|
HC EBV ANTIBODY PANEL CMPT
|
Facility
|
OP
|
$32.48
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
30200508
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.49 |
| Max. Negotiated Rate |
$29.23 |
| Rate for Payer: Aetna American Axle |
$21.11
|
| Rate for Payer: Aetna Commercial |
$27.61
|
| Rate for Payer: Aetna Medicare |
$18.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.68
|
| Rate for Payer: BCBS Complete |
$9.96
|
| Rate for Payer: BCBS MAPPO |
$18.14
|
| Rate for Payer: BCBS Trust/PPO |
$20.98
|
| Rate for Payer: BCN Commercial |
$20.98
|
| Rate for Payer: BCN Medicare Advantage |
$18.14
|
| Rate for Payer: Cash Price |
$25.98
|
| Rate for Payer: Cash Price |
$25.98
|
| Rate for Payer: Cofinity Advantage |
$22.74
|
| Rate for Payer: Cofinity Commercial |
$27.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.14
|
| Rate for Payer: Healthscope Commercial |
$29.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.36
|
| Rate for Payer: Mclaren Medicaid |
$18.14
|
| Rate for Payer: Mclaren Medicare |
$18.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.05
|
| Rate for Payer: Meridian Medicaid |
$19.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.61
|
| Rate for Payer: Nomi Health Commercial |
$27.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.36
|
| Rate for Payer: PACE Medicare |
$17.23
|
| Rate for Payer: PACE SWMI |
$18.14
|
| Rate for Payer: PHP Commercial |
$27.61
|
| Rate for Payer: PHP Medicare Advantage |
$18.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$18.14
|
| Rate for Payer: Priority Health Medicare |
$18.14
|
| Rate for Payer: Priority Health SBD |
$20.46
|
| Rate for Payer: Priority Health Tiered Network |
$14.51
|
| Rate for Payer: Railroad Medicare Medicare |
$18.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.21
|
| Rate for Payer: UHC Core |
$27.21
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18.14
|
| Rate for Payer: UHC Exchange |
$27.21
|
| Rate for Payer: UHC Medicaid |
$9.49
|
| Rate for Payer: UHCCP Medicaid |
$9.49
|
| Rate for Payer: UMR Bronson Commercial |
$12.02
|
| Rate for Payer: VA VA |
$18.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.36
|
|
|
HC EBV ANTIBODY PANEL, S
|
Facility
|
OP
|
$37.76
|
|
|
Service Code
|
CPT 86664
|
| Hospital Charge Code |
30200507
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$33.98 |
| Rate for Payer: Aetna American Axle |
$24.54
|
| Rate for Payer: Aetna Commercial |
$32.10
|
| Rate for Payer: Aetna Medicare |
$15.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.11
|
| Rate for Payer: BCBS Complete |
$8.40
|
| Rate for Payer: BCBS MAPPO |
$15.29
|
| Rate for Payer: BCBS Trust/PPO |
$17.68
|
| Rate for Payer: BCN Commercial |
$17.68
|
| Rate for Payer: BCN Medicare Advantage |
$15.29
|
| Rate for Payer: Cash Price |
$30.21
|
| Rate for Payer: Cash Price |
$30.21
|
| Rate for Payer: Cofinity Advantage |
$26.43
|
| Rate for Payer: Cofinity Commercial |
$32.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.29
|
| Rate for Payer: Healthscope Commercial |
$33.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.32
|
| Rate for Payer: Mclaren Medicaid |
$15.29
|
| Rate for Payer: Mclaren Medicare |
$15.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.05
|
| Rate for Payer: Meridian Medicaid |
$16.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.58
|
| Rate for Payer: Molina Medicare/Medicaid |
$16.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.10
|
| Rate for Payer: Nomi Health Commercial |
$22.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.32
|
| Rate for Payer: PACE Medicare |
$14.53
|
| Rate for Payer: PACE SWMI |
$15.29
|
| Rate for Payer: PHP Commercial |
$32.10
|
| Rate for Payer: PHP Medicare Advantage |
$15.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$15.29
|
| Rate for Payer: Priority Health Medicare |
$15.29
|
| Rate for Payer: Priority Health SBD |
$23.79
|
| Rate for Payer: Priority Health Tiered Network |
$12.23
|
| Rate for Payer: Railroad Medicare Medicare |
$15.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.94
|
| Rate for Payer: UHC Core |
$22.94
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$15.29
|
| Rate for Payer: UHC Exchange |
$22.94
|
| Rate for Payer: UHC Medicaid |
$8.00
|
| Rate for Payer: UHCCP Medicaid |
$8.00
|
| Rate for Payer: UMR Bronson Commercial |
$13.97
|
| Rate for Payer: VA VA |
$15.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.32
|
|
|
HC EBV ANTIBODY PANEL, S
|
Facility
|
IP
|
$37.76
|
|
|
Service Code
|
CPT 86664
|
| Hospital Charge Code |
30200507
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.61 |
| Max. Negotiated Rate |
$33.98 |
| Rate for Payer: Aetna American Axle |
$24.54
|
| Rate for Payer: Aetna Commercial |
$32.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.54
|
| Rate for Payer: Cash Price |
$30.21
|
| Rate for Payer: Cofinity Advantage |
$26.43
|
| Rate for Payer: Cofinity Commercial |
$32.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.21
|
| Rate for Payer: Healthscope Commercial |
$33.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.32
|
| Rate for Payer: PHP Commercial |
$32.10
|
| Rate for Payer: Priority Health SBD |
$23.79
|
| Rate for Payer: UMR Bronson Commercial |
$16.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.32
|
|
|
HC EBV HETEROPHILE AB
|
Facility
|
OP
|
$38.20
|
|
|
Service Code
|
CPT 86309
|
| Hospital Charge Code |
30000169
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.38 |
