|
HC EEG W/O VID 12-26 HRS INTMT MNTR
|
Facility
|
OP
|
$2,809.76
|
|
|
Service Code
|
CPT 95709
|
| Hospital Charge Code |
74000030
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$278.65 |
| Max. Negotiated Rate |
$2,528.78 |
| Rate for Payer: Aetna American Axle |
$1,826.34
|
| Rate for Payer: Aetna Commercial |
$2,388.30
|
| Rate for Payer: Aetna Medicare |
$540.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,826.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$649.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$649.84
|
| Rate for Payer: BCBS Complete |
$292.58
|
| Rate for Payer: BCBS MAPPO |
$519.87
|
| Rate for Payer: BCBS Trust/PPO |
$1,351.46
|
| Rate for Payer: BCN Commercial |
$1,351.46
|
| Rate for Payer: BCN Medicare Advantage |
$519.87
|
| Rate for Payer: Cash Price |
$2,247.81
|
| Rate for Payer: Cash Price |
$2,247.81
|
| Rate for Payer: Cash Price |
$2,247.81
|
| Rate for Payer: Cofinity Commercial |
$1,966.83
|
| Rate for Payer: Cofinity Commercial |
$2,416.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,966.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,247.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$519.87
|
| Rate for Payer: Healthscope Commercial |
$2,528.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,966.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,107.32
|
| Rate for Payer: Mclaren Medicaid |
$278.65
|
| Rate for Payer: Mclaren Medicare |
$519.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$545.86
|
| Rate for Payer: Meridian Medicaid |
$292.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$597.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,388.30
|
| Rate for Payer: Nomi Health Commercial |
$1,559.61
|
| Rate for Payer: PACE Medicare |
$493.88
|
| Rate for Payer: PACE SWMI |
$519.87
|
| Rate for Payer: PHP Commercial |
$2,388.30
|
| Rate for Payer: PHP Medicare Advantage |
$519.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$278.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,826.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,633.95
|
| Rate for Payer: Priority Health Medicare |
$519.87
|
| Rate for Payer: Priority Health Narrow Network |
$1,307.16
|
| Rate for Payer: Priority Health SBD |
$1,770.15
|
| Rate for Payer: Railroad Medicare Medicare |
$519.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,463.38
|
| Rate for Payer: UHC Core |
$1,633.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$519.87
|
| Rate for Payer: UHC Exchange |
$993.52
|
| Rate for Payer: UHC Medicare Advantage |
$519.87
|
| Rate for Payer: UHCCP Medicaid |
$278.65
|
| Rate for Payer: UMR Bronson Commercial |
$1,039.61
|
| Rate for Payer: VA VA |
$519.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,107.32
|
|
|
HC EEG W/O VID 2-12 HRS CONT MNTR
|
Facility
|
IP
|
$1,646.48
|
|
|
Service Code
|
CPT 95707
|
| Hospital Charge Code |
74000029
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$724.45 |
| Max. Negotiated Rate |
$1,481.83 |
| Rate for Payer: Aetna American Axle |
$1,070.21
|
| Rate for Payer: Aetna Commercial |
$1,399.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,070.21
|
| Rate for Payer: Cash Price |
$1,317.18
|
| Rate for Payer: Cofinity Commercial |
$1,152.54
|
| Rate for Payer: Cofinity Commercial |
$1,415.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,152.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,317.18
|
| Rate for Payer: Healthscope Commercial |
$1,481.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,152.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,234.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,399.51
|
| Rate for Payer: PHP Commercial |
$1,399.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,070.21
|
| Rate for Payer: Priority Health SBD |
$1,037.28
|
| Rate for Payer: UMR Bronson Commercial |
$724.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,234.86
|
|
|
HC EEG W/O VID 2-12 HRS CONT MNTR
|
Facility
|
OP
|
$1,646.48
|
|
|
Service Code
|
CPT 95707
|
| Hospital Charge Code |
74000029
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$163.53 |
| Max. Negotiated Rate |
$1,633.00 |
| Rate for Payer: Aetna American Axle |
$1,070.21
|
| Rate for Payer: Aetna Commercial |
$1,399.51
|
| Rate for Payer: Aetna Medicare |
$317.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,070.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$381.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$381.38
|
| Rate for Payer: BCBS Complete |
$171.71
|
| Rate for Payer: BCBS MAPPO |
$305.10
|
| Rate for Payer: BCBS Trust/PPO |
$791.43
|
| Rate for Payer: BCN Commercial |
$791.43
|
| Rate for Payer: BCN Medicare Advantage |
$305.10
|
| Rate for Payer: Cash Price |
$1,317.18
|
| Rate for Payer: Cash Price |
$1,317.18
|
| Rate for Payer: Cash Price |
$1,317.18
|
