|
HC EXERCISE CHALLENGE
|
Facility
|
OP
|
$1,020.24
|
|
|
Service Code
|
CPT 93464
|
| Hospital Charge Code |
48100108
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$242.31 |
| Max. Negotiated Rate |
$918.22 |
| Rate for Payer: Aetna Commercial |
$867.20
|
| Rate for Payer: Aetna Medicare |
$265.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$318.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$318.82
|
| Rate for Payer: BCBS Complete |
$408.10
|
| Rate for Payer: BCBS MAPPO |
$255.06
|
| Rate for Payer: BCBS Trust/PPO |
$838.74
|
| Rate for Payer: BCN Commercial |
$793.24
|
| Rate for Payer: BCN Medicare Advantage |
$255.06
|
| Rate for Payer: Cash Price |
$816.19
|
| Rate for Payer: Cofinity Commercial |
$877.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$816.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$255.06
|
| Rate for Payer: Healthscope Commercial |
$918.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$765.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$267.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$293.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$867.20
|
| Rate for Payer: Nomi Health Commercial |
$836.60
|
| Rate for Payer: PACE Senior Care Partners |
$242.31
|
| Rate for Payer: PACE SWMI |
$255.06
|
| Rate for Payer: PHP Commercial |
$867.20
|
| Rate for Payer: PHP Medicare Advantage |
$255.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$663.16
|
| Rate for Payer: Priority Health HMO/PPO |
$887.61
|
| Rate for Payer: Priority Health Medicare |
$257.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$683.56
|
| Rate for Payer: Railroad Medicare Medicare |
$255.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$897.81
|
| Rate for Payer: UHC Core |
$851.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$255.06
|
| Rate for Payer: UHC Exchange |
$255.06
|
| Rate for Payer: UHC Medicare Advantage |
$255.06
|
| Rate for Payer: VA VA |
$255.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$765.18
|
|
|
HC EXERCISE CHALLENGE
|
Facility
|
IP
|
$1,020.24
|
|
|
Service Code
|
CPT 93464
|
| Hospital Charge Code |
48100108
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$663.16 |
| Max. Negotiated Rate |
$918.22 |
| Rate for Payer: Aetna Commercial |
$867.20
|
| Rate for Payer: BCBS Trust/PPO |
$832.82
|
| Rate for Payer: BCN Commercial |
$788.44
|
| Rate for Payer: Cash Price |
$816.19
|
| Rate for Payer: Cofinity Commercial |
$877.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$816.19
|
| Rate for Payer: Healthscope Commercial |
$918.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$765.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$867.20
|
| Rate for Payer: Nomi Health Commercial |
$836.60
|
| Rate for Payer: PHP Commercial |
$867.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$663.16
|
| Rate for Payer: Priority Health HMO/PPO |
$887.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$683.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$897.81
|
| Rate for Payer: UHC Core |
$851.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$765.18
|
|
|
HC EXERCISE TEST FOR BRONCHOSPASM W/EKG
|
Facility
|
IP
|
$344.70
|
|
|
Service Code
|
CPT 94617
|
| Hospital Charge Code |
46000033
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$224.06 |
| Max. Negotiated Rate |
$310.23 |
| Rate for Payer: Aetna Commercial |
$293.00
|
| Rate for Payer: BCBS Trust/PPO |
$281.38
|
| Rate for Payer: BCN Commercial |
$266.38
|
| Rate for Payer: Cash Price |
$275.76
|
| Rate for Payer: Cofinity Commercial |
$296.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$275.76
|
| Rate for Payer: Healthscope Commercial |
$310.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$258.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$293.00
|
| Rate for Payer: Nomi Health Commercial |
$282.65
|
| Rate for Payer: PHP Commercial |
$293.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$224.06
|
| Rate for Payer: Priority Health HMO/PPO |
$299.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$230.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$303.34
|
| Rate for Payer: UHC Core |
$287.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$258.52
|
|
|
HC EXERCISE TEST FOR BRONCHOSPASM W/EKG
|
Facility
|
OP
|
$344.70
|
|
|
Service Code
|
CPT 94617
|
| Hospital Charge Code |
46000033
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$81.87 |
| Max. Negotiated Rate |
$310.23 |
| Rate for Payer: Aetna Commercial |
$293.00
|
| Rate for Payer: Aetna Medicare |
$89.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$107.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$107.72
|
| Rate for Payer: BCBS Complete |
$97.86
|
| Rate for Payer: BCBS MAPPO |
$86.17
|
| Rate for Payer: BCBS Trust/PPO |
$283.38
|
| Rate for Payer: BCN Commercial |
$268.00
|
| Rate for Payer: BCN Medicare Advantage |
$86.17
|
| Rate for Payer: Cash Price |
$275.76
|
| Rate for Payer: Cash Price |
$275.76
|
| Rate for Payer: Cofinity Commercial |
