|
HC USE OF SPEECH DEVICE SERVICE
|
Facility
|
IP
|
$473.16
|
|
|
Service Code
|
CPT 92609
|
| Hospital Charge Code |
44000003
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$307.55 |
| Max. Negotiated Rate |
$425.84 |
| Rate for Payer: Aetna Commercial |
$402.19
|
| Rate for Payer: BCBS Trust/PPO |
$386.24
|
| Rate for Payer: BCN Commercial |
$365.66
|
| Rate for Payer: Cash Price |
$378.53
|
| Rate for Payer: Cofinity Commercial |
$406.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$378.53
|
| Rate for Payer: Healthscope Commercial |
$425.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$354.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$402.19
|
| Rate for Payer: Nomi Health Commercial |
$387.99
|
| Rate for Payer: PHP Commercial |
$402.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$307.55
|
| Rate for Payer: Priority Health HMO/PPO |
$411.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$317.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$416.38
|
| Rate for Payer: UHC Core |
$395.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$354.87
|
|
|
HC USE OF SPEECH DEVICE SERVICE
|
Facility
|
OP
|
$473.16
|
|
|
Service Code
|
CPT 92609
|
| Hospital Charge Code |
44000003
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$112.38 |
| Max. Negotiated Rate |
$425.84 |
| Rate for Payer: Aetna Commercial |
$402.19
|
| Rate for Payer: Aetna Medicare |
$123.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$147.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$147.86
|
| Rate for Payer: BCBS Complete |
$189.26
|
| Rate for Payer: BCBS MAPPO |
$118.29
|
| Rate for Payer: BCBS Trust/PPO |
$388.98
|
| Rate for Payer: BCN Commercial |
$367.88
|
| Rate for Payer: BCN Medicare Advantage |
$118.29
|
| Rate for Payer: Cash Price |
$378.53
|
| Rate for Payer: Cofinity Commercial |
$406.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$378.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$118.29
|
| Rate for Payer: Healthscope Commercial |
$425.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$354.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$124.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$136.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$402.19
|
| Rate for Payer: Nomi Health Commercial |
$387.99
|
| Rate for Payer: PACE Senior Care Partners |
$112.38
|
| Rate for Payer: PACE SWMI |
$118.29
|
| Rate for Payer: PHP Commercial |
$402.19
|
| Rate for Payer: PHP Medicare Advantage |
$118.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$307.55
|
| Rate for Payer: Priority Health HMO/PPO |
$411.65
|
| Rate for Payer: Priority Health Medicare |
$119.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$317.02
|
| Rate for Payer: Railroad Medicare Medicare |
$118.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$416.38
|
| Rate for Payer: UHC Core |
$395.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$118.29
|
| Rate for Payer: UHC Exchange |
$118.29
|
| Rate for Payer: UHC Medicare Advantage |
$118.29
|
| Rate for Payer: VA VA |
$118.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$354.87
|
|
|
HC US EXTREMITY NONVASC LTD
|
Facility
|
OP
|
$687.01
|
|
|
Service Code
|
CPT 76882
|
| Hospital Charge Code |
40200038
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$76.88 |
| Max. Negotiated Rate |
$618.31 |
| Rate for Payer: Aetna Commercial |
$583.96
|
| Rate for Payer: Aetna Medicare |
$178.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$214.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$214.69
|
| Rate for Payer: BCBS Complete |
$80.73
|
| Rate for Payer: BCBS MAPPO |
$171.75
|
| Rate for Payer: BCBS Trust/PPO |
$564.79
|
| Rate for Payer: BCN Commercial |
$534.15
|
| Rate for Payer: BCN Medicare Advantage |
$171.75
|
| Rate for Payer: Cash Price |
$549.61
|
| Rate for Payer: Cash Price |
$549.61
|
| Rate for Payer: Cofinity Commercial |
$590.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$549.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$171.75
|
| Rate for Payer: Healthscope Commercial |
$618.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$515.26
|
| Rate for Payer: Mclaren Medicaid |
$76.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$180.34
|
| Rate for Payer: Meridian Medicaid |
$80.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$197.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$583.96
|
| Rate for Payer: Nomi Health Commercial |
$563.35
|
| Rate for Payer: PACE Senior Care Partners |
$163.16
|
| Rate for Payer: PACE SWMI |
$171.75
|
| Rate for Payer: PHP Commercial |
$583.96
|
| Rate for Payer: PHP Medicare Advantage |
$171.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$446.56
|
| Rate for Payer: Priority Health HMO/PPO |
$597.70
|
| Rate for Payer: Priority Health Medicare |
$173.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$460.30
|
| Rate for Payer: Railroad Medicare Medicare |
$171.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$604.57
|
| Rate for Payer: UHC Core |
$573.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$171.75
|
| Rate for Payer: UHC Exchange |
$171.75
|
| Rate for Payer: UHC Medicare Advantage |