| Rate for Payer: Cofinity Commercial |
$1,152.54
|
| Rate for Payer: Cofinity Commercial |
$1,415.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,152.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,317.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.10
|
| Rate for Payer: Healthscope Commercial |
$1,481.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,152.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,234.86
|
| Rate for Payer: Mclaren Medicaid |
$163.53
|
| Rate for Payer: Mclaren Medicare |
$305.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$320.36
|
| Rate for Payer: Meridian Medicaid |
$171.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$350.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,399.51
|
| Rate for Payer: Nomi Health Commercial |
$915.30
|
| Rate for Payer: PACE Medicare |
$289.84
|
| Rate for Payer: PACE SWMI |
$305.10
|
| Rate for Payer: PHP Commercial |
$1,399.51
|
| Rate for Payer: PHP Medicare Advantage |
$305.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$163.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,070.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$958.92
|
| Rate for Payer: Priority Health Medicare |
$305.10
|
| Rate for Payer: Priority Health Narrow Network |
$767.14
|
| Rate for Payer: Priority Health SBD |
$1,037.28
|
| Rate for Payer: Railroad Medicare Medicare |
$305.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$858.83
|
| Rate for Payer: UHC Core |
$1,633.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$305.10
|
| Rate for Payer: UHC Exchange |
$583.08
|
| Rate for Payer: UHC Medicare Advantage |
$305.10
|
| Rate for Payer: UHCCP Medicaid |
$163.53
|
| Rate for Payer: UMR Bronson Commercial |
$609.20
|
| Rate for Payer: VA VA |
$305.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,234.86
|
|
|
HC EEG W/O VID 2-12 HRS INTMT MNTR
|
Facility
|
OP
|
$1,646.29
|
|
|
Service Code
|
CPT 95706
|
| Hospital Charge Code |
74000028
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$163.53 |
| Max. Negotiated Rate |
$1,633.00 |
| Rate for Payer: Aetna American Axle |
$1,070.09
|
| Rate for Payer: Aetna Commercial |
$1,399.35
|
| Rate for Payer: Aetna Medicare |
$317.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,070.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$381.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$381.38
|
| Rate for Payer: BCBS Complete |
$171.71
|
| Rate for Payer: BCBS MAPPO |
$305.10
|
| Rate for Payer: BCBS Trust/PPO |
$791.43
|
| Rate for Payer: BCN Commercial |
$791.43
|
| Rate for Payer: BCN Medicare Advantage |
$305.10
|
| Rate for Payer: Cash Price |
$1,317.03
|
| Rate for Payer: Cash Price |
$1,317.03
|
| Rate for Payer: Cash Price |
$1,317.03
|
| Rate for Payer: Cofinity Commercial |
$1,152.40
|
| Rate for Payer: Cofinity Commercial |
$1,415.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,152.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,317.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.10
|
| Rate for Payer: Healthscope Commercial |
$1,481.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,152.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,234.72
|
| Rate for Payer: Mclaren Medicaid |
$163.53
|
| Rate for Payer: Mclaren Medicare |
$305.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$320.36
|
| Rate for Payer: Meridian Medicaid |
$171.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$350.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,399.35
|
| Rate for Payer: Nomi Health Commercial |
$915.30
|
| Rate for Payer: PACE Medicare |
$289.84
|
| Rate for Payer: PACE SWMI |
$305.10
|
| Rate for Payer: PHP Commercial |
$1,399.35
|
| Rate for Payer: PHP Medicare Advantage |
$305.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$163.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,070.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$958.92
|
| Rate for Payer: Priority Health Medicare |
$305.10
|
| Rate for Payer: Priority Health Narrow Network |
$767.14
|
| Rate for Payer: Priority Health SBD |
$1,037.16
|
| Rate for Payer: Railroad Medicare Medicare |
$305.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$858.83
|
| Rate for Payer: UHC Core |
$1,633.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$305.10
|
| Rate for Payer: UHC Exchange |
$583.08
|
| Rate for Payer: UHC Medicare Advantage |
$305.10
|
| Rate for Payer: UHCCP Medicaid |
$163.53
|
| Rate for Payer: UMR Bronson Commercial |
$609.13
|
| Rate for Payer: VA VA |
$305.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,234.72
|
|
|
HC EEG W/O VID 2-12 HRS INTMT MNTR
|
Facility
|
IP
|
$1,646.29
|
|
|
Service Code
|
CPT 95706
|
| Hospital Charge Code |
74000028
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$724.37 |
| Max. Negotiated Rate |
$1,481.66 |
| Rate for Payer: Aetna American Axle |