| Max. Negotiated Rate |
$34.38 |
| Rate for Payer: Aetna American Axle |
$24.83
|
| Rate for Payer: Aetna Commercial |
$32.47
|
| Rate for Payer: Aetna Medicare |
$6.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.09
|
| Rate for Payer: BCBS Complete |
$3.55
|
| Rate for Payer: BCBS MAPPO |
$6.47
|
| Rate for Payer: BCBS Trust/PPO |
$7.48
|
| Rate for Payer: BCN Commercial |
$7.48
|
| Rate for Payer: BCN Medicare Advantage |
$6.47
|
| Rate for Payer: Cash Price |
$30.56
|
| Rate for Payer: Cash Price |
$30.56
|
| Rate for Payer: Cofinity Advantage |
$26.74
|
| Rate for Payer: Cofinity Commercial |
$32.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.47
|
| Rate for Payer: Healthscope Commercial |
$34.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.65
|
| Rate for Payer: Mclaren Medicaid |
$6.47
|
| Rate for Payer: Mclaren Medicare |
$6.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.79
|
| Rate for Payer: Meridian Medicaid |
$6.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.47
|
| Rate for Payer: Nomi Health Commercial |
$9.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.65
|
| Rate for Payer: PACE Medicare |
$6.15
|
| Rate for Payer: PACE SWMI |
$6.47
|
| Rate for Payer: PHP Commercial |
$32.47
|
| Rate for Payer: PHP Medicare Advantage |
$6.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6.47
|
| Rate for Payer: Priority Health Medicare |
$6.47
|
| Rate for Payer: Priority Health SBD |
$24.07
|
| Rate for Payer: Priority Health Tiered Network |
$5.18
|
| Rate for Payer: Railroad Medicare Medicare |
$6.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.71
|
| Rate for Payer: UHC Core |
$9.71
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6.47
|
| Rate for Payer: UHC Exchange |
$9.71
|
| Rate for Payer: UHC Medicaid |
$3.38
|
| Rate for Payer: UHCCP Medicaid |
$3.38
|
| Rate for Payer: UMR Bronson Commercial |
$14.13
|
| Rate for Payer: VA VA |
$6.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.65
|
|
|
HC EBV HETEROPHILE AB
|
Facility
|
IP
|
$38.20
|
|
|
Service Code
|
CPT 86309
|
| Hospital Charge Code |
30000169
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.81 |
| Max. Negotiated Rate |
$34.38 |
| Rate for Payer: Aetna American Axle |
$24.83
|
| Rate for Payer: Aetna Commercial |
$32.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.83
|
| Rate for Payer: Cash Price |
$30.56
|
| Rate for Payer: Cofinity Advantage |
$26.74
|
| Rate for Payer: Cofinity Commercial |
$32.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.56
|
| Rate for Payer: Healthscope Commercial |
$34.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.65
|
| Rate for Payer: PHP Commercial |
$32.47
|
| Rate for Payer: Priority Health SBD |
$24.07
|
| Rate for Payer: UMR Bronson Commercial |
$16.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.65
|
|
|
HC ECG 1-3 LEADS TRACING ONLY
|
Facility
|
IP
|
$53.06
|
|
|
Service Code
|
CPT 93041
|
| Hospital Charge Code |
73000003
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$23.35 |
| Max. Negotiated Rate |
$47.75 |
| Rate for Payer: Aetna American Axle |
$34.49
|
| Rate for Payer: Aetna Commercial |
$45.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.49
|
| Rate for Payer: Cash Price |
$42.45
|
| Rate for Payer: Cofinity Advantage |
$37.14
|
| Rate for Payer: Cofinity Commercial |
$45.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.45
|
| Rate for Payer: Healthscope Commercial |
$47.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.80
|
| Rate for Payer: PHP Commercial |
$45.10
|
| Rate for Payer: Priority Health SBD |
$33.43
|
| Rate for Payer: UMR Bronson Commercial |
$23.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.80
|
|
|
HC ECG 1-3 LEADS TRACING ONLY
|
Facility
|
OP
|
$53.06
|
|
|
Service Code
|
CPT 93041
|
| Hospital Charge Code |
73000003
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$19.63 |
| Max. Negotiated Rate |
$190.09 |
| Rate for Payer: Aetna American Axle |
$34.49
|
| Rate for Payer: Aetna Commercial |
$45.10
|
| Rate for Payer: Aetna Medicare |
$61.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$73.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$73.47
|
| Rate for Payer: BCBS Complete |
$32.28
|
| Rate for Payer: BCBS MAPPO |
$58.78
|
| Rate for Payer: BCBS Trust/PPO |
$26.77
|
| Rate for Payer: BCN Commercial |
$26.77
|
| Rate for Payer: BCN Medicare Advantage |
$58.78
|
| Rate for Payer: Cash Price |
$42.45
|
| Rate for Payer: Cash Price |
$42.45
|
| Rate for Payer: Cofinity Advantage |
$37.14
|
| Rate for Payer: Cofinity Commercial |
$45.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.78
|
| Rate for Payer: Healthscope Commercial |
$47.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.80
|
| Rate for Payer: Mclaren Medicaid |
$58.78
|
| Rate for Payer: Mclaren Medicare |
$58.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.72
|
| Rate for Payer: Meridian Medicaid |
$61.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$67.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$64.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.10
|
| Rate for Payer: Nomi Health Commercial |
$176.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.80
|
| Rate for Payer: PACE Medicare |
$55.84
|
| Rate for Payer: PACE SWMI |
$58.78
|
| Rate for Payer: PHP Commercial |
$45.10
|
| Rate for Payer: PHP Medicare Advantage |
$58.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$190.09