$171.75
|
| Rate for Payer: UHCCP Medicaid |
$76.88
|
| Rate for Payer: VA VA |
$171.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$515.26
|
|
|
HC US EXTREMITY NONVASC LTD
|
Facility
|
IP
|
$687.01
|
|
|
Service Code
|
CPT 76882
|
| Hospital Charge Code |
40200038
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$446.56 |
| Max. Negotiated Rate |
$618.31 |
| Rate for Payer: Aetna Commercial |
$583.96
|
| Rate for Payer: BCBS Trust/PPO |
$560.81
|
| Rate for Payer: BCN Commercial |
$530.92
|
| Rate for Payer: Cash Price |
$549.61
|
| Rate for Payer: Cofinity Commercial |
$590.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$549.61
|
| Rate for Payer: Healthscope Commercial |
$618.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$515.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$583.96
|
| Rate for Payer: Nomi Health Commercial |
$563.35
|
| Rate for Payer: PHP Commercial |
$583.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$446.56
|
| Rate for Payer: Priority Health HMO/PPO |
$597.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$460.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$604.57
|
| Rate for Payer: UHC Core |
$573.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$515.26
|
|
|
HC US EXTREMITY NONVASCULAR COMP
|
Facility
|
IP
|
$687.01
|
|
|
Service Code
|
CPT 76881
|
| Hospital Charge Code |
40200037
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$446.56 |
| Max. Negotiated Rate |
$618.31 |
| Rate for Payer: Aetna Commercial |
$583.96
|
| Rate for Payer: BCBS Trust/PPO |
$560.81
|
| Rate for Payer: BCN Commercial |
$530.92
|
| Rate for Payer: Cash Price |
$549.61
|
| Rate for Payer: Cofinity Commercial |
$590.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$549.61
|
| Rate for Payer: Healthscope Commercial |
$618.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$515.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$583.96
|
| Rate for Payer: Nomi Health Commercial |
$563.35
|
| Rate for Payer: PHP Commercial |
$583.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$446.56
|
| Rate for Payer: Priority Health HMO/PPO |
$597.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$460.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$604.57
|
| Rate for Payer: UHC Core |
$573.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$515.26
|
|
|
HC US EXTREMITY NONVASCULAR COMP
|
Facility
|
OP
|
$687.01
|
|
|
Service Code
|
CPT 76881
|
| Hospital Charge Code |
40200037
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$76.88 |
| Max. Negotiated Rate |
$618.31 |
| Rate for Payer: Aetna Commercial |
$583.96
|
| Rate for Payer: Aetna Medicare |
$178.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$214.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$214.69
|
| Rate for Payer: BCBS Complete |
$80.73
|
| Rate for Payer: BCBS MAPPO |
$171.75
|
| Rate for Payer: BCBS Trust/PPO |
$564.79
|
| Rate for Payer: BCN Commercial |
$534.15
|
| Rate for Payer: BCN Medicare Advantage |
$171.75
|
| Rate for Payer: Cash Price |
$549.61
|
| Rate for Payer: Cash Price |
$549.61
|
| Rate for Payer: Cofinity Commercial |
$590.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$549.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$171.75
|
| Rate for Payer: Healthscope Commercial |
$618.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$515.26
|
| Rate for Payer: Mclaren Medicaid |
$76.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$180.34
|
| Rate for Payer: Meridian Medicaid |
$80.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$197.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$583.96
|
| Rate for Payer: Nomi Health Commercial |
$563.35
|
| Rate for Payer: PACE Senior Care Partners |
$163.16
|
| Rate for Payer: PACE SWMI |
$171.75
|
| Rate for Payer: PHP Commercial |
$583.96
|
| Rate for Payer: PHP Medicare Advantage |
$171.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$446.56
|
| Rate for Payer: Priority Health HMO/PPO |
$597.70
|
| Rate for Payer: Priority Health Medicare |
$173.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$460.30
|
| Rate for Payer: Railroad Medicare Medicare |
$171.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$604.57
|
| Rate for Payer: UHC Core |
$573.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$171.75
|
| Rate for Payer: UHC Exchange |
$171.75
|
| Rate for Payer: UHC Medicare Advantage |
$171.75
|
| Rate for Payer: UHCCP Medicaid |
$76.88
|
| Rate for Payer: VA VA |
$171.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$515.26
|
|
|
HC US EYE B MODE
|
Facility
|
IP
|
$1,212.48
|
|
|
Service Code
|
CPT 76512
|
| Hospital Charge Code |
40200004
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$788.11 |
| Max. Negotiated Rate |
$1,091.23 |
| Rate for Payer: Aetna Commercial |
$1,030.61
|
| Rate for Payer: BCBS Trust/PPO |
$989.75
|
| Rate for Payer: BCN Commercial |
$937.00
|
| Rate for Payer: Cash Price |
$969.98
|
| Rate for Payer: Cofinity Commercial |
$1,042.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$969.98
|
| Rate for Payer: Healthscope Commercial |