$1,070.09
|
| Rate for Payer: Aetna Commercial |
$1,399.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,070.09
|
| Rate for Payer: Cash Price |
$1,317.03
|
| Rate for Payer: Cofinity Commercial |
$1,152.40
|
| Rate for Payer: Cofinity Commercial |
$1,415.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,152.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,317.03
|
| Rate for Payer: Healthscope Commercial |
$1,481.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,152.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,234.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,399.35
|
| Rate for Payer: PHP Commercial |
$1,399.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,070.09
|
| Rate for Payer: Priority Health SBD |
$1,037.16
|
| Rate for Payer: UMR Bronson Commercial |
$724.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,234.72
|
|
|
HC EEG W/O VID 2-12 HR UNMNTR
|
Facility
|
IP
|
$1,021.26
|
|
|
Service Code
|
CPT 95705
|
| Hospital Charge Code |
74000020
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$449.35 |
| Max. Negotiated Rate |
$919.13 |
| Rate for Payer: Aetna American Axle |
$663.82
|
| Rate for Payer: Aetna Commercial |
$868.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$663.82
|
| Rate for Payer: Cash Price |
$817.01
|
| Rate for Payer: Cofinity Commercial |
$714.88
|
| Rate for Payer: Cofinity Commercial |
$878.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$714.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$817.01
|
| Rate for Payer: Healthscope Commercial |
$919.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$714.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$765.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$868.07
|
| Rate for Payer: PHP Commercial |
$868.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$663.82
|
| Rate for Payer: Priority Health SBD |
$643.39
|
| Rate for Payer: UMR Bronson Commercial |
$449.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$765.94
|
|
|
HC EEG W/O VID 2-12 HR UNMNTR
|
Facility
|
OP
|
$1,021.26
|
|
|
Service Code
|
CPT 95705
|
| Hospital Charge Code |
74000020
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$163.53 |
| Max. Negotiated Rate |
$1,633.00 |
| Rate for Payer: Aetna American Axle |
$663.82
|
| Rate for Payer: Aetna Commercial |
$868.07
|
| Rate for Payer: Aetna Medicare |
$317.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$663.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$381.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$381.38
|
| Rate for Payer: BCBS Complete |
$171.71
|
| Rate for Payer: BCBS MAPPO |
$305.10
|
| Rate for Payer: BCBS Trust/PPO |
$791.43
|
| Rate for Payer: BCN Commercial |
$791.43
|
| Rate for Payer: BCN Medicare Advantage |
$305.10
|
| Rate for Payer: Cash Price |
$817.01
|
| Rate for Payer: Cash Price |
$817.01
|
| Rate for Payer: Cash Price |
$817.01
|
| Rate for Payer: Cofinity Commercial |
$714.88
|
| Rate for Payer: Cofinity Commercial |
$878.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$714.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$817.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.10
|
| Rate for Payer: Healthscope Commercial |
$919.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$714.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$765.94
|
| Rate for Payer: Mclaren Medicaid |
$163.53
|
| Rate for Payer: Mclaren Medicare |
$305.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$320.36
|
| Rate for Payer: Meridian Medicaid |
$171.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$350.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$868.07
|
| Rate for Payer: Nomi Health Commercial |
$915.30
|
| Rate for Payer: PACE Medicare |
$289.84
|
| Rate for Payer: PACE SWMI |
$305.10
|
| Rate for Payer: PHP Commercial |
$868.07
|
| Rate for Payer: PHP Medicare Advantage |
$305.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$163.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$663.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$958.92
|
| Rate for Payer: Priority Health Medicare |
$305.10
|
| Rate for Payer: Priority Health Narrow Network |
$767.14
|
| Rate for Payer: Priority Health SBD |
$643.39
|
| Rate for Payer: Railroad Medicare Medicare |
$305.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$858.83
|
| Rate for Payer: UHC Core |
$1,633.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$305.10
|
| Rate for Payer: UHC Exchange |
$583.08
|
| Rate for Payer: UHC Medicare Advantage |
$305.10
|
| Rate for Payer: UHCCP Medicaid |
$163.53
|
| Rate for Payer: UMR Bronson Commercial |
$377.87
|
| Rate for Payer: VA VA |
$305.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$765.94
|
|
|
HC EEG W/O VID EA 12-26 HR UNMNTR
|
Facility
|
OP
|
$1,959.46
|
|
|
Service Code
|
CPT 95708
|