$296.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$275.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.17
|
| Rate for Payer: Healthscope Commercial |
$310.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$258.52
|
| Rate for Payer: Mclaren Medicaid |
$93.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.48
|
| Rate for Payer: Meridian Medicaid |
$97.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$293.00
|
| Rate for Payer: Nomi Health Commercial |
$282.65
|
| Rate for Payer: PACE Senior Care Partners |
$81.87
|
| Rate for Payer: PACE SWMI |
$86.17
|
| Rate for Payer: PHP Commercial |
$293.00
|
| Rate for Payer: PHP Medicare Advantage |
$86.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$224.06
|
| Rate for Payer: Priority Health HMO/PPO |
$299.89
|
| Rate for Payer: Priority Health Medicare |
$87.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$230.95
|
| Rate for Payer: Railroad Medicare Medicare |
$86.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$303.34
|
| Rate for Payer: UHC Core |
$287.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$86.17
|
| Rate for Payer: UHC Exchange |
$86.17
|
| Rate for Payer: UHC Medicare Advantage |
$86.17
|
| Rate for Payer: UHCCP Medicaid |
$93.19
|
| Rate for Payer: VA VA |
$86.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$258.52
|
|
|
HC EXERCISE TEST FOR BRONCHOSPASM WO ECG
|
Facility
|
IP
|
$136.25
|
|
|
Service Code
|
CPT 94619
|
| Hospital Charge Code |
46000032
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$88.56 |
| Max. Negotiated Rate |
$122.62 |
| Rate for Payer: Aetna Commercial |
$115.81
|
| Rate for Payer: BCBS Trust/PPO |
$111.22
|
| Rate for Payer: BCN Commercial |
$105.29
|
| Rate for Payer: Cash Price |
$109.00
|
| Rate for Payer: Cofinity Commercial |
$117.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.00
|
| Rate for Payer: Healthscope Commercial |
$122.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$102.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.81
|
| Rate for Payer: Nomi Health Commercial |
$111.72
|
| Rate for Payer: PHP Commercial |
$115.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.56
|
| Rate for Payer: Priority Health HMO/PPO |
$118.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$91.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$119.90
|
| Rate for Payer: UHC Core |
$113.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$102.19
|
|
|
HC EXERCISE TEST FOR BRONCHOSPASM WO ECG
|
Facility
|
OP
|
$136.25
|
|
|
Service Code
|
CPT 94619
|
| Hospital Charge Code |
46000032
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$32.36 |
| Max. Negotiated Rate |
$122.62 |
| Rate for Payer: Aetna Commercial |
$115.81
|
| Rate for Payer: Aetna Medicare |
$35.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$42.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$42.58
|
| Rate for Payer: BCBS Complete |
$45.10
|
| Rate for Payer: BCBS MAPPO |
$34.06
|
| Rate for Payer: BCBS Trust/PPO |
$112.01
|
| Rate for Payer: BCN Commercial |
$105.93
|
| Rate for Payer: BCN Medicare Advantage |
$34.06
|
| Rate for Payer: Cash Price |
$109.00
|
| Rate for Payer: Cash Price |
$109.00
|
| Rate for Payer: Cofinity Commercial |
$117.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34.06
|
| Rate for Payer: Healthscope Commercial |
$122.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$102.19
|
| Rate for Payer: Mclaren Medicaid |
$42.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$35.77
|
| Rate for Payer: Meridian Medicaid |
$45.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.81
|
| Rate for Payer: Nomi Health Commercial |
$111.72
|
| Rate for Payer: PACE Senior Care Partners |
$32.36
|
| Rate for Payer: PACE SWMI |
$34.06
|
| Rate for Payer: PHP Commercial |
$115.81
|
| Rate for Payer: PHP Medicare Advantage |
$34.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$42.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.56
|
| Rate for Payer: Priority Health HMO/PPO |
$118.54
|
| Rate for Payer: Priority Health Medicare |
$34.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$91.29
|
| Rate for Payer: Railroad Medicare Medicare |
$34.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$119.90
|
| Rate for Payer: UHC Core |
$113.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$34.06
|
| Rate for Payer: UHC Exchange |
$34.06
|
| Rate for Payer: UHC Medicare Advantage |
$34.06
|
| Rate for Payer: UHCCP Medicaid |
$42.95
|
| Rate for Payer: VA VA |
$34.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$102.19
|
|
|
HC EXPLORE WOUND EXTREMITY
|
Facility
|
OP
|
$1,942.34
|
|
|
Service Code
|
CPT 20103
|
| Hospital Charge Code |
45000007
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$461.31 |
| Max. Negotiated Rate |
$1,748.11 |
| Rate for Payer: Aetna Commercial |
$1,650.99
|
| Rate for Payer: Aetna Medicare |
$505.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$606.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$606.98
|
| Rate for Payer: BCBS Complete |
