|
HC ECHO, 2D, DOPPLER, COLOR FLOW
|
Facility
|
OP
|
$1,969.00
|
|
|
Service Code
|
CPT 93306
|
| Hospital Charge Code |
48300001
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$192.86 |
| Max. Negotiated Rate |
$1,772.10 |
| Rate for Payer: Aetna American Axle |
$1,279.85
|
| Rate for Payer: Aetna Commercial |
$1,673.65
|
| Rate for Payer: Aetna Medicare |
$509.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,279.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$612.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$612.96
|
| Rate for Payer: BCBS Complete |
$281.67
|
| Rate for Payer: BCBS MAPPO |
$490.37
|
| Rate for Payer: BCBS Trust/PPO |
$645.12
|
| Rate for Payer: BCN Medicare Advantage |
$490.37
|
| Rate for Payer: Cash Price |
$1,575.20
|
| Rate for Payer: Cash Price |
$1,575.20
|
| Rate for Payer: Cash Price |
$1,575.20
|
| Rate for Payer: Cofinity Commercial |
$1,693.34
|
| Rate for Payer: Cofinity Commercial |
$1,378.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,575.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$490.37
|
| Rate for Payer: Healthscope Commercial |
$1,772.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,378.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,476.75
|
| Rate for Payer: Mclaren Medicaid |
$268.23
|
| Rate for Payer: Mclaren Medicare |
$490.37
|
| Rate for Payer: Meridian Medicaid |
$281.67
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$514.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$563.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,673.65
|
| Rate for Payer: PACE Medicare |
$465.85
|
| Rate for Payer: PACE SWMI |
$490.37
|
| Rate for Payer: PHP Commercial |
$1,673.65
|
| Rate for Payer: PHP Medicare Advantage |
$490.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$268.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,378.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,543.71
|
| Rate for Payer: Priority Health Medicare |
$490.37
|
| Rate for Payer: Priority Health Narrow Network |
$1,234.97
|
| Rate for Payer: Priority Health SBD |
$1,240.47
|
| Rate for Payer: Railroad Medicare Medicare |
$490.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$212.15
|
| Rate for Payer: UHC Core |
$816.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$490.37
|
| Rate for Payer: UHC Exchange |
$192.86
|
| Rate for Payer: UHC Medicare Advantage |
$505.08
|
| Rate for Payer: UMR Bronson Commercial |
$728.53
|
| Rate for Payer: VA VA |
$490.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,476.75
|
|
|
HC ECHO, 2D, DOPPLER, COLOR FLOW
|
Facility
|
IP
|
$1,969.00
|
|
|
Service Code
|
CPT 93306
|
| Hospital Charge Code |
48300001
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$866.36 |
| Max. Negotiated Rate |
$1,772.10 |
| Rate for Payer: Aetna American Axle |
$1,279.85
|
| Rate for Payer: Aetna Commercial |
$1,673.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,279.85
|
| Rate for Payer: Cash Price |
$1,575.20
|
| Rate for Payer: Cofinity Commercial |
$1,378.30
|
| Rate for Payer: Cofinity Commercial |
$1,693.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,575.20
|
| Rate for Payer: Healthscope Commercial |
$1,772.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,378.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,476.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,673.65
|
| Rate for Payer: PHP Commercial |
$1,673.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,378.30
|
| Rate for Payer: Priority Health SBD |
$1,240.47
|
| Rate for Payer: UMR Bronson Commercial |
$866.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,476.75
|
|
|
HC ECHO COMPLETE W/DEFINITY
|
Facility
|
OP
|
$1,969.00
|
|
|
Service Code
|
HCPCS C8929
|
| Hospital Charge Code |
48300003
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$389.31 |
| Max. Negotiated Rate |
$2,240.48 |
| Rate for Payer: Aetna American Axle |
$1,279.85
|
| Rate for Payer: Aetna Commercial |
$1,673.65
|
| Rate for Payer: Aetna Medicare |
$740.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,279.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$889.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$889.64
|
| Rate for Payer: BCBS Complete |
$408.81
|
| Rate for Payer: BCBS MAPPO |
$711.71
|
| Rate for Payer: BCBS Trust/PPO |
$888.23
|
| Rate for Payer: BCN Medicare Advantage |
$711.71
|
| Rate for Payer: Cash Price |
$1,575.20
|
| Rate for Payer: Cash Price |
$1,575.20
|
| Rate for Payer: Cash Price |
$1,575.20
|
| Rate for Payer: Cofinity Commercial |
$1,693.34
|
| Rate for Payer: Cofinity Commercial |
$1,378.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,575.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$711.71
|
| Rate for Payer: Healthscope Commercial |
$1,772.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,378.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,476.75
|