$1,091.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$909.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,030.61
|
| Rate for Payer: Nomi Health Commercial |
$994.23
|
| Rate for Payer: PHP Commercial |
$1,030.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$788.11
|
| Rate for Payer: Priority Health HMO/PPO |
$1,054.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$812.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,066.98
|
| Rate for Payer: UHC Core |
$1,012.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$909.36
|
|
|
HC US EYE B MODE
|
Facility
|
OP
|
$1,212.48
|
|
|
Service Code
|
CPT 76512
|
| Hospital Charge Code |
40200004
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$76.88 |
| Max. Negotiated Rate |
$1,091.23 |
| Rate for Payer: Aetna Commercial |
$1,030.61
|
| Rate for Payer: Aetna Medicare |
$315.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$378.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$378.90
|
| Rate for Payer: BCBS Complete |
$80.73
|
| Rate for Payer: BCBS MAPPO |
$303.12
|
| Rate for Payer: BCBS Trust/PPO |
$996.78
|
| Rate for Payer: BCN Commercial |
$942.70
|
| Rate for Payer: BCN Medicare Advantage |
$303.12
|
| Rate for Payer: Cash Price |
$969.98
|
| Rate for Payer: Cash Price |
$969.98
|
| Rate for Payer: Cofinity Commercial |
$1,042.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$969.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$303.12
|
| Rate for Payer: Healthscope Commercial |
$1,091.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$909.36
|
| Rate for Payer: Mclaren Medicaid |
$76.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$318.28
|
| Rate for Payer: Meridian Medicaid |
$80.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$348.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,030.61
|
| Rate for Payer: Nomi Health Commercial |
$994.23
|
| Rate for Payer: PACE Senior Care Partners |
$287.96
|
| Rate for Payer: PACE SWMI |
$303.12
|
| Rate for Payer: PHP Commercial |
$1,030.61
|
| Rate for Payer: PHP Medicare Advantage |
$303.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$788.11
|
| Rate for Payer: Priority Health HMO/PPO |
$1,054.86
|
| Rate for Payer: Priority Health Medicare |
$306.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$812.36
|
| Rate for Payer: Railroad Medicare Medicare |
$303.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,066.98
|
| Rate for Payer: UHC Core |
$1,012.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$303.12
|
| Rate for Payer: UHC Exchange |
$303.12
|
| Rate for Payer: UHC Medicare Advantage |
$303.12
|
| Rate for Payer: UHCCP Medicaid |
$76.88
|
| Rate for Payer: VA VA |
$303.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$909.36
|
|
|
HC US EYE B MODE BILAT
|
Facility
|
OP
|
$2,425.09
|
|
|
Service Code
|
CPT 76512
|
| Hospital Charge Code |
40200005
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$76.88 |
| Max. Negotiated Rate |
$2,182.58 |
| Rate for Payer: Aetna Commercial |
$2,061.33
|
| Rate for Payer: Aetna Medicare |
$630.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$757.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$757.84
|
| Rate for Payer: BCBS Complete |
$80.73
|
| Rate for Payer: BCBS MAPPO |
$606.27
|
| Rate for Payer: BCBS Trust/PPO |
$1,993.67
|
| Rate for Payer: BCN Commercial |
$1,885.51
|
| Rate for Payer: BCN Medicare Advantage |
$606.27
|
| Rate for Payer: Cash Price |
$1,940.07
|
| Rate for Payer: Cash Price |
$1,940.07
|
| Rate for Payer: Cofinity Commercial |
$2,085.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,940.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$606.27
|
| Rate for Payer: Healthscope Commercial |
$2,182.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,818.82
|
| Rate for Payer: Mclaren Medicaid |
$76.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$636.59
|
| Rate for Payer: Meridian Medicaid |
$80.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$697.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,061.33
|
| Rate for Payer: Nomi Health Commercial |
$1,988.57
|
| Rate for Payer: PACE Senior Care Partners |
$575.96
|
| Rate for Payer: PACE SWMI |
$606.27
|
| Rate for Payer: PHP Commercial |
$2,061.33
|
| Rate for Payer: PHP Medicare Advantage |
$606.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,576.31
|
| Rate for Payer: Priority Health HMO/PPO |
$2,109.83
|
| Rate for Payer: Priority Health Medicare |
$612.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,624.81
|
| Rate for Payer: Railroad Medicare Medicare |
$606.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,134.08
|
| Rate for Payer: UHC Core |
$2,024.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$606.27
|
| Rate for Payer: UHC Exchange |
$606.27
|
| Rate for Payer: UHC Medicare Advantage |
$606.27
|
| Rate for Payer: UHCCP Medicaid |
$76.88
|
| Rate for Payer: VA VA |
$606.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,818.82
|
|
|
HC US EYE B MODE BILAT
|
Facility
|
IP
|
$2,425.09
|
|
|
Service Code
|
CPT 76512
|
| Hospital Charge Code |
40200005
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,576.31 |
| Max. Negotiated Rate |
$2,182.58 |