| Hospital Charge Code |
74000021
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$278.65 |
| Max. Negotiated Rate |
$1,763.51 |
| Rate for Payer: Aetna American Axle |
$1,273.65
|
| Rate for Payer: Aetna Commercial |
$1,665.54
|
| Rate for Payer: Aetna Medicare |
$540.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,273.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$649.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$649.84
|
| Rate for Payer: BCBS Complete |
$292.58
|
| Rate for Payer: BCBS MAPPO |
$519.87
|
| Rate for Payer: BCBS Trust/PPO |
$1,351.46
|
| Rate for Payer: BCN Commercial |
$1,351.46
|
| Rate for Payer: BCN Medicare Advantage |
$519.87
|
| Rate for Payer: Cash Price |
$1,567.57
|
| Rate for Payer: Cash Price |
$1,567.57
|
| Rate for Payer: Cash Price |
$1,567.57
|
| Rate for Payer: Cofinity Commercial |
$1,371.62
|
| Rate for Payer: Cofinity Commercial |
$1,685.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,371.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,567.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$519.87
|
| Rate for Payer: Healthscope Commercial |
$1,763.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,371.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,469.60
|
| Rate for Payer: Mclaren Medicaid |
$278.65
|
| Rate for Payer: Mclaren Medicare |
$519.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$545.86
|
| Rate for Payer: Meridian Medicaid |
$292.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$597.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,665.54
|
| Rate for Payer: Nomi Health Commercial |
$1,559.61
|
| Rate for Payer: PACE Medicare |
$493.88
|
| Rate for Payer: PACE SWMI |
$519.87
|
| Rate for Payer: PHP Commercial |
$1,665.54
|
| Rate for Payer: PHP Medicare Advantage |
$519.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$278.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,273.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,633.95
|
| Rate for Payer: Priority Health Medicare |
$519.87
|
| Rate for Payer: Priority Health Narrow Network |
$1,307.16
|
| Rate for Payer: Priority Health SBD |
$1,234.46
|
| Rate for Payer: Railroad Medicare Medicare |
$519.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,463.38
|
| Rate for Payer: UHC Core |
$1,633.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$519.87
|
| Rate for Payer: UHC Exchange |
$993.52
|
| Rate for Payer: UHC Medicare Advantage |
$519.87
|
| Rate for Payer: UHCCP Medicaid |
$278.65
|
| Rate for Payer: UMR Bronson Commercial |
$725.00
|
| Rate for Payer: VA VA |
$519.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,469.60
|
|
|
HC EEG W/O VID EA 12-26 HR UNMNTR
|
Facility
|
IP
|
$1,959.46
|
|
|
Service Code
|
CPT 95708
|
| Hospital Charge Code |
74000021
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$862.16 |
| Max. Negotiated Rate |
$1,763.51 |
| Rate for Payer: Aetna American Axle |
$1,273.65
|
| Rate for Payer: Aetna Commercial |
$1,665.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,273.65
|
| Rate for Payer: Cash Price |
$1,567.57
|
| Rate for Payer: Cofinity Commercial |
$1,371.62
|
| Rate for Payer: Cofinity Commercial |
$1,685.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,371.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,567.57
|
| Rate for Payer: Healthscope Commercial |
$1,763.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,371.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,469.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,665.54
|
| Rate for Payer: PHP Commercial |
$1,665.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,273.65
|
| Rate for Payer: Priority Health SBD |
$1,234.46
|
| Rate for Payer: UMR Bronson Commercial |
$862.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,469.60
|
|
|
HC EGD W EUS EXAM ESOPH ONLY
|
Facility
|
IP
|
$2,852.05
|
|
| Hospital Charge Code |
36000035
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,254.90 |
| Max. Negotiated Rate |
$2,566.84 |
| Rate for Payer: Aetna American Axle |
$1,853.83
|
| Rate for Payer: Aetna Commercial |
$2,424.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,853.83
|
| Rate for Payer: Cash Price |
$2,281.64
|
| Rate for Payer: Cofinity Commercial |
$1,996.44
|
| Rate for Payer: Cofinity Commercial |
$2,452.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,996.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,281.64
|
| Rate for Payer: Healthscope Commercial |
$2,566.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,996.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,139.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,424.24
|
| Rate for Payer: PHP Commercial |
$2,424.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,853.83
|
| Rate for Payer: Priority Health SBD |
$1,796.79
|
| Rate for Payer: UMR Bronson Commercial |