$1,230.09
|
| Rate for Payer: BCBS MAPPO |
$485.58
|
| Rate for Payer: BCBS Trust/PPO |
$1,596.80
|
| Rate for Payer: BCN Commercial |
$1,510.17
|
| Rate for Payer: BCN Medicare Advantage |
$485.58
|
| Rate for Payer: Cash Price |
$1,553.87
|
| Rate for Payer: Cash Price |
$1,553.87
|
| Rate for Payer: Cofinity Commercial |
$1,670.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,553.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$485.58
|
| Rate for Payer: Healthscope Commercial |
$1,748.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,456.76
|
| Rate for Payer: Mclaren Medicaid |
$1,171.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$509.86
|
| Rate for Payer: Meridian Medicaid |
$1,230.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$558.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,650.99
|
| Rate for Payer: Nomi Health Commercial |
$1,592.72
|
| Rate for Payer: PACE Senior Care Partners |
$461.31
|
| Rate for Payer: PACE SWMI |
$485.58
|
| Rate for Payer: PHP Commercial |
$1,650.99
|
| Rate for Payer: PHP Medicare Advantage |
$485.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,171.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,262.52
|
| Rate for Payer: Priority Health HMO/PPO |
$1,689.84
|
| Rate for Payer: Priority Health Medicare |
$490.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,301.37
|
| Rate for Payer: Railroad Medicare Medicare |
$485.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,709.26
|
| Rate for Payer: UHC Core |
$1,621.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$485.58
|
| Rate for Payer: UHC Exchange |
$485.58
|
| Rate for Payer: UHC Medicare Advantage |
$485.58
|
| Rate for Payer: UHCCP Medicaid |
$1,171.43
|
| Rate for Payer: VA VA |
$485.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,456.76
|
|
|
HC EXPLORE WOUND EXTREMITY
|
Facility
|
IP
|
$1,942.34
|
|
|
Service Code
|
CPT 20103
|
| Hospital Charge Code |
45000007
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,262.52 |
| Max. Negotiated Rate |
$1,748.11 |
| Rate for Payer: Aetna Commercial |
$1,650.99
|
| Rate for Payer: BCBS Trust/PPO |
$1,585.53
|
| Rate for Payer: BCN Commercial |
$1,501.04
|
| Rate for Payer: Cash Price |
$1,553.87
|
| Rate for Payer: Cofinity Commercial |
$1,670.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,553.87
|
| Rate for Payer: Healthscope Commercial |
$1,748.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,456.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,650.99
|
| Rate for Payer: Nomi Health Commercial |
$1,592.72
|
| Rate for Payer: PHP Commercial |
$1,650.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,262.52
|
| Rate for Payer: Priority Health HMO/PPO |
$1,689.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,301.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,709.26
|
| Rate for Payer: UHC Core |
$1,621.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,456.76
|
|
|
HC EXTENDED RECOVERY 0-6 HRS
|
Facility
|
OP
|
$1,760.92
|
|
| Hospital Charge Code |
71000005
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$418.22 |
| Max. Negotiated Rate |
$1,584.83 |
| Rate for Payer: Aetna Commercial |
$1,496.78
|
| Rate for Payer: Aetna Medicare |
$457.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$550.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$550.29
|
| Rate for Payer: BCBS Complete |
$704.37
|
| Rate for Payer: BCBS MAPPO |
$440.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,447.65
|
| Rate for Payer: BCN Commercial |
$1,369.12
|
| Rate for Payer: BCN Medicare Advantage |
$440.23
|
| Rate for Payer: Cash Price |
$1,408.74
|
| Rate for Payer: Cofinity Commercial |
$1,514.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,408.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$440.23
|
| Rate for Payer: Healthscope Commercial |
$1,584.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,320.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$462.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$506.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,496.78
|
| Rate for Payer: Nomi Health Commercial |
$1,443.95
|
| Rate for Payer: PACE Senior Care Partners |
$418.22
|
| Rate for Payer: PACE SWMI |
$440.23
|
| Rate for Payer: PHP Commercial |
$1,496.78
|
| Rate for Payer: PHP Medicare Advantage |
$440.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,144.60
|
| Rate for Payer: Priority Health HMO/PPO |
$1,532.00
|
| Rate for Payer: Priority Health Medicare |
$444.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,179.82
|
| Rate for Payer: Railroad Medicare Medicare |
$440.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,549.61
|
| Rate for Payer: UHC Core |
$1,470.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$440.23
|
| Rate for Payer: UHC Exchange |
$440.23
|
| Rate for Payer: UHC Medicare Advantage |
$440.23
|
| Rate for Payer: VA VA |
$440.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,320.69
|
|
|
HC EXTENDED RECOVERY 0-6 HRS
|
Facility
|