| Rate for Payer: Aetna Commercial |
$2,061.33
|
| Rate for Payer: BCBS Trust/PPO |
$1,979.60
|
| Rate for Payer: BCN Commercial |
$1,874.11
|
| Rate for Payer: Cash Price |
$1,940.07
|
| Rate for Payer: Cofinity Commercial |
$2,085.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,940.07
|
| Rate for Payer: Healthscope Commercial |
$2,182.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,818.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,061.33
|
| Rate for Payer: Nomi Health Commercial |
$1,988.57
|
| Rate for Payer: PHP Commercial |
$2,061.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,576.31
|
| Rate for Payer: Priority Health HMO/PPO |
$2,109.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,624.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,134.08
|
| Rate for Payer: UHC Core |
$2,024.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,818.82
|
|
|
HC US FETAL FLUID DRAIN INCL GUID
|
Facility
|
OP
|
$862.48
|
|
|
Service Code
|
CPT 59074
|
| Hospital Charge Code |
36100088
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$204.84 |
| Max. Negotiated Rate |
$776.23 |
| Rate for Payer: Aetna Commercial |
$733.11
|
| Rate for Payer: Aetna Medicare |
$224.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$269.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$269.52
|
| Rate for Payer: BCBS Complete |
$230.94
|
| Rate for Payer: BCBS MAPPO |
$215.62
|
| Rate for Payer: BCBS Trust/PPO |
$709.04
|
| Rate for Payer: BCN Commercial |
$670.58
|
| Rate for Payer: BCN Medicare Advantage |
$215.62
|
| Rate for Payer: Cash Price |
$689.98
|
| Rate for Payer: Cash Price |
$689.98
|
| Rate for Payer: Cofinity Commercial |
$741.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$689.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$215.62
|
| Rate for Payer: Healthscope Commercial |
$776.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$646.86
|
| Rate for Payer: Mclaren Medicaid |
$219.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$226.40
|
| Rate for Payer: Meridian Medicaid |
$230.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$247.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$733.11
|
| Rate for Payer: Nomi Health Commercial |
$707.23
|
| Rate for Payer: PACE Senior Care Partners |
$204.84
|
| Rate for Payer: PACE SWMI |
$215.62
|
| Rate for Payer: PHP Commercial |
$733.11
|
| Rate for Payer: PHP Medicare Advantage |
$215.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$219.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$560.61
|
| Rate for Payer: Priority Health HMO/PPO |
$750.36
|
| Rate for Payer: Priority Health Medicare |
$217.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$577.86
|
| Rate for Payer: Railroad Medicare Medicare |
$215.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$758.98
|
| Rate for Payer: UHC Core |
$720.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$215.62
|
| Rate for Payer: UHC Exchange |
$215.62
|
| Rate for Payer: UHC Medicare Advantage |
$215.62
|
| Rate for Payer: UHCCP Medicaid |
$219.93
|
| Rate for Payer: VA VA |
$215.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$646.86
|
|
|
HC US FETAL FLUID DRAIN INCL GUID
|
Facility
|
IP
|
$862.48
|
|
|
Service Code
|
CPT 59074
|
| Hospital Charge Code |
36100088
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$560.61 |
| Max. Negotiated Rate |
$776.23 |
| Rate for Payer: Aetna Commercial |
$733.11
|
| Rate for Payer: BCBS Trust/PPO |
$704.04
|
| Rate for Payer: BCN Commercial |
$666.52
|
| Rate for Payer: Cash Price |
$689.98
|
| Rate for Payer: Cofinity Commercial |
$741.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$689.98
|
| Rate for Payer: Healthscope Commercial |
$776.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$646.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$733.11
|
| Rate for Payer: Nomi Health Commercial |
$707.23
|
| Rate for Payer: PHP Commercial |
$733.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$560.61
|
| Rate for Payer: Priority Health HMO/PPO |
$750.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$577.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$758.98
|
| Rate for Payer: UHC Core |
$720.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$646.86
|
|
|
HC US FETAL MCA DOPPLER VELOCIMETREY
|
Facility
|
OP
|
$291.84
|
|
|
Service Code
|
CPT 76821
|
| Hospital Charge Code |
40200029
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$69.31 |
| Max. Negotiated Rate |
$262.66 |
| Rate for Payer: Aetna Commercial |
$248.06
|
| Rate for Payer: Aetna Medicare |
$75.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$91.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$91.20
|
| Rate for Payer: BCBS Complete |
$80.73
|
| Rate for Payer: BCBS MAPPO |
$72.96
|
| Rate for Payer: BCBS Trust/PPO |
$239.92
|
| Rate for Payer: BCN Commercial |
$226.91
|
| Rate for Payer: BCN Medicare Advantage |
$72.96
|
| Rate for Payer: Cash Price |
$233.47
|
| Rate for Payer: Cash Price |
$233.47
|
| Rate for Payer: Cofinity Commercial |
$250.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$72.96
|
| Rate for Payer: Healthscope Commercial |