$1,254.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,139.04
|
|
|
HC EGD W EUS EXAM ESOPH ONLY
|
Facility
|
OP
|
$2,852.05
|
|
| Hospital Charge Code |
36000035
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,055.26 |
| Max. Negotiated Rate |
$2,566.84 |
| Rate for Payer: Aetna American Axle |
$1,853.83
|
| Rate for Payer: Aetna Commercial |
$2,424.24
|
| Rate for Payer: Aetna Medicare |
$1,426.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,853.83
|
| Rate for Payer: BCBS Complete |
$1,140.82
|
| Rate for Payer: Cash Price |
$2,281.64
|
| Rate for Payer: Cofinity Commercial |
$1,996.44
|
| Rate for Payer: Cofinity Commercial |
$2,452.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,996.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,281.64
|
| Rate for Payer: Healthscope Commercial |
$2,566.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,996.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,139.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,424.24
|
| Rate for Payer: PHP Commercial |
$2,424.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,853.83
|
| Rate for Payer: Priority Health SBD |
$1,796.79
|
| Rate for Payer: UMR Bronson Commercial |
$1,055.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,139.04
|
|
|
HC EGD W EUS EXAM ESOPH,STOM,DUO,
|
Facility
|
IP
|
$2,979.09
|
|
| Hospital Charge Code |
36000036
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,310.80 |
| Max. Negotiated Rate |
$2,681.18 |
| Rate for Payer: Aetna American Axle |
$1,936.41
|
| Rate for Payer: Aetna Commercial |
$2,532.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,936.41
|
| Rate for Payer: Cash Price |
$2,383.27
|
| Rate for Payer: Cofinity Commercial |
$2,085.36
|
| Rate for Payer: Cofinity Commercial |
$2,562.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,085.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,383.27
|
| Rate for Payer: Healthscope Commercial |
$2,681.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,085.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,234.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,532.23
|
| Rate for Payer: PHP Commercial |
$2,532.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,936.41
|
| Rate for Payer: Priority Health SBD |
$1,876.83
|
| Rate for Payer: UMR Bronson Commercial |
$1,310.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,234.32
|
|
|
HC EGD W EUS EXAM ESOPH,STOM,DUO,
|
Facility
|
OP
|
$2,979.09
|
|
| Hospital Charge Code |
36000036
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,102.26 |
| Max. Negotiated Rate |
$2,681.18 |
| Rate for Payer: Aetna American Axle |
$1,936.41
|
| Rate for Payer: Aetna Commercial |
$2,532.23
|
| Rate for Payer: Aetna Medicare |
$1,489.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,936.41
|
| Rate for Payer: BCBS Complete |
$1,191.64
|
| Rate for Payer: Cash Price |
$2,383.27
|
| Rate for Payer: Cofinity Commercial |
$2,085.36
|
| Rate for Payer: Cofinity Commercial |
$2,562.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,085.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,383.27
|
| Rate for Payer: Healthscope Commercial |
$2,681.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,085.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,234.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,532.23
|
| Rate for Payer: PHP Commercial |
$2,532.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,936.41
|
| Rate for Payer: Priority Health SBD |
$1,876.83
|
| Rate for Payer: UMR Bronson Commercial |
$1,102.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,234.32
|
|
|
HC EGG WHITE IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200041
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.17 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna American Axle |
$16.50
|
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health SBD |
$16.00
|
| Rate for Payer: UMR Bronson Commercial |
$11.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.04
|
|
|
HC EGG WHITE IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200041
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna American Axle |
$16.50
|
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$5.04
|
| Rate for Payer: BCN Commercial |
$5.04
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.04
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$7.83
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.37
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$4.30
|
| Rate for Payer: Priority Health SBD |
$16.00
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$5.22
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.80
|
| Rate for Payer: UMR Bronson Commercial |
$9.39
|
| Rate for Payer: VA VA |
$5.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.04
|
|
|