|
| Rate for Payer: Priority Health Medicare |
$58.78
|
| Rate for Payer: Priority Health SBD |
$33.43
|
| Rate for Payer: Priority Health Tiered Network |
$152.07
|
| Rate for Payer: Railroad Medicare Medicare |
$58.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.49
|
| Rate for Payer: UHC Core |
$27.64
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$58.78
|
| Rate for Payer: UHC Exchange |
$20.85
|
| Rate for Payer: UHC Medicaid |
$30.74
|
| Rate for Payer: UHCCP Medicaid |
$30.74
|
| Rate for Payer: UMR Bronson Commercial |
$19.63
|
| Rate for Payer: VA VA |
$58.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.80
|
|
|
HC ECHO, 2D, DOPPLER, COLOR FLOW
|
Facility
|
OP
|
$2,048.55
|
|
|
Service Code
|
CPT 93306
|
| Hospital Charge Code |
48300001
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$284.75 |
| Max. Negotiated Rate |
$1,843.69 |
| Rate for Payer: Aetna American Axle |
$1,331.56
|
| Rate for Payer: Aetna Commercial |
$1,741.27
|
| Rate for Payer: Aetna Medicare |
$566.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,331.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$680.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$680.56
|
| Rate for Payer: BCBS Complete |
$299.01
|
| Rate for Payer: BCBS MAPPO |
$544.45
|
| Rate for Payer: BCBS Trust/PPO |
$533.98
|
| Rate for Payer: BCN Commercial |
$533.98
|
| Rate for Payer: BCN Medicare Advantage |
$544.45
|
| Rate for Payer: Cash Price |
$1,638.84
|
| Rate for Payer: Cash Price |
$1,638.84
|
| Rate for Payer: Cofinity Advantage |
$1,433.98
|
| Rate for Payer: Cofinity Commercial |
$1,761.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,638.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$544.45
|
| Rate for Payer: Healthscope Commercial |
$1,843.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,433.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,536.41
|
| Rate for Payer: Mclaren Medicaid |
$544.45
|
| Rate for Payer: Mclaren Medicare |
$544.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$571.67
|
| Rate for Payer: Meridian Medicaid |
$571.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$626.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$598.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,741.27
|
| Rate for Payer: Nomi Health Commercial |
$1,633.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,536.41
|
| Rate for Payer: PACE Medicare |
$517.23
|
| Rate for Payer: PACE SWMI |
$544.45
|
| Rate for Payer: PHP Commercial |
$1,741.27
|
| Rate for Payer: PHP Medicare Advantage |
$544.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$284.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,760.71
|
| Rate for Payer: Priority Health Medicare |
$544.45
|
| Rate for Payer: Priority Health SBD |
$1,290.59
|
| Rate for Payer: Priority Health Tiered Network |
$1,408.57
|
| Rate for Payer: Railroad Medicare Medicare |
$544.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,331.56
|
| Rate for Payer: UHC Core |
$1,067.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$544.45
|
| Rate for Payer: UHC Exchange |
$805.08
|
| Rate for Payer: UHC Medicaid |
$284.75
|
| Rate for Payer: UHCCP Medicaid |
$284.75
|
| Rate for Payer: UMR Bronson Commercial |
$757.96
|
| Rate for Payer: VA VA |
$544.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,536.41
|
|
|
HC ECHO, 2D, DOPPLER, COLOR FLOW
|
Facility
|
IP
|
$2,048.55
|
|
|
Service Code
|
CPT 93306
|
| Hospital Charge Code |
48300001
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$901.36 |
| Max. Negotiated Rate |
$1,843.69 |
| Rate for Payer: Aetna American Axle |
$1,331.56
|
| Rate for Payer: Aetna Commercial |
$1,741.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,331.56
|
| Rate for Payer: Cash Price |
$1,638.84
|
| Rate for Payer: Cofinity Advantage |
$1,433.98
|
| Rate for Payer: Cofinity Commercial |
$1,761.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,638.84
|
| Rate for Payer: Healthscope Commercial |
$1,843.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,433.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,536.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,741.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,536.41
|
| Rate for Payer: PHP Commercial |
$1,741.27
|
| Rate for Payer: Priority Health SBD |
$1,290.59
|
| Rate for Payer: UMR Bronson Commercial |
$901.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,536.41
|
|
|
HC ECHO COMPLETE W/DEFINITY
|
Facility
|
IP
|
$2,048.55
|
|
|
Service Code
|
HCPCS C8929
|
| Hospital Charge Code |
48300003
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$901.36 |
| Max. Negotiated Rate |
$1,843.69 |
| Rate for Payer: Aetna American Axle |
$1,331.56
|
| Rate for Payer: Aetna Commercial |
$1,741.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,331.56
|
| Rate for Payer: Cash Price |
$1,638.84
|
| Rate for Payer: Cofinity Advantage |
$1,433.98
|
| Rate for Payer: Cofinity Commercial |
$1,761.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,638.84
|
| Rate for Payer: Healthscope Commercial |
$1,843.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,433.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,536.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,741.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,536.41
|
| Rate for Payer: PHP Commercial |
$1,741.27
|
| Rate for Payer: Priority Health SBD |
$1,290.59
|
| Rate for Payer: UMR Bronson Commercial |