| Rate for Payer: Mclaren Medicaid |
$389.31
|
| Rate for Payer: Mclaren Medicare |
$711.71
|
| Rate for Payer: Meridian Medicaid |
$408.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$747.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$818.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,673.65
|
| Rate for Payer: PACE Medicare |
$676.12
|
| Rate for Payer: PACE SWMI |
$711.71
|
| Rate for Payer: PHP Commercial |
$1,673.65
|
| Rate for Payer: PHP Medicare Advantage |
$711.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$389.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,378.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,240.48
|
| Rate for Payer: Priority Health Medicare |
$711.71
|
| Rate for Payer: Priority Health Narrow Network |
$1,792.38
|
| Rate for Payer: Priority Health SBD |
$1,240.47
|
| Rate for Payer: Railroad Medicare Medicare |
$711.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,995.42
|
| Rate for Payer: UHC Core |
$816.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$711.71
|
| Rate for Payer: UHC Exchange |
$1,360.15
|
| Rate for Payer: UHC Medicare Advantage |
$733.06
|
| Rate for Payer: UMR Bronson Commercial |
$728.53
|
| Rate for Payer: VA VA |
$711.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,476.75
|
|
|
HC ECHO COMPLETE W/DEFINITY
|
Facility
|
IP
|
$1,969.00
|
|
|
Service Code
|
HCPCS C8929
|
| Hospital Charge Code |
48300003
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$866.36 |
| Max. Negotiated Rate |
$1,772.10 |
| Rate for Payer: Aetna American Axle |
$1,279.85
|
| Rate for Payer: Aetna Commercial |
$1,673.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,279.85
|
| Rate for Payer: Cash Price |
$1,575.20
|
| Rate for Payer: Cofinity Commercial |
$1,378.30
|
| Rate for Payer: Cofinity Commercial |
$1,693.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,575.20
|
| Rate for Payer: Healthscope Commercial |
$1,772.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,378.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,476.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,673.65
|
| Rate for Payer: PHP Commercial |
$1,673.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,378.30
|
| Rate for Payer: Priority Health SBD |
$1,240.47
|
| Rate for Payer: UMR Bronson Commercial |
$866.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,476.75
|
|
|
HC ECHO CONGENITAL
|
Facility
|
OP
|
$1,606.80
|
|
|
Service Code
|
CPT 93303
|
| Hospital Charge Code |
48000004
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$215.46 |
| Max. Negotiated Rate |
$1,543.71 |
| Rate for Payer: Aetna American Axle |
$1,044.42
|
| Rate for Payer: Aetna Commercial |
$1,365.78
|
| Rate for Payer: Aetna Medicare |
$509.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,044.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$612.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$612.96
|
| Rate for Payer: BCBS Complete |
$281.67
|
| Rate for Payer: BCBS MAPPO |
$490.37
|
| Rate for Payer: BCBS Trust/PPO |
$802.63
|
| Rate for Payer: BCN Medicare Advantage |
$490.37
|
| Rate for Payer: Cash Price |
$1,285.44
|
| Rate for Payer: Cash Price |
$1,285.44
|
| Rate for Payer: Cash Price |
$1,285.44
|
| Rate for Payer: Cofinity Commercial |
$1,124.76
|
| Rate for Payer: Cofinity Commercial |
$1,381.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,285.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$490.37
|
| Rate for Payer: Healthscope Commercial |
$1,446.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,124.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,205.10
|
| Rate for Payer: Mclaren Medicaid |
$268.23
|
| Rate for Payer: Mclaren Medicare |
$490.37
|
| Rate for Payer: Meridian Medicaid |
$281.67
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$514.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$563.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,365.78
|
| Rate for Payer: PACE Medicare |
$465.85
|
| Rate for Payer: PACE SWMI |
$490.37
|
| Rate for Payer: PHP Commercial |
$1,365.78
|
| Rate for Payer: PHP Medicare Advantage |
$490.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$268.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,124.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,543.71
|
| Rate for Payer: Priority Health Medicare |
$490.37
|
| Rate for Payer: Priority Health Narrow Network |
$1,234.97
|
| Rate for Payer: Priority Health SBD |
$1,012.28
|
| Rate for Payer: Railroad Medicare Medicare |
$490.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$237.01
|
| Rate for Payer: UHC Core |
$816.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$490.37
|
| Rate for Payer: UHC Exchange |
$215.46
|
| Rate for Payer: UHC Medicare Advantage |
$505.08
|
| Rate for Payer: UMR Bronson Commercial |
$594.52
|
| Rate for Payer: VA VA |
$490.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,205.10