HC EGG YOLK, IGE
|
Facility
|
OP
|
$31.21
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200482
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$28.09 |
| Rate for Payer: Aetna American Axle |
$20.29
|
| Rate for Payer: Aetna Commercial |
$26.53
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$5.04
|
| Rate for Payer: BCN Commercial |
$5.04
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$24.97
|
| Rate for Payer: Cash Price |
$24.97
|
| Rate for Payer: Cofinity Commercial |
$26.84
|
| Rate for Payer: Cofinity Commercial |
$21.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$28.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.41
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.53
|
| Rate for Payer: Nomi Health Commercial |
$7.83
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$26.53
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.37
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$4.30
|
| Rate for Payer: Priority Health SBD |
$19.66
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$5.22
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.80
|
| Rate for Payer: UMR Bronson Commercial |
$11.55
|
| Rate for Payer: VA VA |
$5.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.41
|
|
|
HC EGG YOLK, IGE
|
Facility
|
IP
|
$31.21
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200482
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.73 |
| Max. Negotiated Rate |
$28.09 |
| Rate for Payer: Aetna American Axle |
$20.29
|
| Rate for Payer: Aetna Commercial |
$26.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.29
|
| Rate for Payer: Cash Price |
$24.97
|
| Rate for Payer: Cofinity Commercial |
$21.85
|
| Rate for Payer: Cofinity Commercial |
$26.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.97
|
| Rate for Payer: Healthscope Commercial |
$28.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.53
|
| Rate for Payer: PHP Commercial |
$26.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.29
|
| Rate for Payer: Priority Health SBD |
$19.66
|
| Rate for Payer: UMR Bronson Commercial |
$13.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.41
|
|
|
HC EKG RHYTHM STRIP
|
Facility
|
OP
|
$73.86
|
|
|
Service Code
|
CPT 93041
|
| Hospital Charge Code |
73000002
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$5.75 |
| Max. Negotiated Rate |
$294.00 |
| Rate for Payer: Aetna American Axle |
$48.01
|
| Rate for Payer: Aetna Commercial |
$62.78
|
| Rate for Payer: Aetna Medicare |
$60.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.75
|
| Rate for Payer: BCBS Complete |
$32.75
|
| Rate for Payer: BCBS MAPPO |
$58.20
|
| Rate for Payer: BCBS Trust/PPO |
$25.38
|
| Rate for Payer: BCN Commercial |
$25.38
|
| Rate for Payer: BCN Medicare Advantage |
$58.20
|
| Rate for Payer: Cash Price |
$59.09
|
| Rate for Payer: Cash Price |
$59.09
|
| Rate for Payer: Cash Price |
$59.09
|
| Rate for Payer: Cofinity Commercial |
$51.70
|
| Rate for Payer: Cofinity Commercial |
$63.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$51.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.20
|
| Rate for Payer: Healthscope Commercial |
$66.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$51.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.40
|
| Rate for Payer: Mclaren Medicaid |
$31.20
|
| Rate for Payer: Mclaren Medicare |
$58.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.11
|
| Rate for Payer: Meridian Medicaid |
$32.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.78
|
| Rate for Payer: Nomi Health Commercial |
$174.60
|
| Rate for Payer: PACE Medicare |
$55.29
|
| Rate for Payer: PACE SWMI |
$58.20
|
| Rate for Payer: PHP Commercial |
$62.78
|
| Rate for Payer: PHP Medicare Advantage |
$58.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$182.90
|
| Rate for Payer: Priority Health Medicare |
$58.20
|
| Rate for Payer: Priority Health Narrow Network |
$146.32
|
| Rate for Payer: Priority Health SBD |
$46.53
|
| Rate for Payer: Railroad Medicare Medicare |
$58.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.32
|
| Rate for Payer: UHC Core |
$294.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$58.20
|
| Rate for Payer: UHC Exchange |
$5.75
|
| Rate for Payer: UHC Medicare Advantage |
$58.20
|
| Rate for Payer: UHCCP Medicaid |
$31.20
|
| Rate for Payer: UMR Bronson Commercial |
$27.33
|
| Rate for Payer: VA VA |
$58.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.40
|
|
|
HC EKG RHYTHM STRIP
|
Facility
|
IP
|
$73.86
|
|
|
Service Code
|
CPT 93041
|
| Hospital Charge Code |
73000002
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$32.50 |
| Max. Negotiated Rate |
$66.47 |
| Rate for Payer: Aetna American Axle |
$48.01
|
| Rate for Payer: Aetna Commercial |
$62.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.01
|
| Rate for Payer: Cash Price |