$901.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,536.41
|
|
|
HC ECHO COMPLETE W/DEFINITY
|
Facility
|
OP
|
$2,048.55
|
|
|
Service Code
|
HCPCS C8929
|
| Hospital Charge Code |
48300003
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$408.52 |
| Max. Negotiated Rate |
$2,526.00 |
| Rate for Payer: Aetna American Axle |
$1,331.56
|
| Rate for Payer: Aetna Commercial |
$1,741.27
|
| Rate for Payer: Aetna Medicare |
$812.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,331.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$976.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$976.38
|
| Rate for Payer: BCBS Complete |
$428.98
|
| Rate for Payer: BCBS MAPPO |
$781.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,217.72
|
| Rate for Payer: BCN Commercial |
$1,217.72
|
| Rate for Payer: BCN Medicare Advantage |
$781.10
|
| Rate for Payer: Cash Price |
$1,638.84
|
| Rate for Payer: Cash Price |
$1,638.84
|
| Rate for Payer: Cofinity Advantage |
$1,433.98
|
| Rate for Payer: Cofinity Commercial |
$1,761.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,638.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$781.10
|
| Rate for Payer: Healthscope Commercial |
$1,843.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,433.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,536.41
|
| Rate for Payer: Mclaren Medicaid |
$781.10
|
| Rate for Payer: Mclaren Medicare |
$781.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$820.15
|
| Rate for Payer: Meridian Medicaid |
$820.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$898.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$859.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,741.27
|
| Rate for Payer: Nomi Health Commercial |
$2,343.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,536.41
|
| Rate for Payer: PACE Medicare |
$742.04
|
| Rate for Payer: PACE SWMI |
$781.10
|
| Rate for Payer: PHP Commercial |
$1,741.27
|
| Rate for Payer: PHP Medicare Advantage |
$781.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$408.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,526.00
|
| Rate for Payer: Priority Health Medicare |
$781.10
|
| Rate for Payer: Priority Health SBD |
$1,290.59
|
| Rate for Payer: Priority Health Tiered Network |
$2,020.80
|
| Rate for Payer: Railroad Medicare Medicare |
$781.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,331.56
|
| Rate for Payer: UHC Core |
$1,067.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$781.10
|
| Rate for Payer: UHC Exchange |
$805.08
|
| Rate for Payer: UHC Medicaid |
$408.52
|
| Rate for Payer: UHCCP Medicaid |
$408.52
|
| Rate for Payer: UMR Bronson Commercial |
$757.96
|
| Rate for Payer: VA VA |
$781.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,536.41
|
|
|
HC ECHO CONGENITAL
|
Facility
|
OP
|
$1,671.72
|
|
|
Service Code
|
CPT 93303
|
| Hospital Charge Code |
48000004
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$284.75 |
| Max. Negotiated Rate |
$1,760.71 |
| Rate for Payer: Aetna American Axle |
$1,086.62
|
| Rate for Payer: Aetna Commercial |
$1,420.96
|
| Rate for Payer: Aetna Medicare |
$566.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,086.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$680.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$680.56
|
| Rate for Payer: BCBS Complete |
$299.01
|
| Rate for Payer: BCBS MAPPO |
$544.45
|
| Rate for Payer: BCBS Trust/PPO |
$655.13
|
| Rate for Payer: BCN Commercial |
$655.13
|
| Rate for Payer: BCN Medicare Advantage |
$544.45
|
| Rate for Payer: Cash Price |
$1,337.38
|
| Rate for Payer: Cash Price |
$1,337.38
|
| Rate for Payer: Cofinity Advantage |
$1,170.20
|
| Rate for Payer: Cofinity Commercial |
$1,437.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,337.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$544.45
|
| Rate for Payer: Healthscope Commercial |
$1,504.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,170.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,253.79
|
| Rate for Payer: Mclaren Medicaid |
$544.45
|
| Rate for Payer: Mclaren Medicare |
$544.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$571.67
|
| Rate for Payer: Meridian Medicaid |
$571.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$626.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$598.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,420.96
|
| Rate for Payer: Nomi Health Commercial |
$1,633.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,253.79
|
| Rate for Payer: PACE Medicare |
$517.23
|
| Rate for Payer: PACE SWMI |
$544.45
|
| Rate for Payer: PHP Commercial |
$1,420.96
|
| Rate for Payer: PHP Medicare Advantage |
$544.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$284.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,760.71
|
| Rate for Payer: Priority Health Medicare |
$544.45
|
| Rate for Payer: Priority Health SBD |
$1,053.18
|
| Rate for Payer: Priority Health Tiered Network |
$1,408.57
|
| Rate for Payer: Railroad Medicare Medicare |
$544.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,086.62
|
| Rate for Payer: UHC Core |
$870.97
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$544.45
|
| Rate for Payer: UHC Exchange |
$656.99
|
| Rate for Payer: UHC Medicaid |
$284.75
|
| Rate for Payer: UHCCP Medicaid |
$284.75
|
| Rate for Payer: UMR Bronson Commercial |
$618.54
|
| Rate for Payer: VA VA |
$544.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,253.79