IP
|
$1,760.92
|
|
| Hospital Charge Code |
71000005
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$1,144.60 |
| Max. Negotiated Rate |
$1,584.83 |
| Rate for Payer: Aetna Commercial |
$1,496.78
|
| Rate for Payer: BCBS Trust/PPO |
$1,437.44
|
| Rate for Payer: BCN Commercial |
$1,360.84
|
| Rate for Payer: Cash Price |
$1,408.74
|
| Rate for Payer: Cofinity Commercial |
$1,514.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,408.74
|
| Rate for Payer: Healthscope Commercial |
$1,584.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,320.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,496.78
|
| Rate for Payer: Nomi Health Commercial |
$1,443.95
|
| Rate for Payer: PHP Commercial |
$1,496.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,144.60
|
| Rate for Payer: Priority Health HMO/PPO |
$1,532.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,179.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,549.61
|
| Rate for Payer: UHC Core |
$1,470.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,320.69
|
|
|
HC EXTENDED RECOVERY 12-18 HRS
|
Facility
|
OP
|
$2,058.81
|
|
| Hospital Charge Code |
71000006
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$488.97 |
| Max. Negotiated Rate |
$1,852.93 |
| Rate for Payer: Aetna Commercial |
$1,749.99
|
| Rate for Payer: Aetna Medicare |
$535.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$643.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$643.38
|
| Rate for Payer: BCBS Complete |
$823.52
|
| Rate for Payer: BCBS MAPPO |
$514.70
|
| Rate for Payer: BCBS Trust/PPO |
$1,692.55
|
| Rate for Payer: BCN Commercial |
$1,600.72
|
| Rate for Payer: BCN Medicare Advantage |
$514.70
|
| Rate for Payer: Cash Price |
$1,647.05
|
| Rate for Payer: Cofinity Commercial |
$1,770.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,647.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$514.70
|
| Rate for Payer: Healthscope Commercial |
$1,852.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,544.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$540.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$591.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,749.99
|
| Rate for Payer: Nomi Health Commercial |
$1,688.22
|
| Rate for Payer: PACE Senior Care Partners |
$488.97
|
| Rate for Payer: PACE SWMI |
$514.70
|
| Rate for Payer: PHP Commercial |
$1,749.99
|
| Rate for Payer: PHP Medicare Advantage |
$514.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,338.23
|
| Rate for Payer: Priority Health HMO/PPO |
$1,791.16
|
| Rate for Payer: Priority Health Medicare |
$519.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,379.40
|
| Rate for Payer: Railroad Medicare Medicare |
$514.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,811.75
|
| Rate for Payer: UHC Core |
$1,719.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$514.70
|
| Rate for Payer: UHC Exchange |
$514.70
|
| Rate for Payer: UHC Medicare Advantage |
$514.70
|
| Rate for Payer: VA VA |
$514.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,544.11
|
|
|
HC EXTENDED RECOVERY 12-18 HRS
|
Facility
|
IP
|
$2,058.81
|
|
| Hospital Charge Code |
71000006
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$1,338.23 |
| Max. Negotiated Rate |
$1,852.93 |
| Rate for Payer: Aetna Commercial |
$1,749.99
|
| Rate for Payer: BCBS Trust/PPO |
$1,680.61
|
| Rate for Payer: BCN Commercial |
$1,591.05
|
| Rate for Payer: Cash Price |
$1,647.05
|
| Rate for Payer: Cofinity Commercial |
$1,770.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,647.05
|
| Rate for Payer: Healthscope Commercial |
$1,852.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,544.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,749.99
|
| Rate for Payer: Nomi Health Commercial |
$1,688.22
|
| Rate for Payer: PHP Commercial |
$1,749.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,338.23
|
| Rate for Payer: Priority Health HMO/PPO |
$1,791.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,379.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,811.75
|
| Rate for Payer: UHC Core |
$1,719.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,544.11
|
|
|
HC EXTENDED RECOVERY 18-24 HRS
|
Facility
|
IP
|
$2,250.28
|
|
| Hospital Charge Code |
71000007
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$1,462.68 |
| Max. Negotiated Rate |
$2,025.25 |
| Rate for Payer: Aetna Commercial |
$1,912.74
|
| Rate for Payer: BCBS Trust/PPO |
$1,836.90
|
| Rate for Payer: BCN Commercial |
$1,739.02
|
| Rate for Payer: Cash Price |
$1,800.22
|
| Rate for Payer: Cofinity Commercial |
$1,935.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,800.22
|
| Rate for Payer: Healthscope Commercial |
$2,025.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,687.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,912.74
|
| Rate for Payer: Nomi Health Commercial |
$1,845.23
|
| Rate for Payer: PHP Commercial |
$1,912.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,462.68
|
| Rate for Payer: Priority Health HMO/PPO |