$59.09
|
| Rate for Payer: Cofinity Commercial |
$51.70
|
| Rate for Payer: Cofinity Commercial |
$63.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$51.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.09
|
| Rate for Payer: Healthscope Commercial |
$66.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$51.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.78
|
| Rate for Payer: PHP Commercial |
$62.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.01
|
| Rate for Payer: Priority Health SBD |
$46.53
|
| Rate for Payer: UMR Bronson Commercial |
$32.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.40
|
|
|
HC EKG TRACING FOR INITIAL PREV
|
Facility
|
OP
|
$36.39
|
|
|
Service Code
|
HCPCS G0404
|
| Hospital Charge Code |
73000004
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$5.75 |
| Max. Negotiated Rate |
$294.00 |
| Rate for Payer: Aetna American Axle |
$23.65
|
| Rate for Payer: Aetna Commercial |
$30.93
|
| Rate for Payer: Aetna Medicare |
$24.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.99
|
| Rate for Payer: BCBS Complete |
$13.50
|
| Rate for Payer: BCBS MAPPO |
$23.99
|
| Rate for Payer: BCN Medicare Advantage |
$23.99
|
| Rate for Payer: Cash Price |
$29.11
|
| Rate for Payer: Cash Price |
$29.11
|
| Rate for Payer: Cash Price |
$29.11
|
| Rate for Payer: Cofinity Commercial |
$25.47
|
| Rate for Payer: Cofinity Commercial |
$31.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$25.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.99
|
| Rate for Payer: Healthscope Commercial |
$32.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.29
|
| Rate for Payer: Mclaren Medicaid |
$12.86
|
| Rate for Payer: Mclaren Medicare |
$23.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.19
|
| Rate for Payer: Meridian Medicaid |
$13.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.93
|
| Rate for Payer: Nomi Health Commercial |
$71.97
|
| Rate for Payer: PACE Medicare |
$22.79
|
| Rate for Payer: PACE SWMI |
$23.99
|
| Rate for Payer: PHP Commercial |
$30.93
|
| Rate for Payer: PHP Medicare Advantage |
$23.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75.43
|
| Rate for Payer: Priority Health Medicare |
$23.99
|
| Rate for Payer: Priority Health Narrow Network |
$60.34
|
| Rate for Payer: Priority Health SBD |
$22.93
|
| Rate for Payer: Railroad Medicare Medicare |
$23.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.32
|
| Rate for Payer: UHC Core |
$294.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.99
|
| Rate for Payer: UHC Exchange |
$5.75
|
| Rate for Payer: UHC Medicare Advantage |
$23.99
|
| Rate for Payer: UHCCP Medicaid |
$12.86
|
| Rate for Payer: UMR Bronson Commercial |
$13.46
|
| Rate for Payer: VA VA |
$23.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.29
|
|
|
HC EKG TRACING FOR INITIAL PREV
|
Facility
|
IP
|
$36.39
|
|
|
Service Code
|
HCPCS G0404
|
| Hospital Charge Code |
73000004
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$16.01 |
| Max. Negotiated Rate |
$32.75 |
| Rate for Payer: Aetna American Axle |
$23.65
|
| Rate for Payer: Aetna Commercial |
$30.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.65
|
| Rate for Payer: Cash Price |
$29.11
|
| Rate for Payer: Cofinity Commercial |
$25.47
|
| Rate for Payer: Cofinity Commercial |
$31.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$25.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.11
|
| Rate for Payer: Healthscope Commercial |
$32.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.93
|
| Rate for Payer: PHP Commercial |
$30.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.65
|
| Rate for Payer: Priority Health SBD |
$22.93
|
| Rate for Payer: UMR Bronson Commercial |
$16.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.29
|
|
|
HC EKO INFUSION SYSTEM
|
Facility
|
IP
|
$7,696.07
|
|
| Hospital Charge Code |
27200279
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,386.27 |
| Max. Negotiated Rate |
$6,926.46 |
| Rate for Payer: Aetna American Axle |
$5,002.45
|
| Rate for Payer: Aetna Commercial |
$6,541.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,002.45
|
| Rate for Payer: Cash Price |
$6,156.86
|
| Rate for Payer: Cofinity Commercial |
$5,387.25
|
| Rate for Payer: Cofinity Commercial |
$6,618.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,387.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,156.86
|
| Rate for Payer: Healthscope Commercial |
$6,926.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,387.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,772.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,541.66
|
| Rate for Payer: PHP Commercial |
$6,541.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,002.45
|
| Rate for Payer: Priority Health SBD |
$4,848.52
|
| Rate for Payer: UMR Bronson Commercial |