$262.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$218.88
|
| Rate for Payer: Mclaren Medicaid |
$76.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$76.61
|
| Rate for Payer: Meridian Medicaid |
$80.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$83.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$248.06
|
| Rate for Payer: Nomi Health Commercial |
$239.31
|
| Rate for Payer: PACE Senior Care Partners |
$69.31
|
| Rate for Payer: PACE SWMI |
$72.96
|
| Rate for Payer: PHP Commercial |
$248.06
|
| Rate for Payer: PHP Medicare Advantage |
$72.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.70
|
| Rate for Payer: Priority Health HMO/PPO |
$253.90
|
| Rate for Payer: Priority Health Medicare |
$73.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$195.53
|
| Rate for Payer: Railroad Medicare Medicare |
$72.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$256.82
|
| Rate for Payer: UHC Core |
$243.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$72.96
|
| Rate for Payer: UHC Exchange |
$72.96
|
| Rate for Payer: UHC Medicare Advantage |
$72.96
|
| Rate for Payer: UHCCP Medicaid |
$76.88
|
| Rate for Payer: VA VA |
$72.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$218.88
|
|
|
HC US FETAL MCA DOPPLER VELOCIMETREY
|
Facility
|
IP
|
$291.84
|
|
|
Service Code
|
CPT 76821
|
| Hospital Charge Code |
40200029
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$189.70 |
| Max. Negotiated Rate |
$262.66 |
| Rate for Payer: Aetna Commercial |
$248.06
|
| Rate for Payer: BCBS Trust/PPO |
$238.23
|
| Rate for Payer: BCN Commercial |
$225.53
|
| Rate for Payer: Cash Price |
$233.47
|
| Rate for Payer: Cofinity Commercial |
$250.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.47
|
| Rate for Payer: Healthscope Commercial |
$262.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$218.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$248.06
|
| Rate for Payer: Nomi Health Commercial |
$239.31
|
| Rate for Payer: PHP Commercial |
$248.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.70
|
| Rate for Payer: Priority Health HMO/PPO |
$253.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$195.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$256.82
|
| Rate for Payer: UHC Core |
$243.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$218.88
|
|
|
HC US FETAL UMBILICAL ART DOPPLER
|
Facility
|
IP
|
$291.84
|
|
|
Service Code
|
CPT 76820
|
| Hospital Charge Code |
40200028
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$189.70 |
| Max. Negotiated Rate |
$262.66 |
| Rate for Payer: Aetna Commercial |
$248.06
|
| Rate for Payer: BCBS Trust/PPO |
$238.23
|
| Rate for Payer: BCN Commercial |
$225.53
|
| Rate for Payer: Cash Price |
$233.47
|
| Rate for Payer: Cofinity Commercial |
$250.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.47
|
| Rate for Payer: Healthscope Commercial |
$262.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$218.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$248.06
|
| Rate for Payer: Nomi Health Commercial |
$239.31
|
| Rate for Payer: PHP Commercial |
$248.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.70
|
| Rate for Payer: Priority Health HMO/PPO |
$253.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$195.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$256.82
|
| Rate for Payer: UHC Core |
$243.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$218.88
|
|
|
HC US FETAL UMBILICAL ART DOPPLER
|
Facility
|
OP
|
$291.84
|
|
|
Service Code
|
CPT 76820
|
| Hospital Charge Code |
40200028
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$69.31 |
| Max. Negotiated Rate |
$262.66 |
| Rate for Payer: Aetna Commercial |
$248.06
|
| Rate for Payer: Aetna Medicare |
$75.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$91.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$91.20
|
| Rate for Payer: BCBS Complete |
$80.73
|
| Rate for Payer: BCBS MAPPO |
$72.96
|
| Rate for Payer: BCBS Trust/PPO |
$239.92
|
| Rate for Payer: BCN Commercial |
$226.91
|
| Rate for Payer: BCN Medicare Advantage |
$72.96
|
| Rate for Payer: Cash Price |
$233.47
|
| Rate for Payer: Cash Price |
$233.47
|
| Rate for Payer: Cofinity Commercial |
$250.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$72.96
|
| Rate for Payer: Healthscope Commercial |
$262.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$218.88
|
| Rate for Payer: Mclaren Medicaid |
$76.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$76.61
|
| Rate for Payer: Meridian Medicaid |
$80.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$83.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$248.06
|
| Rate for Payer: Nomi Health Commercial |
$239.31
|
| Rate for Payer: PACE Senior Care Partners |
$69.31
|
| Rate for Payer: PACE SWMI |
$72.96
|
| Rate for Payer: PHP Commercial |
$248.06
|
| Rate for Payer: PHP Medicare Advantage |
$72.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.70
|
| Rate for Payer: Priority Health HMO/PPO |
$253.90
|
| Rate for Payer: Priority Health Medicare |
$73.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$195.53
|
| Rate for Payer: Railroad Medicare Medicare |