|
|
|
HC ECHO CONGENITAL
|
Facility
|
IP
|
$1,606.80
|
|
|
Service Code
|
CPT 93303
|
| Hospital Charge Code |
48000004
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$706.99 |
| Max. Negotiated Rate |
$1,446.12 |
| Rate for Payer: Aetna American Axle |
$1,044.42
|
| Rate for Payer: Aetna Commercial |
$1,365.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,044.42
|
| Rate for Payer: Cash Price |
$1,285.44
|
| Rate for Payer: Cofinity Commercial |
$1,124.76
|
| Rate for Payer: Cofinity Commercial |
$1,381.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,285.44
|
| Rate for Payer: Healthscope Commercial |
$1,446.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,124.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,205.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,365.78
|
| Rate for Payer: PHP Commercial |
$1,365.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,124.76
|
| Rate for Payer: Priority Health SBD |
$1,012.28
|
| Rate for Payer: UMR Bronson Commercial |
$706.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,205.10
|
|
|
HC ECHO CONGENITAL LMTD
|
Facility
|
OP
|
$1,122.22
|
|
|
Service Code
|
CPT 93304
|
| Hospital Charge Code |
48000005
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$152.59 |
| Max. Negotiated Rate |
$1,543.71 |
| Rate for Payer: Aetna American Axle |
$729.44
|
| Rate for Payer: Aetna Commercial |
$953.89
|
| Rate for Payer: Aetna Medicare |
$509.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$729.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$612.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$612.96
|
| Rate for Payer: BCBS Complete |
$281.67
|
| Rate for Payer: BCBS MAPPO |
$490.37
|
| Rate for Payer: BCBS Trust/PPO |
$601.54
|
| Rate for Payer: BCN Medicare Advantage |
$490.37
|
| Rate for Payer: Cash Price |
$897.78
|
| Rate for Payer: Cash Price |
$897.78
|
| Rate for Payer: Cash Price |
$897.78
|
| Rate for Payer: Cofinity Commercial |
$785.55
|
| Rate for Payer: Cofinity Commercial |
$965.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$897.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$490.37
|
| Rate for Payer: Healthscope Commercial |
$1,010.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$785.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$841.66
|
| Rate for Payer: Mclaren Medicaid |
$268.23
|
| Rate for Payer: Mclaren Medicare |
$490.37
|
| Rate for Payer: Meridian Medicaid |
$281.67
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$514.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$563.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$953.89
|
| Rate for Payer: PACE Medicare |
$465.85
|
| Rate for Payer: PACE SWMI |
$490.37
|
| Rate for Payer: PHP Commercial |
$953.89
|
| Rate for Payer: PHP Medicare Advantage |
$490.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$268.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$785.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,543.71
|
| Rate for Payer: Priority Health Medicare |
$490.37
|
| Rate for Payer: Priority Health Narrow Network |
$1,234.97
|
| Rate for Payer: Priority Health SBD |
$707.00
|
| Rate for Payer: Railroad Medicare Medicare |
$490.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$167.85
|
| Rate for Payer: UHC Core |
$816.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$490.37
|
| Rate for Payer: UHC Exchange |
$152.59
|
| Rate for Payer: UHC Medicare Advantage |
$505.08
|
| Rate for Payer: UMR Bronson Commercial |
$415.22
|
| Rate for Payer: VA VA |
$490.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$841.66
|
|
|
HC ECHO CONGENITAL LMTD
|
Facility
|
IP
|
$1,122.22
|
|
|
Service Code
|
CPT 93304
|
| Hospital Charge Code |
48000005
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$493.78 |
| Max. Negotiated Rate |
$1,010.00 |
| Rate for Payer: Aetna American Axle |
$729.44
|
| Rate for Payer: Aetna Commercial |
$953.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$729.44
|
| Rate for Payer: Cash Price |
$897.78
|
| Rate for Payer: Cofinity Commercial |
$785.55
|
| Rate for Payer: Cofinity Commercial |
$965.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$897.78
|
| Rate for Payer: Healthscope Commercial |
$1,010.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$785.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$841.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$953.89
|
| Rate for Payer: PHP Commercial |
$953.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$785.55
|
| Rate for Payer: Priority Health SBD |
$707.00
|
| Rate for Payer: UMR Bronson Commercial |
$493.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$841.66
|
|
|
HC ECHO FETAL COMPLETE
|
Facility
|
OP
|
$947.89
|
|
|
Service Code
|
CPT 76825
|
| Hospital Charge Code |
40200030
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$257.04 |
| Max. Negotiated Rate |
$1,543.71 |