$1,957.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,507.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,980.25
|
| Rate for Payer: UHC Core |
$1,878.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,687.71
|
|
|
HC EXTENDED RECOVERY 18-24 HRS
|
Facility
|
OP
|
$2,250.28
|
|
| Hospital Charge Code |
71000007
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$534.44 |
| Max. Negotiated Rate |
$2,025.25 |
| Rate for Payer: Aetna Commercial |
$1,912.74
|
| Rate for Payer: Aetna Medicare |
$585.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$703.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$703.21
|
| Rate for Payer: BCBS Complete |
$900.11
|
| Rate for Payer: BCBS MAPPO |
$562.57
|
| Rate for Payer: BCBS Trust/PPO |
$1,849.96
|
| Rate for Payer: BCN Commercial |
$1,749.59
|
| Rate for Payer: BCN Medicare Advantage |
$562.57
|
| Rate for Payer: Cash Price |
$1,800.22
|
| Rate for Payer: Cofinity Commercial |
$1,935.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,800.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$562.57
|
| Rate for Payer: Healthscope Commercial |
$2,025.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,687.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$590.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$646.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,912.74
|
| Rate for Payer: Nomi Health Commercial |
$1,845.23
|
| Rate for Payer: PACE Senior Care Partners |
$534.44
|
| Rate for Payer: PACE SWMI |
$562.57
|
| Rate for Payer: PHP Commercial |
$1,912.74
|
| Rate for Payer: PHP Medicare Advantage |
$562.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,462.68
|
| Rate for Payer: Priority Health HMO/PPO |
$1,957.74
|
| Rate for Payer: Priority Health Medicare |
$568.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,507.69
|
| Rate for Payer: Railroad Medicare Medicare |
$562.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,980.25
|
| Rate for Payer: UHC Core |
$1,878.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$562.57
|
| Rate for Payer: UHC Exchange |
$562.57
|
| Rate for Payer: UHC Medicare Advantage |
$562.57
|
| Rate for Payer: VA VA |
$562.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,687.71
|
|
|
HC EXTENDED RECOVERY 6-12 HRS
|
Facility
|
OP
|
$1,925.80
|
|
| Hospital Charge Code |
71000008
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$457.38 |
| Max. Negotiated Rate |
$1,733.22 |
| Rate for Payer: Aetna Commercial |
$1,636.93
|
| Rate for Payer: Aetna Medicare |
$500.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$601.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$601.81
|
| Rate for Payer: BCBS Complete |
$770.32
|
| Rate for Payer: BCBS MAPPO |
$481.45
|
| Rate for Payer: BCBS Trust/PPO |
$1,583.20
|
| Rate for Payer: BCN Commercial |
$1,497.31
|
| Rate for Payer: BCN Medicare Advantage |
$481.45
|
| Rate for Payer: Cash Price |
$1,540.64
|
| Rate for Payer: Cofinity Commercial |
$1,656.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,540.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$481.45
|
| Rate for Payer: Healthscope Commercial |
$1,733.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,444.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$505.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$553.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,636.93
|
| Rate for Payer: Nomi Health Commercial |
$1,579.16
|
| Rate for Payer: PACE Senior Care Partners |
$457.38
|
| Rate for Payer: PACE SWMI |
$481.45
|
| Rate for Payer: PHP Commercial |
$1,636.93
|
| Rate for Payer: PHP Medicare Advantage |
$481.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,251.77
|
| Rate for Payer: Priority Health HMO/PPO |
$1,675.45
|
| Rate for Payer: Priority Health Medicare |
$486.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,290.29
|
| Rate for Payer: Railroad Medicare Medicare |
$481.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,694.70
|
| Rate for Payer: UHC Core |
$1,608.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$481.45
|
| Rate for Payer: UHC Exchange |
$481.45
|
| Rate for Payer: UHC Medicare Advantage |
$481.45
|
| Rate for Payer: VA VA |
$481.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,444.35
|
|
|
HC EXTENDED RECOVERY 6-12 HRS
|
Facility
|
IP
|
$1,925.80
|
|
| Hospital Charge Code |
71000008
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$1,251.77 |
| Max. Negotiated Rate |
$1,733.22 |
| Rate for Payer: Aetna Commercial |
$1,636.93
|
| Rate for Payer: BCBS Trust/PPO |
$1,572.03
|
| Rate for Payer: BCN Commercial |
$1,488.26
|
| Rate for Payer: Cash Price |
$1,540.64
|
| Rate for Payer: Cofinity Commercial |
$1,656.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,540.64
|
| Rate for Payer: Healthscope Commercial |
$1,733.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,444.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,636.93
|
| Rate for Payer: Nomi Health Commercial |
$1,579.16
|