|
|
|
HC ECHO CONGENITAL
|
Facility
|
IP
|
$1,671.72
|
|
|
Service Code
|
CPT 93303
|
| Hospital Charge Code |
48000004
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$735.56 |
| Max. Negotiated Rate |
$1,504.55 |
| Rate for Payer: Aetna American Axle |
$1,086.62
|
| Rate for Payer: Aetna Commercial |
$1,420.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,086.62
|
| Rate for Payer: Cash Price |
$1,337.38
|
| Rate for Payer: Cofinity Advantage |
$1,170.20
|
| Rate for Payer: Cofinity Commercial |
$1,437.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,337.38
|
| Rate for Payer: Healthscope Commercial |
$1,504.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,170.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,253.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,420.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,253.79
|
| Rate for Payer: PHP Commercial |
$1,420.96
|
| Rate for Payer: Priority Health SBD |
$1,053.18
|
| Rate for Payer: UMR Bronson Commercial |
$735.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,253.79
|
|
|
HC ECHO CONGENITAL LMTD
|
Facility
|
IP
|
$1,167.55
|
|
|
Service Code
|
CPT 93304
|
| Hospital Charge Code |
48000005
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$513.72 |
| Max. Negotiated Rate |
$1,050.80 |
| Rate for Payer: Aetna American Axle |
$758.91
|
| Rate for Payer: Aetna Commercial |
$992.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$758.91
|
| Rate for Payer: Cash Price |
$934.04
|
| Rate for Payer: Cofinity Advantage |
$817.28
|
| Rate for Payer: Cofinity Commercial |
$1,004.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$934.04
|
| Rate for Payer: Healthscope Commercial |
$1,050.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$817.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$875.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$992.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$875.66
|
| Rate for Payer: PHP Commercial |
$992.42
|
| Rate for Payer: Priority Health SBD |
$735.56
|
| Rate for Payer: UMR Bronson Commercial |
$513.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$875.66
|
|
|
HC ECHO CONGENITAL LMTD
|
Facility
|
OP
|
$1,167.55
|
|
|
Service Code
|
CPT 93304
|
| Hospital Charge Code |
48000005
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$284.75 |
| Max. Negotiated Rate |
$1,760.71 |
| Rate for Payer: Aetna American Axle |
$758.91
|
| Rate for Payer: Aetna Commercial |
$992.42
|
| Rate for Payer: Aetna Medicare |
$566.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$758.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$680.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$680.56
|
| Rate for Payer: BCBS Complete |
$299.01
|
| Rate for Payer: BCBS MAPPO |
$544.45
|
| Rate for Payer: BCBS Trust/PPO |
$493.11
|
| Rate for Payer: BCN Commercial |
$493.11
|
| Rate for Payer: BCN Medicare Advantage |
$544.45
|
| Rate for Payer: Cash Price |
$934.04
|
| Rate for Payer: Cash Price |
$934.04
|
| Rate for Payer: Cofinity Advantage |
$817.28
|
| Rate for Payer: Cofinity Commercial |
$1,004.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$934.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$544.45
|
| Rate for Payer: Healthscope Commercial |
$1,050.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$817.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$875.66
|
| Rate for Payer: Mclaren Medicaid |
$544.45
|
| Rate for Payer: Mclaren Medicare |
$544.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$571.67
|
| Rate for Payer: Meridian Medicaid |
$571.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$626.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$598.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$992.42
|
| Rate for Payer: Nomi Health Commercial |
$1,633.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$875.66
|
| Rate for Payer: PACE Medicare |
$517.23
|
| Rate for Payer: PACE SWMI |
$544.45
|
| Rate for Payer: PHP Commercial |
$992.42
|
| Rate for Payer: PHP Medicare Advantage |
$544.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$284.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,760.71
|
| Rate for Payer: Priority Health Medicare |
$544.45
|
| Rate for Payer: Priority Health SBD |
$735.56
|
| Rate for Payer: Priority Health Tiered Network |
$1,408.57
|
| Rate for Payer: Railroad Medicare Medicare |
$544.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$758.91
|
| Rate for Payer: UHC Core |
$608.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$544.45
|
| Rate for Payer: UHC Exchange |
$458.85
|
| Rate for Payer: UHC Medicaid |
$284.75
|
| Rate for Payer: UHCCP Medicaid |
$284.75
|
| Rate for Payer: UMR Bronson Commercial |
$431.99
|
| Rate for Payer: VA VA |
$544.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$875.66
|
|
|
HC ECHO FETAL COMPLETE
|
Facility
|
IP
|
$986.19
|
|
|
Service Code
|
CPT 76825
|
| Hospital Charge Code |
40200030
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$433.92 |
| Max. Negotiated Rate |
$887.57 |
| Rate for Payer: Aetna American Axle |
$641.02
|
| Rate for Payer: Aetna Commercial |
$838.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$641.02
|
| Rate for Payer: Cash Price |
$788.95
|
| Rate for Payer: Cofinity Advantage |
$690.33
|
| Rate for Payer: Cofinity Commercial |
$848.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$788.95
|
| Rate for Payer: Healthscope Commercial |