| Rate for Payer: Aetna American Axle |
$616.13
|
| Rate for Payer: Aetna Commercial |
$805.71
|
| Rate for Payer: Aetna Medicare |
$509.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$616.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$612.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$612.96
|
| Rate for Payer: BCBS Complete |
$281.67
|
| Rate for Payer: BCBS MAPPO |
$490.37
|
| Rate for Payer: BCBS Trust/PPO |
$350.32
|
| Rate for Payer: BCN Medicare Advantage |
$490.37
|
| Rate for Payer: Cash Price |
$758.31
|
| Rate for Payer: Cash Price |
$758.31
|
| Rate for Payer: Cofinity Commercial |
$663.52
|
| Rate for Payer: Cofinity Commercial |
$815.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$758.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$490.37
|
| Rate for Payer: Healthscope Commercial |
$853.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$663.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$710.92
|
| Rate for Payer: Mclaren Medicaid |
$268.23
|
| Rate for Payer: Mclaren Medicare |
$490.37
|
| Rate for Payer: Meridian Medicaid |
$281.67
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$514.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$563.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$805.71
|
| Rate for Payer: PACE Medicare |
$465.85
|
| Rate for Payer: PACE SWMI |
$490.37
|
| Rate for Payer: PHP Commercial |
$805.71
|
| Rate for Payer: PHP Medicare Advantage |
$490.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$268.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$663.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,543.71
|
| Rate for Payer: Priority Health Medicare |
$490.37
|
| Rate for Payer: Priority Health Narrow Network |
$1,234.97
|
| Rate for Payer: Priority Health SBD |
$597.17
|
| Rate for Payer: Railroad Medicare Medicare |
$490.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$282.74
|
| Rate for Payer: UHC Core |
$367.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$490.37
|
| Rate for Payer: UHC Exchange |
$257.04
|
| Rate for Payer: UHC Medicare Advantage |
$505.08
|
| Rate for Payer: UMR Bronson Commercial |
$350.72
|
| Rate for Payer: VA VA |
$490.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$710.92
|
|
|
HC ECHO FETAL COMPLETE
|
Facility
|
IP
|
$947.89
|
|
|
Service Code
|
CPT 76825
|
| Hospital Charge Code |
40200030
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$417.07 |
| Max. Negotiated Rate |
$853.10 |
| Rate for Payer: Aetna American Axle |
$616.13
|
| Rate for Payer: Aetna Commercial |
$805.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$616.13
|
| Rate for Payer: Cash Price |
$758.31
|
| Rate for Payer: Cofinity Commercial |
$663.52
|
| Rate for Payer: Cofinity Commercial |
$815.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$758.31
|
| Rate for Payer: Healthscope Commercial |
$853.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$663.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$710.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$805.71
|
| Rate for Payer: PHP Commercial |
$805.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$663.52
|
| Rate for Payer: Priority Health SBD |
$597.17
|
| Rate for Payer: UMR Bronson Commercial |
$417.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$710.92
|
|
|
HC ECHO FETAL FOLLOWUP/REPEAT
|
Facility
|
IP
|
$722.16
|
|
|
Service Code
|
CPT 76826
|
| Hospital Charge Code |
40200077
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$317.75 |
| Max. Negotiated Rate |
$649.94 |
| Rate for Payer: Aetna American Axle |
$469.40
|
| Rate for Payer: Aetna Commercial |
$613.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$469.40
|
| Rate for Payer: Cash Price |
$577.73
|
| Rate for Payer: Cofinity Commercial |
$505.51
|
| Rate for Payer: Cofinity Commercial |
$621.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$577.73
|
| Rate for Payer: Healthscope Commercial |
$649.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$505.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$541.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$613.84
|
| Rate for Payer: PHP Commercial |
$613.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$505.51
|
| Rate for Payer: Priority Health SBD |
$454.96
|
| Rate for Payer: UMR Bronson Commercial |
$317.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$541.62
|
|
|
HC ECHO FETAL FOLLOWUP/REPEAT
|
Facility
|
OP
|
$722.16
|
|
|
Service Code
|
CPT 76826
|
| Hospital Charge Code |
40200077
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$119.14 |
| Max. Negotiated Rate |
$685.66 |
| Rate for Payer: Aetna American Axle |
$469.40
|
| Rate for Payer: Aetna Commercial |
$613.84
|
| Rate for Payer: Aetna Medicare |
$226.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$469.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$272.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$272.26
