer: UHC Core |
$172.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$154.91
|
|
|
HC ELECTRICAL STIM UNATTENDED
|
Facility
|
OP
|
$92.60
|
|
|
Service Code
|
CPT 97014
|
| Hospital Charge Code |
42000010
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$21.99 |
| Max. Negotiated Rate |
$83.34 |
| Rate for Payer: Aetna Commercial |
$78.71
|
| Rate for Payer: Aetna Medicare |
$24.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.94
|
| Rate for Payer: BCBS Complete |
$37.04
|
| Rate for Payer: BCBS MAPPO |
$23.15
|
| Rate for Payer: BCBS Trust/PPO |
$76.13
|
| Rate for Payer: BCN Commercial |
$72.00
|
| Rate for Payer: BCN Medicare Advantage |
$23.15
|
| Rate for Payer: Cash Price |
$74.08
|
| Rate for Payer: Cofinity Commercial |
$79.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.15
|
| Rate for Payer: Healthscope Commercial |
$83.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.71
|
| Rate for Payer: Nomi Health Commercial |
$75.93
|
| Rate for Payer: PACE Senior Care Partners |
$21.99
|
| Rate for Payer: PACE SWMI |
$23.15
|
| Rate for Payer: PHP Commercial |
$78.71
|
| Rate for Payer: PHP Medicare Advantage |
$23.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.19
|
| Rate for Payer: Priority Health HMO/PPO |
$80.56
|
| Rate for Payer: Priority Health Medicare |
$23.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$62.04
|
| Rate for Payer: Railroad Medicare Medicare |
$23.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$81.49
|
| Rate for Payer: UHC Core |
$77.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.15
|
| Rate for Payer: UHC Exchange |
$23.15
|
| Rate for Payer: UHC Medicare Advantage |
$23.15
|
| Rate for Payer: VA VA |
$23.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.45
|
|
|
HC ELECTRICAL STIM UNATTENDED
|
Facility
|
IP
|
$92.60
|
|
|
Service Code
|
CPT 97014
|
| Hospital Charge Code |
42000010
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$60.19 |
| Max. Negotiated Rate |
$83.34 |
| Rate for Payer: Aetna Commercial |
$78.71
|
| Rate for Payer: BCBS Trust/PPO |
$75.59
|
| Rate for Payer: BCN Commercial |
$71.56
|
| Rate for Payer: Cash Price |
$74.08
|
| Rate for Payer: Cofinity Commercial |
$79.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.08
|
| Rate for Payer: Healthscope Commercial |
$83.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.71
|
| Rate for Payer: Nomi Health Commercial |
$75.93
|
| Rate for Payer: PHP Commercial |
$78.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.19
|
| Rate for Payer: Priority Health HMO/PPO |
$80.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$62.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$81.49
|
| Rate for Payer: UHC Core |
$77.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.45
|
|
|
HC ELECTRICAL STIM UNATTENDED FOR PRESSURE
|
Facility
|
OP
|
$102.44
|
|
|
Service Code
|
HCPCS G0281
|
| Hospital Charge Code |
42000057
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$24.33 |
| Max. Negotiated Rate |
$92.20 |
| Rate for Payer: Aetna Commercial |
$87.07
|
| Rate for Payer: Aetna Medicare |
$26.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.01
|
| Rate for Payer: BCBS Complete |
$40.98
|
| Rate for Payer: BCBS MAPPO |
$25.61
|
| Rate for Payer: BCBS Trust/PPO |
$84.22
|
| Rate for Payer: BCN Commercial |
$79.65
|
| Rate for Payer: BCN Medicare Advantage |
$25.61
|
| Rate for Payer: Cash Price |
$81.95
|
| Rate for Payer: Cofinity Commercial |
$88.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.61
|
| Rate for Payer: Healthscope Commercial |
$92.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.07
|
| Rate for Payer: Nomi Health Commercial |
$84.00
|
| Rate for Payer: PACE Senior Care Partners |
$24.33
|
| Rate for Payer: PACE SWMI |
$25.61
|
| Rate for Payer: PHP Commercial |
$87.07
|
| Rate for Payer: PHP Medicare Advantage |
$25.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.59
|
| Rate for Payer: Priority Health HMO/PPO |
$89.12
|
| Rate for Payer: Priority Health Medicare |
$25.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$68.63
|
| Rate for Payer: Railroad Medicare Medicare |
$25.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$90.15
|
| Rate for Payer: UHC Core |
$85.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.61
|
| Rate for Payer: UHC Exchange |
$25.61
|
| Rate for Payer: UHC Medicare Advantage |
$25.61
|
| Rate for Payer: VA VA |
$25.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.83
|
|