| Rate for Payer: PHP Commercial |
$1,636.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,251.77
|
| Rate for Payer: Priority Health HMO/PPO |
$1,675.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,290.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,694.70
|
| Rate for Payer: UHC Core |
$1,608.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,444.35
|
|
|
HC EXTENSION KIT
|
Facility
|
OP
|
$2,031.98
|
|
|
Service Code
|
HCPCS C1883
|
| Hospital Charge Code |
27800052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$482.60 |
| Max. Negotiated Rate |
$1,828.78 |
| Rate for Payer: Aetna Commercial |
$1,727.18
|
| Rate for Payer: Aetna Medicare |
$528.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$634.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$634.99
|
| Rate for Payer: BCBS Complete |
$812.79
|
| Rate for Payer: BCBS MAPPO |
$508.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,670.49
|
| Rate for Payer: BCN Commercial |
$1,579.86
|
| Rate for Payer: BCN Medicare Advantage |
$508.00
|
| Rate for Payer: Cash Price |
$1,625.58
|
| Rate for Payer: Cofinity Commercial |
$1,747.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,625.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$508.00
|
| Rate for Payer: Healthscope Commercial |
$1,828.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,523.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$533.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$584.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,727.18
|
| Rate for Payer: Nomi Health Commercial |
$1,666.22
|
| Rate for Payer: PACE Senior Care Partners |
$482.60
|
| Rate for Payer: PACE SWMI |
$508.00
|
| Rate for Payer: PHP Commercial |
$1,727.18
|
| Rate for Payer: PHP Medicare Advantage |
$508.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,320.79
|
| Rate for Payer: Priority Health HMO/PPO |
$1,767.82
|
| Rate for Payer: Priority Health Medicare |
$513.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,361.43
|
| Rate for Payer: Railroad Medicare Medicare |
$508.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,788.14
|
| Rate for Payer: UHC Core |
$1,696.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$508.00
|
| Rate for Payer: UHC Exchange |
$508.00
|
| Rate for Payer: UHC Medicare Advantage |
$508.00
|
| Rate for Payer: VA VA |
$508.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,523.98
|
|
|
HC EXTENSION KIT
|
Facility
|
IP
|
$2,031.98
|
|
|
Service Code
|
HCPCS C1883
|
| Hospital Charge Code |
27800052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,320.79 |
| Max. Negotiated Rate |
$1,828.78 |
| Rate for Payer: Aetna Commercial |
$1,727.18
|
| Rate for Payer: BCBS Trust/PPO |
$1,658.71
|
| Rate for Payer: BCN Commercial |
$1,570.31
|
| Rate for Payer: Cash Price |
$1,625.58
|
| Rate for Payer: Cofinity Commercial |
$1,747.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,625.58
|
| Rate for Payer: Healthscope Commercial |
$1,828.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,523.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,727.18
|
| Rate for Payer: Nomi Health Commercial |
$1,666.22
|
| Rate for Payer: PHP Commercial |
$1,727.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,320.79
|
| Rate for Payer: Priority Health HMO/PPO |
$1,767.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,361.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,788.14
|
| Rate for Payer: UHC Core |
$1,696.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,523.98
|
|
|
HC EXTENSION ST JUDE
|
Facility
|
IP
|
$2,370.66
|
|
|
Service Code
|
HCPCS C1883
|
| Hospital Charge Code |
27800053
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,540.93 |
| Max. Negotiated Rate |
$2,133.59 |
| Rate for Payer: Aetna Commercial |
$2,015.06
|
| Rate for Payer: BCBS Trust/PPO |
$1,935.17
|
| Rate for Payer: BCN Commercial |
$1,832.05
|
| Rate for Payer: Cash Price |
$1,896.53
|
| Rate for Payer: Cofinity Commercial |
$2,038.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,896.53
|
| Rate for Payer: Healthscope Commercial |
$2,133.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,777.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,015.06
|
| Rate for Payer: Nomi Health Commercial |
$1,943.94
|
| Rate for Payer: PHP Commercial |
$2,015.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,540.93
|
| Rate for Payer: Priority Health HMO/PPO |
$2,062.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,588.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,086.18
|
| Rate for Payer: UHC Core |
$1,979.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,777.99
|
|
|
HC EXTENSION ST JUDE
|
Facility
|
OP
|
$2,370.66
|
|
|
Service Code
|
HCPCS C1883
|
| Hospital Charge Code |
27800053
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$563.03 |
| Max. Negotiated Rate |
$2,133.59 |
| Rate for Payer: Aetna Commercial |
$2,015.06
|
| Rate for Payer: Aetna Medicare |
$616.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$740.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$740.83