|
| Rate for Payer: BCBS Complete |
$125.11
|
| Rate for Payer: BCBS MAPPO |
$217.81
|
| Rate for Payer: BCBS Trust/PPO |
$224.89
|
| Rate for Payer: BCN Medicare Advantage |
$217.81
|
| Rate for Payer: Cash Price |
$577.73
|
| Rate for Payer: Cash Price |
$577.73
|
| Rate for Payer: Cofinity Commercial |
$505.51
|
| Rate for Payer: Cofinity Commercial |
$621.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$577.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$217.81
|
| Rate for Payer: Healthscope Commercial |
$649.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$505.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$541.62
|
| Rate for Payer: Mclaren Medicaid |
$119.14
|
| Rate for Payer: Mclaren Medicare |
$217.81
|
| Rate for Payer: Meridian Medicaid |
$125.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$228.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$250.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$613.84
|
| Rate for Payer: PACE Medicare |
$206.92
|
| Rate for Payer: PACE SWMI |
$217.81
|
| Rate for Payer: PHP Commercial |
$613.84
|
| Rate for Payer: PHP Medicare Advantage |
$217.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$119.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$505.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$685.66
|
| Rate for Payer: Priority Health Medicare |
$217.81
|
| Rate for Payer: Priority Health Narrow Network |
$548.53
|
| Rate for Payer: Priority Health SBD |
$454.96
|
| Rate for Payer: Railroad Medicare Medicare |
$217.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$169.29
|
| Rate for Payer: UHC Core |
$367.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$217.81
|
| Rate for Payer: UHC Exchange |
$153.90
|
| Rate for Payer: UHC Medicare Advantage |
$224.34
|
| Rate for Payer: UMR Bronson Commercial |
$267.20
|
| Rate for Payer: VA VA |
$217.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$541.62
|
|
|
HC ECHO FETAL FOLLOW UP SPECTRAL
|
Facility
|
IP
|
$417.18
|
|
|
Service Code
|
CPT 76828
|
| Hospital Charge Code |
40200079
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$183.56 |
| Max. Negotiated Rate |
$375.46 |
| Rate for Payer: Aetna American Axle |
$271.17
|
| Rate for Payer: Aetna Commercial |
$354.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$271.17
|
| Rate for Payer: Cash Price |
$333.74
|
| Rate for Payer: Cofinity Commercial |
$292.03
|
| Rate for Payer: Cofinity Commercial |
$358.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$333.74
|
| Rate for Payer: Healthscope Commercial |
$375.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$292.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$312.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$354.60
|
| Rate for Payer: PHP Commercial |
$354.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$292.03
|
| Rate for Payer: Priority Health SBD |
$262.82
|
| Rate for Payer: UMR Bronson Commercial |
$183.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$312.88
|
|
|
HC ECHO FETAL FOLLOW UP SPECTRAL
|
Facility
|
OP
|
$417.18
|
|
|
Service Code
|
CPT 76828
|
| Hospital Charge Code |
40200079
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$43.71 |
| Max. Negotiated Rate |
$375.46 |
| Rate for Payer: Aetna American Axle |
$271.17
|
| Rate for Payer: Aetna Commercial |
$354.60
|
| Rate for Payer: Aetna Medicare |
$101.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$271.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.15
|
| Rate for Payer: BCBS Complete |
$56.13
|
| Rate for Payer: BCBS MAPPO |
$97.72
|
| Rate for Payer: BCBS Trust/PPO |
$43.71
|
| Rate for Payer: BCN Medicare Advantage |
$97.72
|
| Rate for Payer: Cash Price |
$333.74
|
| Rate for Payer: Cash Price |
$333.74
|
| Rate for Payer: Cofinity Commercial |
$358.77
|
| Rate for Payer: Cofinity Commercial |
$292.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$333.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.72
|
| Rate for Payer: Healthscope Commercial |
$375.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$292.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$312.88
|
| Rate for Payer: Mclaren Medicaid |
$53.45
|
| Rate for Payer: Mclaren Medicare |
$97.72
|
| Rate for Payer: Meridian Medicaid |
$56.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$354.60
|
| Rate for Payer: PACE Medicare |
$92.83
|
| Rate for Payer: PACE SWMI |
$97.72
|
| Rate for Payer: PHP Commercial |
$354.60
|
| Rate for Payer: PHP Medicare Advantage |
$97.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$292.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$307.65
|
| Rate for Payer: Priority Health Medicare |
$97.72
|
| Rate for Payer: Priority Health Narrow Network |
$246.12
|
| Rate for Payer: Priority Health SBD |
$262.82
|
| Rate for Payer: Railroad Medicare Medicare |
$97.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.59