$887.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$690.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$739.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$838.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$739.64
|
| Rate for Payer: PHP Commercial |
$838.26
|
| Rate for Payer: Priority Health SBD |
$621.30
|
| Rate for Payer: UMR Bronson Commercial |
$433.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$739.64
|
|
|
HC ECHO FETAL COMPLETE
|
Facility
|
OP
|
$986.19
|
|
|
Service Code
|
CPT 76825
|
| Hospital Charge Code |
40200030
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$284.75 |
| Max. Negotiated Rate |
$1,760.71 |
| Rate for Payer: Aetna American Axle |
$641.02
|
| Rate for Payer: Aetna Commercial |
$838.26
|
| Rate for Payer: Aetna Medicare |
$566.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$641.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$680.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$680.56
|
| Rate for Payer: BCBS Complete |
$299.01
|
| Rate for Payer: BCBS MAPPO |
$544.45
|
| Rate for Payer: BCBS Trust/PPO |
$438.36
|
| Rate for Payer: BCN Commercial |
$438.36
|
| Rate for Payer: BCN Medicare Advantage |
$544.45
|
| Rate for Payer: Cash Price |
$788.95
|
| Rate for Payer: Cash Price |
$788.95
|
| Rate for Payer: Cofinity Advantage |
$690.33
|
| Rate for Payer: Cofinity Commercial |
$848.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$788.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$544.45
|
| Rate for Payer: Healthscope Commercial |
$887.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$690.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$739.64
|
| Rate for Payer: Mclaren Medicaid |
$544.45
|
| Rate for Payer: Mclaren Medicare |
$544.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$571.67
|
| Rate for Payer: Meridian Medicaid |
$571.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$626.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$598.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$838.26
|
| Rate for Payer: Nomi Health Commercial |
$1,633.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$739.64
|
| Rate for Payer: PACE Medicare |
$517.23
|
| Rate for Payer: PACE SWMI |
$544.45
|
| Rate for Payer: PHP Commercial |
$838.26
|
| Rate for Payer: PHP Medicare Advantage |
$544.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$284.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,760.71
|
| Rate for Payer: Priority Health Medicare |
$544.45
|
| Rate for Payer: Priority Health SBD |
$621.30
|
| Rate for Payer: Priority Health Tiered Network |
$1,408.57
|
| Rate for Payer: Railroad Medicare Medicare |
$544.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$641.02
|
| Rate for Payer: UHC Core |
$513.80
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$544.45
|
| Rate for Payer: UHC Exchange |
$387.57
|
| Rate for Payer: UHC Medicaid |
$284.75
|
| Rate for Payer: UHCCP Medicaid |
$284.75
|
| Rate for Payer: UMR Bronson Commercial |
$364.89
|
| Rate for Payer: VA VA |
$544.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$739.64
|
|
|
HC ECHO FETAL FOLLOWUP/REPEAT
|
Facility
|
IP
|
$751.33
|
|
|
Service Code
|
CPT 76826
|
| Hospital Charge Code |
40200077
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$330.59 |
| Max. Negotiated Rate |
$676.20 |
| Rate for Payer: Aetna American Axle |
$488.36
|
| Rate for Payer: Aetna Commercial |
$638.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$488.36
|
| Rate for Payer: Cash Price |
$601.06
|
| Rate for Payer: Cofinity Advantage |
$525.93
|
| Rate for Payer: Cofinity Commercial |
$646.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$601.06
|
| Rate for Payer: Healthscope Commercial |
$676.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$525.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$563.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$638.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$563.50
|
| Rate for Payer: PHP Commercial |
$638.63
|
| Rate for Payer: Priority Health SBD |
$473.34
|
| Rate for Payer: UMR Bronson Commercial |
$330.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$563.50
|
|
|
HC ECHO FETAL FOLLOWUP/REPEAT
|
Facility
|
OP
|
$751.33
|
|
|
Service Code
|
CPT 76826
|
| Hospital Charge Code |
40200077
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$124.34 |
| Max. Negotiated Rate |
$768.83 |
| Rate for Payer: Aetna American Axle |
$488.36
|
| Rate for Payer: Aetna Commercial |
$638.63
|
| Rate for Payer: Aetna Medicare |
$247.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$488.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$297.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$297.18
|
| Rate for Payer: BCBS Complete |
$130.57
|
| Rate for Payer: BCBS MAPPO |
$237.74
|
| Rate for Payer: BCBS Trust/PPO |
$283.21
|
| Rate for Payer: BCN Commercial |
$283.21
|
| Rate for Payer: BCN Medicare Advantage |
$237.74
|
| Rate for Payer: Cash Price |
$601.06
|
| Rate for Payer: Cash Price |
$601.06
|
| Rate for Payer: Cofinity Advantage |
$525.93
|
| Rate for Payer: Cofinity Commercial |
$646.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$601.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$237.74
|
| Rate for Payer: Healthscope Commercial |
$676.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$525.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$563.50
|
| Rate for Payer: Mclaren Medicaid |
$237.74
|