$72.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$256.82
|
| Rate for Payer: UHC Core |
$243.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$72.96
|
| Rate for Payer: UHC Exchange |
$72.96
|
| Rate for Payer: UHC Medicare Advantage |
$72.96
|
| Rate for Payer: UHCCP Medicaid |
$76.88
|
| Rate for Payer: VA VA |
$72.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$218.88
|
|
|
HC US GUIDED INTERSTITIAL THERAPY
|
Facility
|
OP
|
$413.36
|
|
|
Service Code
|
CPT 76965
|
| Hospital Charge Code |
40200063
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$98.17 |
| Max. Negotiated Rate |
$372.02 |
| Rate for Payer: Aetna Commercial |
$351.36
|
| Rate for Payer: Aetna Medicare |
$107.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$129.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$129.18
|
| Rate for Payer: BCBS Complete |
$165.34
|
| Rate for Payer: BCBS MAPPO |
$103.34
|
| Rate for Payer: BCBS Trust/PPO |
$339.82
|
| Rate for Payer: BCN Commercial |
$321.39
|
| Rate for Payer: BCN Medicare Advantage |
$103.34
|
| Rate for Payer: Cash Price |
$330.69
|
| Rate for Payer: Cofinity Commercial |
$355.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$330.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.34
|
| Rate for Payer: Healthscope Commercial |
$372.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$310.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$108.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$118.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$351.36
|
| Rate for Payer: Nomi Health Commercial |
$338.96
|
| Rate for Payer: PACE Senior Care Partners |
$98.17
|
| Rate for Payer: PACE SWMI |
$103.34
|
| Rate for Payer: PHP Commercial |
$351.36
|
| Rate for Payer: PHP Medicare Advantage |
$103.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$268.68
|
| Rate for Payer: Priority Health HMO/PPO |
$359.62
|
| Rate for Payer: Priority Health Medicare |
$104.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$276.95
|
| Rate for Payer: Railroad Medicare Medicare |
$103.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$363.76
|
| Rate for Payer: UHC Core |
$345.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.34
|
| Rate for Payer: UHC Exchange |
$103.34
|
| Rate for Payer: UHC Medicare Advantage |
$103.34
|
| Rate for Payer: VA VA |
$103.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$310.02
|
|
|
HC US GUIDED INTERSTITIAL THERAPY
|
Facility
|
IP
|
$413.36
|
|
|
Service Code
|
CPT 76965
|
| Hospital Charge Code |
40200063
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$268.68 |
| Max. Negotiated Rate |
$372.02 |
| Rate for Payer: Aetna Commercial |
$351.36
|
| Rate for Payer: BCBS Trust/PPO |
$337.43
|
| Rate for Payer: BCN Commercial |
$319.44
|
| Rate for Payer: Cash Price |
$330.69
|
| Rate for Payer: Cofinity Commercial |
$355.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$330.69
|
| Rate for Payer: Healthscope Commercial |
$372.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$310.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$351.36
|
| Rate for Payer: Nomi Health Commercial |
$338.96
|
| Rate for Payer: PHP Commercial |
$351.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$268.68
|
| Rate for Payer: Priority Health HMO/PPO |
$359.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$276.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$363.76
|
| Rate for Payer: UHC Core |
$345.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$310.02
|
|
|
HC US GUIDE FOR NEEDLE PLACEMENT
|
Facility
|
IP
|
$643.95
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
40200045
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$418.57 |
| Max. Negotiated Rate |
$579.55 |
| Rate for Payer: Aetna Commercial |
$547.36
|
| Rate for Payer: BCBS Trust/PPO |
$525.66
|
| Rate for Payer: BCN Commercial |
$497.64
|
| Rate for Payer: Cash Price |
$515.16
|
| Rate for Payer: Cofinity Commercial |
$553.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$515.16
|
| Rate for Payer: Healthscope Commercial |
$579.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$482.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$547.36
|
| Rate for Payer: Nomi Health Commercial |
$528.04
|
| Rate for Payer: PHP Commercial |
$547.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$418.57
|
| Rate for Payer: Priority Health HMO/PPO |
$560.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$431.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$566.68
|
| Rate for Payer: UHC Core |
$537.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$482.96
|
|
|
HC US GUIDE FOR NEEDLE PLACEMENT
|
Facility
|
OP
|
$643.95
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
40200045
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$152.94 |
| Max. Negotiated Rate |
$579.55 |
| Rate for Payer: Aetna Commercial |
$547.36
|
| Rate for Payer: Aetna Medicare |
$167.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$201.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$201.23
|
| Rate for Payer: BCBS Complete |
$257.58
|
| Rate for Payer: BCBS MAPPO |
$160.99
|
| Rate for Payer: BCBS Trust/PPO |