|
| Rate for Payer: UHC Core |
$367.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.72
|
| Rate for Payer: UHC Exchange |
$47.81
|
| Rate for Payer: UHC Medicare Advantage |
$100.65
|
| Rate for Payer: UMR Bronson Commercial |
$154.36
|
| Rate for Payer: VA VA |
$97.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$312.88
|
|
|
HC ECHO FETAL SPECTRAL
|
Facility
|
IP
|
$687.48
|
|
|
Service Code
|
CPT 76827
|
| Hospital Charge Code |
40200078
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$302.49 |
| Max. Negotiated Rate |
$618.73 |
| Rate for Payer: Aetna American Axle |
$446.86
|
| Rate for Payer: Aetna Commercial |
$584.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$446.86
|
| Rate for Payer: Cash Price |
$549.98
|
| Rate for Payer: Cofinity Commercial |
$481.24
|
| Rate for Payer: Cofinity Commercial |
$591.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$549.98
|
| Rate for Payer: Healthscope Commercial |
$618.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$481.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$515.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$584.36
|
| Rate for Payer: PHP Commercial |
$584.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$481.24
|
| Rate for Payer: Priority Health SBD |
$433.11
|
| Rate for Payer: UMR Bronson Commercial |
$302.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$515.61
|
|
|
HC ECHO FETAL SPECTRAL
|
Facility
|
OP
|
$687.48
|
|
|
Service Code
|
CPT 76827
|
| Hospital Charge Code |
40200078
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$53.45 |
| Max. Negotiated Rate |
$618.73 |
| Rate for Payer: Aetna American Axle |
$446.86
|
| Rate for Payer: Aetna Commercial |
$584.36
|
| Rate for Payer: Aetna Medicare |
$101.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$446.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.15
|
| Rate for Payer: BCBS Complete |
$56.13
|
| Rate for Payer: BCBS MAPPO |
$97.72
|
| Rate for Payer: BCBS Trust/PPO |
$80.45
|
| Rate for Payer: BCN Medicare Advantage |
$97.72
|
| Rate for Payer: Cash Price |
$549.98
|
| Rate for Payer: Cash Price |
$549.98
|
| Rate for Payer: Cofinity Commercial |
$481.24
|
| Rate for Payer: Cofinity Commercial |
$591.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$549.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.72
|
| Rate for Payer: Healthscope Commercial |
$618.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$481.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$515.61
|
| Rate for Payer: Mclaren Medicaid |
$53.45
|
| Rate for Payer: Mclaren Medicare |
$97.72
|
| Rate for Payer: Meridian Medicaid |
$56.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$584.36
|
| Rate for Payer: PACE Medicare |
$92.83
|
| Rate for Payer: PACE SWMI |
$97.72
|
| Rate for Payer: PHP Commercial |
$584.36
|
| Rate for Payer: PHP Medicare Advantage |
$97.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$481.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$307.65
|
| Rate for Payer: Priority Health Medicare |
$97.72
|
| Rate for Payer: Priority Health Narrow Network |
$246.12
|
| Rate for Payer: Priority Health SBD |
$433.11
|
| Rate for Payer: Railroad Medicare Medicare |
$97.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.64
|
| Rate for Payer: UHC Core |
$367.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.72
|
| Rate for Payer: UHC Exchange |
$68.76
|
| Rate for Payer: UHC Medicare Advantage |
$100.65
|
| Rate for Payer: UMR Bronson Commercial |
$254.37
|
| Rate for Payer: VA VA |
$97.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$515.61
|
|
|
HC ECHO LIMITED W/DEFINITY
|
Facility
|
IP
|
$903.77
|
|
|
Service Code
|
HCPCS C8924
|
| Hospital Charge Code |
48300007
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$397.66 |
| Max. Negotiated Rate |
$813.39 |
| Rate for Payer: Aetna American Axle |
$587.45
|
| Rate for Payer: Aetna Commercial |
$768.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$587.45
|
| Rate for Payer: Cash Price |
$723.02
|
| Rate for Payer: Cofinity Commercial |
$632.64
|
| Rate for Payer: Cofinity Commercial |
$777.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$723.02
|
| Rate for Payer: Healthscope Commercial |
$813.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$632.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$677.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$768.20
|
| Rate for Payer: PHP Commercial |
$768.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$632.64
|
| Rate for Payer: Priority Health SBD |
$569.38
|
| Rate for Payer: UMR Bronson Commercial |
$397.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$677.83
|
|
|
HC ECHO LIMITED W/DEFINITY
|
Facility
|
OP
|
$903.77
|
|
|
Service Code
|
HCPCS C8924
|
| Hospital Charge Code |
48300007
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$186.99 |