| Rate for Payer: Mclaren Medicare |
$237.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$249.63
|
| Rate for Payer: Meridian Medicaid |
$249.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$273.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$261.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$638.63
|
| Rate for Payer: Nomi Health Commercial |
$713.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$563.50
|
| Rate for Payer: PACE Medicare |
$225.85
|
| Rate for Payer: PACE SWMI |
$237.74
|
| Rate for Payer: PHP Commercial |
$638.63
|
| Rate for Payer: PHP Medicare Advantage |
$237.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$124.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$768.83
|
| Rate for Payer: Priority Health Medicare |
$237.74
|
| Rate for Payer: Priority Health SBD |
$473.34
|
| Rate for Payer: Priority Health Tiered Network |
$615.06
|
| Rate for Payer: Railroad Medicare Medicare |
$237.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$488.36
|
| Rate for Payer: UHC Core |
$391.44
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$237.74
|
| Rate for Payer: UHC Exchange |
$295.27
|
| Rate for Payer: UHC Medicaid |
$124.34
|
| Rate for Payer: UHCCP Medicaid |
$124.34
|
| Rate for Payer: UMR Bronson Commercial |
$277.99
|
| Rate for Payer: VA VA |
$237.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$563.50
|
|
|
HC ECHO FETAL FOLLOW UP SPECTRAL
|
Facility
|
OP
|
$434.03
|
|
|
Service Code
|
CPT 76828
|
| Hospital Charge Code |
40200079
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$54.18 |
| Max. Negotiated Rate |
$390.63 |
| Rate for Payer: Aetna American Axle |
$282.12
|
| Rate for Payer: Aetna Commercial |
$368.93
|
| Rate for Payer: Aetna Medicare |
$108.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$282.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$54.18
|
| Rate for Payer: BCN Commercial |
$54.18
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$347.22
|
| Rate for Payer: Cash Price |
$347.22
|
| Rate for Payer: Cofinity Advantage |
$303.82
|
| Rate for Payer: Cofinity Commercial |
$373.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$347.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$390.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$303.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$325.52
|
| Rate for Payer: Mclaren Medicaid |
$104.17
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Medicaid |
$109.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$368.93
|
| Rate for Payer: Nomi Health Commercial |
$312.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$325.52
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$368.93
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$336.87
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health SBD |
$273.44
|
| Rate for Payer: Priority Health Tiered Network |
$269.50
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$282.12
|
| Rate for Payer: UHC Core |
$226.13
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$170.57
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: UMR Bronson Commercial |
$160.59
|
| Rate for Payer: VA VA |
$104.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$325.52
|
|
|
HC ECHO FETAL FOLLOW UP SPECTRAL
|
Facility
|
IP
|
$434.03
|
|
|
Service Code
|
CPT 76828
|
| Hospital Charge Code |
40200079
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$190.97 |
| Max. Negotiated Rate |
$390.63 |
| Rate for Payer: Aetna American Axle |
$282.12
|
| Rate for Payer: Aetna Commercial |
$368.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$282.12
|
| Rate for Payer: Cash Price |
$347.22
|
| Rate for Payer: Cofinity Advantage |
$303.82
|
| Rate for Payer: Cofinity Commercial |
$373.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$347.22
|
| Rate for Payer: Healthscope Commercial |
$390.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$303.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$325.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$368.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$325.52
|
| Rate for Payer: PHP Commercial |
$368.93
|
| Rate for Payer: Priority Health SBD |
$273.44
|
| Rate for Payer: UMR Bronson Commercial |
$190.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$325.52
|
|
|
HC ECHO FETAL SPECTRAL
|
Facility
|
OP
|
$715.25
|
|
|
Service Code
|
CPT 76827
|
| Hospital Charge Code |
40200078
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$643.73 |
| Rate for Payer: Aetna American Axle |
$464.91
|
| Rate for Payer: Aetna Commercial |
$607.96
|
| Rate for Payer: Aetna Medicare |
$108.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$464.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$101.79
|
| Rate for Payer: BCN Commercial |
$101.79
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$572.20
|
| Rate for Payer: Cash Price |
$572.20
|
| Rate for Payer: Cofinity Advantage |
$500.68
|
| Rate for Payer: Cofinity Commercial |
$615.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$572.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$643.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$500.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$536.44
|
| Rate for Payer: Mclaren Medicaid |
$104.17
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Medicaid |
$109.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$607.96
|
| Rate for Payer: Nomi Health Commercial |