$529.39
|
| Rate for Payer: BCN Commercial |
$500.67
|
| Rate for Payer: BCN Medicare Advantage |
$160.99
|
| Rate for Payer: Cash Price |
$515.16
|
| Rate for Payer: Cofinity Commercial |
$553.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$515.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$160.99
|
| Rate for Payer: Healthscope Commercial |
$579.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$482.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$169.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$185.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$547.36
|
| Rate for Payer: Nomi Health Commercial |
$528.04
|
| Rate for Payer: PACE Senior Care Partners |
$152.94
|
| Rate for Payer: PACE SWMI |
$160.99
|
| Rate for Payer: PHP Commercial |
$547.36
|
| Rate for Payer: PHP Medicare Advantage |
$160.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$418.57
|
| Rate for Payer: Priority Health HMO/PPO |
$560.24
|
| Rate for Payer: Priority Health Medicare |
$162.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$431.45
|
| Rate for Payer: Railroad Medicare Medicare |
$160.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$566.68
|
| Rate for Payer: UHC Core |
$537.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$160.99
|
| Rate for Payer: UHC Exchange |
$160.99
|
| Rate for Payer: UHC Medicare Advantage |
$160.99
|
| Rate for Payer: VA VA |
$160.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$482.96
|
|
|
HC US HYSTEROSONOGRAM
|
Facility
|
OP
|
$357.38
|
|
|
Service Code
|
CPT 76831
|
| Hospital Charge Code |
40200032
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$84.88 |
| Max. Negotiated Rate |
$321.64 |
| Rate for Payer: Aetna Commercial |
$303.77
|
| Rate for Payer: Aetna Medicare |
$92.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$111.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$111.68
|
| Rate for Payer: BCBS Complete |
$183.51
|
| Rate for Payer: BCBS MAPPO |
$89.34
|
| Rate for Payer: BCBS Trust/PPO |
$293.80
|
| Rate for Payer: BCN Commercial |
$277.86
|
| Rate for Payer: BCN Medicare Advantage |
$89.34
|
| Rate for Payer: Cash Price |
$285.90
|
| Rate for Payer: Cash Price |
$285.90
|
| Rate for Payer: Cofinity Commercial |
$307.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$285.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$89.34
|
| Rate for Payer: Healthscope Commercial |
$321.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$268.04
|
| Rate for Payer: Mclaren Medicaid |
$174.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$93.81
|
| Rate for Payer: Meridian Medicaid |
$183.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$102.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$303.77
|
| Rate for Payer: Nomi Health Commercial |
$293.05
|
| Rate for Payer: PACE Senior Care Partners |
$84.88
|
| Rate for Payer: PACE SWMI |
$89.34
|
| Rate for Payer: PHP Commercial |
$303.77
|
| Rate for Payer: PHP Medicare Advantage |
$89.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$174.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.30
|
| Rate for Payer: Priority Health HMO/PPO |
$310.92
|
| Rate for Payer: Priority Health Medicare |
$90.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$239.44
|
| Rate for Payer: Railroad Medicare Medicare |
$89.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$314.49
|
| Rate for Payer: UHC Core |
$298.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$89.34
|
| Rate for Payer: UHC Exchange |
$89.34
|
| Rate for Payer: UHC Medicare Advantage |
$89.34
|
| Rate for Payer: UHCCP Medicaid |
$174.76
|
| Rate for Payer: VA VA |
$89.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$268.04
|
|
|
HC US HYSTEROSONOGRAM
|
Facility
|
IP
|
$357.38
|
|
|
Service Code
|
CPT 76831
|
| Hospital Charge Code |
40200032
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$232.30 |
| Max. Negotiated Rate |
$321.64 |
| Rate for Payer: Aetna Commercial |
$303.77
|
| Rate for Payer: BCBS Trust/PPO |
$291.73
|
| Rate for Payer: BCN Commercial |
$276.18
|
| Rate for Payer: Cash Price |
$285.90
|
| Rate for Payer: Cofinity Commercial |
$307.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$285.90
|
| Rate for Payer: Healthscope Commercial |
$321.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$268.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$303.77
|
| Rate for Payer: Nomi Health Commercial |
$293.05
|
| Rate for Payer: PHP Commercial |
$303.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.30
|
| Rate for Payer: Priority Health HMO/PPO |
$310.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$239.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$314.49
|
| Rate for Payer: UHC Core |
$298.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$268.04
|
|
|
HC US INFANT HIPS W MANIPULATION
|
Facility
|
OP
|
$388.71
|
|
|
Service Code
|
CPT 76885
|
| Hospital Charge Code |
40200040
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$63.66 |
| Max. Negotiated Rate |
$349.84 |
| Rate for Payer: Aetna Commercial |
$330.40
|
| Rate for Payer: Aetna Medicare |