| Max. Negotiated Rate |
$1,076.13 |
| Rate for Payer: Aetna American Axle |
$587.45
|
| Rate for Payer: Aetna Commercial |
$768.20
|
| Rate for Payer: Aetna Medicare |
$355.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$587.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$427.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$427.30
|
| Rate for Payer: BCBS Complete |
$196.35
|
| Rate for Payer: BCBS MAPPO |
$341.84
|
| Rate for Payer: BCBS Trust/PPO |
$441.78
|
| Rate for Payer: BCN Medicare Advantage |
$341.84
|
| Rate for Payer: Cash Price |
$723.02
|
| Rate for Payer: Cash Price |
$723.02
|
| Rate for Payer: Cash Price |
$723.02
|
| Rate for Payer: Cofinity Commercial |
$777.24
|
| Rate for Payer: Cofinity Commercial |
$632.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$723.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$341.84
|
| Rate for Payer: Healthscope Commercial |
$813.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$632.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$677.83
|
| Rate for Payer: Mclaren Medicaid |
$186.99
|
| Rate for Payer: Mclaren Medicare |
$341.84
|
| Rate for Payer: Meridian Medicaid |
$196.35
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$358.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$393.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$768.20
|
| Rate for Payer: PACE Medicare |
$324.75
|
| Rate for Payer: PACE SWMI |
$341.84
|
| Rate for Payer: PHP Commercial |
$768.20
|
| Rate for Payer: PHP Medicare Advantage |
$341.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$186.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$632.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,076.13
|
| Rate for Payer: Priority Health Medicare |
$341.84
|
| Rate for Payer: Priority Health Narrow Network |
$860.90
|
| Rate for Payer: Priority Health SBD |
$569.38
|
| Rate for Payer: Railroad Medicare Medicare |
$341.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$958.42
|
| Rate for Payer: UHC Core |
$816.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$341.84
|
| Rate for Payer: UHC Exchange |
$653.29
|
| Rate for Payer: UHC Medicare Advantage |
$352.10
|
| Rate for Payer: UMR Bronson Commercial |
$334.39
|
| Rate for Payer: VA VA |
$341.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$677.83
|
|
|
HC ECHO/STRESS W DEFINITY.
|
Facility
|
OP
|
$1,458.97
|
|
|
Service Code
|
HCPCS C8928
|
| Hospital Charge Code |
48300008
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$389.31 |
| Max. Negotiated Rate |
$2,240.48 |
| Rate for Payer: Aetna American Axle |
$948.33
|
| Rate for Payer: Aetna Commercial |
$1,240.12
|
| Rate for Payer: Aetna Medicare |
$740.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$948.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$889.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$889.64
|
| Rate for Payer: BCBS Complete |
$408.81
|
| Rate for Payer: BCBS MAPPO |
$711.71
|
| Rate for Payer: BCBS Trust/PPO |
$888.23
|
| Rate for Payer: BCN Medicare Advantage |
$711.71
|
| Rate for Payer: Cash Price |
$1,167.18
|
| Rate for Payer: Cash Price |
$1,167.18
|
| Rate for Payer: Cash Price |
$1,167.18
|
| Rate for Payer: Cofinity Commercial |
$1,254.71
|
| Rate for Payer: Cofinity Commercial |
$1,021.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,167.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$711.71
|
| Rate for Payer: Healthscope Commercial |
$1,313.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,021.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,094.23
|
| Rate for Payer: Mclaren Medicaid |
$389.31
|
| Rate for Payer: Mclaren Medicare |
$711.71
|
| Rate for Payer: Meridian Medicaid |
$408.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$747.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$818.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,240.12
|
| Rate for Payer: PACE Medicare |
$676.12
|
| Rate for Payer: PACE SWMI |
$711.71
|
| Rate for Payer: PHP Commercial |
$1,240.12
|
| Rate for Payer: PHP Medicare Advantage |
$711.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$389.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,021.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,240.48
|
| Rate for Payer: Priority Health Medicare |
$711.71
|
| Rate for Payer: Priority Health Narrow Network |
$1,792.38
|
| Rate for Payer: Priority Health SBD |
$919.15
|
| Rate for Payer: Railroad Medicare Medicare |
$711.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,995.42
|
| Rate for Payer: UHC Core |
$816.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$711.71
|
| Rate for Payer: UHC Exchange |
$1,360.15
|
| Rate for Payer: UHC Medicare Advantage |
$733.06
|
| Rate for Payer: UMR Bronson Commercial |
$539.82
|
| Rate for Payer: VA VA |
$711.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,094.23
|
|
|
HC ECHO/STRESS W DEFINITY.