$312.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$536.44
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$607.96
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$336.87
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health SBD |
$450.61
|
| Rate for Payer: Priority Health Tiered Network |
$269.50
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$464.91
|
| Rate for Payer: UHC Core |
$372.65
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$281.09
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: UMR Bronson Commercial |
$264.64
|
| Rate for Payer: VA VA |
$104.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$536.44
|
|
|
HC ECHO FETAL SPECTRAL
|
Facility
|
IP
|
$715.25
|
|
|
Service Code
|
CPT 76827
|
| Hospital Charge Code |
40200078
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$314.71 |
| Max. Negotiated Rate |
$643.73 |
| Rate for Payer: Aetna American Axle |
$464.91
|
| Rate for Payer: Aetna Commercial |
$607.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$464.91
|
| Rate for Payer: Cash Price |
$572.20
|
| Rate for Payer: Cofinity Advantage |
$500.68
|
| Rate for Payer: Cofinity Commercial |
$615.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$572.20
|
| Rate for Payer: Healthscope Commercial |
$643.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$500.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$536.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$607.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$536.44
|
| Rate for Payer: PHP Commercial |
$607.96
|
| Rate for Payer: Priority Health SBD |
$450.61
|
| Rate for Payer: UMR Bronson Commercial |
$314.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$536.44
|
|
|
HC ECHO LIMITED W/DEFINITY
|
Facility
|
OP
|
$940.29
|
|
|
Service Code
|
HCPCS C8924
|
| Hospital Charge Code |
48300007
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$181.81 |
| Max. Negotiated Rate |
$1,124.16 |
| Rate for Payer: Aetna American Axle |
$611.19
|
| Rate for Payer: Aetna Commercial |
$799.25
|
| Rate for Payer: Aetna Medicare |
$361.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$611.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$434.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$434.52
|
| Rate for Payer: BCBS Complete |
$190.91
|
| Rate for Payer: BCBS MAPPO |
$347.62
|
| Rate for Payer: BCBS Trust/PPO |
$550.44
|
| Rate for Payer: BCN Commercial |
$550.44
|
| Rate for Payer: BCN Medicare Advantage |
$347.62
|
| Rate for Payer: Cash Price |
$752.23
|
| Rate for Payer: Cash Price |
$752.23
|
| Rate for Payer: Cofinity Advantage |
$658.20
|
| Rate for Payer: Cofinity Commercial |
$808.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$752.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$347.62
|
| Rate for Payer: Healthscope Commercial |
$846.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$658.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$705.22
|
| Rate for Payer: Mclaren Medicaid |
$347.62
|
| Rate for Payer: Mclaren Medicare |
$347.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$365.00
|
| Rate for Payer: Meridian Medicaid |
$365.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$399.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$382.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$799.25
|
| Rate for Payer: Nomi Health Commercial |
$1,042.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$705.22
|
| Rate for Payer: PACE Medicare |
$330.24
|
| Rate for Payer: PACE SWMI |
$347.62
|
| Rate for Payer: PHP Commercial |
$799.25
|
| Rate for Payer: PHP Medicare Advantage |
$347.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$181.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,124.16
|
| Rate for Payer: Priority Health Medicare |
$347.62
|
| Rate for Payer: Priority Health SBD |
$592.38
|
| Rate for Payer: Priority Health Tiered Network |
$899.33
|
| Rate for Payer: Railroad Medicare Medicare |
$347.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$611.19
|
| Rate for Payer: UHC Core |
$489.89
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$347.62
|
| Rate for Payer: UHC Exchange |
$369.53
|
| Rate for Payer: UHC Medicaid |
$181.81
|
| Rate for Payer: UHCCP Medicaid |
$181.81
|
| Rate for Payer: UMR Bronson Commercial |
$347.91
|
| Rate for Payer: VA VA |
$347.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$705.22
|
|
|
HC ECHO LIMITED W/DEFINITY
|
Facility
|
IP
|
$940.29
|
|
|
Service Code
|
HCPCS C8924
|
| Hospital Charge Code |
48300007
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$413.73 |
| Max. Negotiated Rate |
$846.26 |
| Rate for Payer: Aetna American Axle |
$611.19
|
| Rate for Payer: Aetna Commercial |
$799.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$611.19
|
| Rate for Payer: Cash Price |
$752.23
|
| Rate for Payer: Cofinity Advantage |
$658.20
|
| Rate for Payer: Cofinity Commercial |
$808.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$752.23
|
| Rate for Payer: Healthscope Commercial |
$846.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$658.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$705.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$799.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$705.22
|
| Rate for Payer: PHP Commercial |
$799.25
|
| Rate for Payer: Priority Health SBD |
$592.38
|
| Rate for Payer: UMR Bronson Commercial |
$413.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$705.22
|
|