$101.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$121.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$121.47
|
| Rate for Payer: BCBS Complete |
$66.85
|
| Rate for Payer: BCBS MAPPO |
$97.18
|
| Rate for Payer: BCBS Trust/PPO |
$319.56
|
| Rate for Payer: BCN Commercial |
$302.22
|
| Rate for Payer: BCN Medicare Advantage |
$97.18
|
| Rate for Payer: Cash Price |
$310.97
|
| Rate for Payer: Cash Price |
$310.97
|
| Rate for Payer: Cofinity Commercial |
$334.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.18
|
| Rate for Payer: Healthscope Commercial |
$349.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$291.53
|
| Rate for Payer: Mclaren Medicaid |
$63.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$102.04
|
| Rate for Payer: Meridian Medicaid |
$66.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$111.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$330.40
|
| Rate for Payer: Nomi Health Commercial |
$318.74
|
| Rate for Payer: PACE Senior Care Partners |
$92.32
|
| Rate for Payer: PACE SWMI |
$97.18
|
| Rate for Payer: PHP Commercial |
$330.40
|
| Rate for Payer: PHP Medicare Advantage |
$97.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$63.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$252.66
|
| Rate for Payer: Priority Health HMO/PPO |
$338.18
|
| Rate for Payer: Priority Health Medicare |
$98.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$260.44
|
| Rate for Payer: Railroad Medicare Medicare |
$97.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$342.06
|
| Rate for Payer: UHC Core |
$324.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.18
|
| Rate for Payer: UHC Exchange |
$97.18
|
| Rate for Payer: UHC Medicare Advantage |
$97.18
|
| Rate for Payer: UHCCP Medicaid |
$63.66
|
| Rate for Payer: VA VA |
$97.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$291.53
|
|
|
HC US INFANT HIPS W MANIPULATION
|
Facility
|
IP
|
$388.71
|
|
|
Service Code
|
CPT 76885
|
| Hospital Charge Code |
40200040
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$252.66 |
| Max. Negotiated Rate |
$349.84 |
| Rate for Payer: Aetna Commercial |
$330.40
|
| Rate for Payer: BCBS Trust/PPO |
$317.30
|
| Rate for Payer: BCN Commercial |
$300.40
|
| Rate for Payer: Cash Price |
$310.97
|
| Rate for Payer: Cofinity Commercial |
$334.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.97
|
| Rate for Payer: Healthscope Commercial |
$349.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$291.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$330.40
|
| Rate for Payer: Nomi Health Commercial |
$318.74
|
| Rate for Payer: PHP Commercial |
$330.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$252.66
|
| Rate for Payer: Priority Health HMO/PPO |
$338.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$260.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$342.06
|
| Rate for Payer: UHC Core |
$324.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$291.53
|
|
|
HC US INFANT HIPS WO MANIPULATION
|
Facility
|
OP
|
$324.21
|
|
|
Service Code
|
CPT 76886
|
| Hospital Charge Code |
40200041
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$63.66 |
| Max. Negotiated Rate |
$291.79 |
| Rate for Payer: Aetna Commercial |
$275.58
|
| Rate for Payer: Aetna Medicare |
$84.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$101.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$101.32
|
| Rate for Payer: BCBS Complete |
$66.85
|
| Rate for Payer: BCBS MAPPO |
$81.05
|
| Rate for Payer: BCBS Trust/PPO |
$266.53
|
| Rate for Payer: BCN Commercial |
$252.07
|
| Rate for Payer: BCN Medicare Advantage |
$81.05
|
| Rate for Payer: Cash Price |
$259.37
|
| Rate for Payer: Cash Price |
$259.37
|
| Rate for Payer: Cofinity Commercial |
$278.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$259.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$81.05
|
| Rate for Payer: Healthscope Commercial |
$291.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$243.16
|
| Rate for Payer: Mclaren Medicaid |
$63.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$85.11
|
| Rate for Payer: Meridian Medicaid |
$66.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$93.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$275.58
|
| Rate for Payer: Nomi Health Commercial |
$265.85
|
| Rate for Payer: PACE Senior Care Partners |
$77.00
|
| Rate for Payer: PACE SWMI |
$81.05
|
| Rate for Payer: PHP Commercial |
$275.58
|
| Rate for Payer: PHP Medicare Advantage |
$81.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$63.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.74
|
| Rate for Payer: Priority Health HMO/PPO |
$282.06
|
| Rate for Payer: Priority Health Medicare |
$81.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$217.22
|
| Rate for Payer: Railroad Medicare Medicare |
$81.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$285.30
|
| Rate for Payer: UHC Core |
$270.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$81.05
|
| Rate for Payer: UHC Exchange |
$81.05
|
| Rate for Payer: UHC Medicare Advantage |
$81.05
|
| Rate for Payer: UHCCP Medicaid |
$63.66
|
| Rate for Payer: VA VA |
$81.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$243.16
|
|