|
| Rate for Payer: BCBS Complete |
$948.26
|
| Rate for Payer: BCBS MAPPO |
$592.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,948.92
|
| Rate for Payer: BCN Commercial |
$1,843.19
|
| Rate for Payer: BCN Medicare Advantage |
$592.66
|
| Rate for Payer: Cash Price |
$1,896.53
|
| Rate for Payer: Cofinity Commercial |
$2,038.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,896.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$592.66
|
| Rate for Payer: Healthscope Commercial |
$2,133.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,777.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$622.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$681.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,015.06
|
| Rate for Payer: Nomi Health Commercial |
$1,943.94
|
| Rate for Payer: PACE Senior Care Partners |
$563.03
|
| Rate for Payer: PACE SWMI |
$592.66
|
| Rate for Payer: PHP Commercial |
$2,015.06
|
| Rate for Payer: PHP Medicare Advantage |
$592.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,540.93
|
| Rate for Payer: Priority Health HMO/PPO |
$2,062.47
|
| Rate for Payer: Priority Health Medicare |
$598.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,588.34
|
| Rate for Payer: Railroad Medicare Medicare |
$592.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,086.18
|
| Rate for Payer: UHC Core |
$1,979.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$592.66
|
| Rate for Payer: UHC Exchange |
$592.66
|
| Rate for Payer: UHC Medicare Advantage |
$592.66
|
| Rate for Payer: VA VA |
$592.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,777.99
|
|
|
HC EXTERNAL EKG RECORDIN >48 HRS UP TO 7 DAYS
|
Facility
|
OP
|
$91.13
|
|
|
Service Code
|
CPT 93242
|
| Hospital Charge Code |
48000030
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$21.64 |
| Max. Negotiated Rate |
$82.02 |
| Rate for Payer: Aetna Commercial |
$77.46
|
| Rate for Payer: Aetna Medicare |
$23.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.48
|
| Rate for Payer: BCBS Complete |
$29.80
|
| Rate for Payer: BCBS MAPPO |
$22.78
|
| Rate for Payer: BCBS Trust/PPO |
$74.92
|
| Rate for Payer: BCN Commercial |
$70.85
|
| Rate for Payer: BCN Medicare Advantage |
$22.78
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cofinity Commercial |
$78.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.78
|
| Rate for Payer: Healthscope Commercial |
$82.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.35
|
| Rate for Payer: Mclaren Medicaid |
$28.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.92
|
| Rate for Payer: Meridian Medicaid |
$29.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.46
|
| Rate for Payer: Nomi Health Commercial |
$74.73
|
| Rate for Payer: PACE Senior Care Partners |
$21.64
|
| Rate for Payer: PACE SWMI |
$22.78
|
| Rate for Payer: PHP Commercial |
$77.46
|
| Rate for Payer: PHP Medicare Advantage |
$22.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$28.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.23
|
| Rate for Payer: Priority Health HMO/PPO |
$79.28
|
| Rate for Payer: Priority Health Medicare |
$23.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.06
|
| Rate for Payer: Railroad Medicare Medicare |
$22.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.19
|
| Rate for Payer: UHC Core |
$76.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.78
|
| Rate for Payer: UHC Exchange |
$22.78
|
| Rate for Payer: UHC Medicare Advantage |
$22.78
|
| Rate for Payer: UHCCP Medicaid |
$28.38
|
| Rate for Payer: VA VA |
$22.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.35
|
|
|
HC EXTERNAL EKG RECORDIN >48 HRS UP TO 7 DAYS
|
Facility
|
IP
|
$91.13
|
|
|
Service Code
|
CPT 93242
|
| Hospital Charge Code |
48000030
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$59.23 |
| Max. Negotiated Rate |
$82.02 |
| Rate for Payer: Aetna Commercial |
$77.46
|
| Rate for Payer: BCBS Trust/PPO |
$74.39
|
| Rate for Payer: BCN Commercial |
$70.43
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cofinity Commercial |
$78.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.90
|
| Rate for Payer: Healthscope Commercial |
$82.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.46
|
| Rate for Payer: Nomi Health Commercial |
$74.73
|
| Rate for Payer: PHP Commercial |
$77.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.23
|
| Rate for Payer: Priority Health HMO/PPO |
$79.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.19
|
| Rate for Payer: UHC Core |
$76.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.35
|
|
|
HC EXTERNAL EKG RECORDING >7 DAYS UP TO 15 DAYS
|
Facility
|
IP
|
$137.39
|
|
|
Service Code
|
CPT 93246
|
| Hospital Charge Code |
48000031
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$89.30 |
| Max. Negotiated Rate |
$123.65 |
| Rate for Payer: Aetna Commercial |
$116.78
|
| Rate for Payer: BCBS Trust/PPO |
$112.15
|
| Rate for Payer: BCN Commercial |
$106.17
|
| Rate for Payer: Cash Price |