|
Facility
|
IP
|
$1,458.97
|
|
|
Service Code
|
HCPCS C8928
|
| Hospital Charge Code |
48300008
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$641.95 |
| Max. Negotiated Rate |
$1,313.07 |
| Rate for Payer: Aetna American Axle |
$948.33
|
| Rate for Payer: Aetna Commercial |
$1,240.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$948.33
|
| Rate for Payer: Cash Price |
$1,167.18
|
| Rate for Payer: Cofinity Commercial |
$1,254.71
|
| Rate for Payer: Cofinity Commercial |
$1,021.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,167.18
|
| Rate for Payer: Healthscope Commercial |
$1,313.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,021.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,094.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,240.12
|
| Rate for Payer: PHP Commercial |
$1,240.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,021.28
|
| Rate for Payer: Priority Health SBD |
$919.15
|
| Rate for Payer: UMR Bronson Commercial |
$641.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,094.23
|
|
|
HC ECMO OR VAD HOURLY CHRG
|
Facility
|
IP
|
$450.00
|
|
| Hospital Charge Code |
27000097
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$198.00 |
| Max. Negotiated Rate |
$405.00 |
| Rate for Payer: Aetna American Axle |
$292.50
|
| Rate for Payer: Aetna Commercial |
$382.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$292.50
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cofinity Commercial |
$315.00
|
| Rate for Payer: Cofinity Commercial |
$387.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.00
|
| Rate for Payer: Healthscope Commercial |
$405.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$315.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$337.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$382.50
|
| Rate for Payer: PHP Commercial |
$382.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.00
|
| Rate for Payer: Priority Health SBD |
$283.50
|
| Rate for Payer: UMR Bronson Commercial |
$198.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$337.50
|
|
|
HC ECMO OR VAD HOURLY CHRG
|
Facility
|
OP
|
$450.00
|
|
| Hospital Charge Code |
27000097
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$166.50 |
| Max. Negotiated Rate |
$405.00 |
| Rate for Payer: Aetna American Axle |
$292.50
|
| Rate for Payer: Aetna Commercial |
$382.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$292.50
|
| Rate for Payer: BCBS Complete |
$180.00
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cofinity Commercial |
$315.00
|
| Rate for Payer: Cofinity Commercial |
$387.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.00
|
| Rate for Payer: Healthscope Commercial |
$405.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$315.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$337.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$382.50
|
| Rate for Payer: PHP Commercial |
$382.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.00
|
| Rate for Payer: Priority Health SBD |
$283.50
|
| Rate for Payer: UMR Bronson Commercial |
$166.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$337.50
|
|
|
HC ECMO OR VAD SUPPT SETUP
|
Facility
|
IP
|
$3,125.00
|
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,375.00 |
| Max. Negotiated Rate |
$2,812.50 |
| Rate for Payer: Aetna American Axle |
$2,031.25
|
| Rate for Payer: Aetna Commercial |
$2,656.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,031.25
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cofinity Commercial |
$2,187.50
|
| Rate for Payer: Cofinity Commercial |
$2,687.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,500.00
|
| Rate for Payer: Healthscope Commercial |
$2,812.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,187.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,343.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,656.25
|
| Rate for Payer: PHP Commercial |
$2,656.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,187.50
|
| Rate for Payer: Priority Health SBD |
$1,968.75
|
| Rate for Payer: UMR Bronson Commercial |
$1,375.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,343.75
|
|
|
HC ECMO OR VAD SUPPT SETUP
|
Facility
|
OP
|
$3,125.00
|
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,156.25 |
| Max. Negotiated Rate |
$2,812.50 |
| Rate for Payer: Aetna American Axle |
$2,031.25
|
| Rate for Payer: Aetna Commercial |
$2,656.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,031.25
|
| Rate for Payer: BCBS Complete |
$1,250.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cofinity Commercial |
$2,187.50
|
| Rate for Payer: Cofinity Commercial |
$2,687.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,500.00
|
| Rate for Payer: Healthscope Commercial |
$2,812.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,187.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,343.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,656.25
|
| Rate for Payer: PHP Commercial |
$2,656.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,187.50
|
| Rate for Payer: Priority Health SBD |
$1,968.75
|
| Rate for Payer: UMR Bronson Commercial |
$1,156.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,343.75
|
|
|
HC EEG AWAKE & ASLEEP
|
Facility
|
IP
|
$2,436.23
|
|
|
Service Code
|
CPT 95819
|
| Hospital Charge Code |
74000006
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,071.94 |
| Max. Negotiated Rate |
$2,192.61 |
| Rate for Payer: Aetna American Axle |
$1,583.55
|
| Rate for Payer: Aetna Commercial |
$2,070.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,583.55
|
| Rate for Payer: Cash Price |
$1,948.98
|
| Rate for Payer: Cofinity Commercial |
$1,705.36
|
| Rate for Payer: Cofinity Commercial |
$2,095.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,948.98
|
| Rate for Payer: Healthscope Commercial |
$2,192.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,705.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,827.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,070.80
|
| Rate for Payer: PHP Commercial |
$2,070.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,705.36
|
| Rate for Payer: Priority Health SBD |
$1,534.82
|
| Rate for Payer: UMR Bronson Commercial |
$1,071.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,827.17
|
|