$109.91
|
| Rate for Payer: Cofinity Commercial |
$118.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.91
|
| Rate for Payer: Healthscope Commercial |
$123.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.78
|
| Rate for Payer: Nomi Health Commercial |
$112.66
|
| Rate for Payer: PHP Commercial |
$116.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.30
|
| Rate for Payer: Priority Health HMO/PPO |
$119.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$92.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$120.90
|
| Rate for Payer: UHC Core |
$114.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.04
|
|
|
HC EXTERNAL EKG RECORDING >7 DAYS UP TO 15 DAYS
|
Facility
|
OP
|
$137.39
|
|
|
Service Code
|
CPT 93246
|
| Hospital Charge Code |
48000031
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$28.38 |
| Max. Negotiated Rate |
$123.65 |
| Rate for Payer: Aetna Commercial |
$116.78
|
| Rate for Payer: Aetna Medicare |
$35.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$42.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$42.93
|
| Rate for Payer: BCBS Complete |
$29.80
|
| Rate for Payer: BCBS MAPPO |
$34.35
|
| Rate for Payer: BCBS Trust/PPO |
$112.95
|
| Rate for Payer: BCN Commercial |
$106.82
|
| Rate for Payer: BCN Medicare Advantage |
$34.35
|
| Rate for Payer: Cash Price |
$109.91
|
| Rate for Payer: Cash Price |
$109.91
|
| Rate for Payer: Cofinity Commercial |
$118.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34.35
|
| Rate for Payer: Healthscope Commercial |
$123.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.04
|
| Rate for Payer: Mclaren Medicaid |
$28.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.06
|
| Rate for Payer: Meridian Medicaid |
$29.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.78
|
| Rate for Payer: Nomi Health Commercial |
$112.66
|
| Rate for Payer: PACE Senior Care Partners |
$32.63
|
| Rate for Payer: PACE SWMI |
$34.35
|
| Rate for Payer: PHP Commercial |
$116.78
|
| Rate for Payer: PHP Medicare Advantage |
$34.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$28.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.30
|
| Rate for Payer: Priority Health HMO/PPO |
$119.53
|
| Rate for Payer: Priority Health Medicare |
$34.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$92.05
|
| Rate for Payer: Railroad Medicare Medicare |
$34.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$120.90
|
| Rate for Payer: UHC Core |
$114.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$34.35
|
| Rate for Payer: UHC Exchange |
$34.35
|
| Rate for Payer: UHC Medicare Advantage |
$34.35
|
| Rate for Payer: UHCCP Medicaid |
$28.38
|
| Rate for Payer: VA VA |
$34.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.04
|
|
|
HC EXTERNAL PACER
|
Facility
|
OP
|
$576.43
|
|
|
Service Code
|
CPT 92953
|
| Hospital Charge Code |
48000001
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$136.90 |
| Max. Negotiated Rate |
$518.79 |
| Rate for Payer: Aetna Commercial |
$489.97
|
| Rate for Payer: Aetna Medicare |
$149.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$180.13
|
| Rate for Payer: Amish Plain Church Group Commercial |
$180.13
|
| Rate for Payer: BCBS Complete |
$496.81
|
| Rate for Payer: BCBS MAPPO |
$144.11
|
| Rate for Payer: BCBS Trust/PPO |
$473.88
|
| Rate for Payer: BCN Commercial |
$448.17
|
| Rate for Payer: BCN Medicare Advantage |
$144.11
|
| Rate for Payer: Cash Price |
$461.14
|
| Rate for Payer: Cash Price |
$461.14
|
| Rate for Payer: Cofinity Commercial |
$495.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$461.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$144.11
|
| Rate for Payer: Healthscope Commercial |
$518.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$432.32
|
| Rate for Payer: Mclaren Medicaid |
$473.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$151.31
|
| Rate for Payer: Meridian Medicaid |
$496.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$165.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$489.97
|
| Rate for Payer: Nomi Health Commercial |
$472.67
|
| Rate for Payer: PACE Senior Care Partners |
$136.90
|
| Rate for Payer: PACE SWMI |
$144.11
|
| Rate for Payer: PHP Commercial |
$489.97
|
| Rate for Payer: PHP Medicare Advantage |
$144.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$473.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$374.68
|
| Rate for Payer: Priority Health HMO/PPO |
$501.49
|
| Rate for Payer: Priority Health Medicare |
$145.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$386.21
|
| Rate for Payer: Railroad Medicare Medicare |
$144.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$507.26
|
| Rate for Payer: UHC Core |
$481.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$144.11
|
| Rate for Payer: UHC Exchange |
$144.11
|
| Rate for Payer: UHC Medicare Advantage |
$144.11
|
| Rate for Payer: UHCCP Medicaid |
$473.12
|
| Rate for Payer: VA VA |
$144.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$432.32
|
|