$3,386.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,772.05
|
|
|
HC EKO INFUSION SYSTEM
|
Facility
|
OP
|
$7,696.07
|
|
| Hospital Charge Code |
27200279
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,847.55 |
| Max. Negotiated Rate |
$6,926.46 |
| Rate for Payer: Cofinity Commercial |
$6,618.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,387.25
|
| Rate for Payer: Aetna American Axle |
$5,002.45
|
| Rate for Payer: Aetna Commercial |
$6,541.66
|
| Rate for Payer: Aetna Medicare |
$3,848.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,002.45
|
| Rate for Payer: BCBS Complete |
$3,078.43
|
| Rate for Payer: Cash Price |
$6,156.86
|
| Rate for Payer: Cofinity Commercial |
$5,387.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,156.86
|
| Rate for Payer: Healthscope Commercial |
$6,926.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,387.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,772.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,541.66
|
| Rate for Payer: PHP Commercial |
$6,541.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,002.45
|
| Rate for Payer: Priority Health SBD |
$4,848.52
|
| Rate for Payer: UMR Bronson Commercial |
$2,847.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,772.05
|
|
|
HC ELEC ALYS IMPLT NPGT CPLX SP/PN PRGM
|
Facility
|
OP
|
$194.55
|
|
|
Service Code
|
CPT 95972
|
| Hospital Charge Code |
92000029
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$38.52 |
| Max. Negotiated Rate |
$294.00 |
| Rate for Payer: Aetna American Axle |
$126.46
|
| Rate for Payer: Aetna Commercial |
$165.37
|
| Rate for Payer: Aetna Medicare |
$93.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$112.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$112.41
|
| Rate for Payer: BCBS Complete |
$50.61
|
| Rate for Payer: BCBS MAPPO |
$89.93
|
| Rate for Payer: BCBS Trust/PPO |
$115.57
|
| Rate for Payer: BCN Commercial |
$115.57
|
| Rate for Payer: BCN Medicare Advantage |
$89.93
|
| Rate for Payer: Cash Price |
$155.64
|
| Rate for Payer: Cash Price |
$155.64
|
| Rate for Payer: Cash Price |
$155.64
|
| Rate for Payer: Cofinity Commercial |
$136.18
|
| Rate for Payer: Cofinity Commercial |
$167.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$136.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$89.93
|
| Rate for Payer: Healthscope Commercial |
$175.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$136.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$145.91
|
| Rate for Payer: Mclaren Medicaid |
$48.20
|
| Rate for Payer: Mclaren Medicare |
$89.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$94.43
|
| Rate for Payer: Meridian Medicaid |
$50.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$103.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.37
|
| Rate for Payer: Nomi Health Commercial |
$269.79
|
| Rate for Payer: PACE Medicare |
$85.43
|
| Rate for Payer: PACE SWMI |
$89.93
|
| Rate for Payer: PHP Commercial |
$165.37
|
| Rate for Payer: PHP Medicare Advantage |
$89.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$48.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$282.66
|
| Rate for Payer: Priority Health Medicare |
$89.93
|
| Rate for Payer: Priority Health Narrow Network |
$226.13
|
| Rate for Payer: Priority Health SBD |
$122.57
|
| Rate for Payer: Railroad Medicare Medicare |
$89.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.37
|
| Rate for Payer: UHC Core |
$294.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$89.93
|
| Rate for Payer: UHC Exchange |
$38.52
|
| Rate for Payer: UHC Medicare Advantage |
$89.93
|
| Rate for Payer: UHCCP Medicaid |
$48.20
|
| Rate for Payer: UMR Bronson Commercial |
$71.98
|
| Rate for Payer: VA VA |
$89.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$145.91
|
|
|
HC ELEC ALYS IMPLT NPGT CPLX SP/PN PRGM
|
Facility
|
IP
|
$194.55
|
|
|
Service Code
|
CPT 95972
|
| Hospital Charge Code |
92000029
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$85.60 |
| Max. Negotiated Rate |
$175.10 |
| Rate for Payer: Aetna American Axle |
$126.46
|
| Rate for Payer: Aetna Commercial |
$165.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.46
|
| Rate for Payer: Cash Price |
$155.64
|
| Rate for Payer: Cofinity Commercial |
$136.18
|
| Rate for Payer: Cofinity Commercial |
$167.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$136.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.64
|
| Rate for Payer: Healthscope Commercial |
$175.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$136.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$145.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.37
|
| Rate for Payer: PHP Commercial |
$165.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.46
|
| Rate for Payer: Priority Health SBD |
$122.57
|
| Rate for Payer: UMR Bronson Commercial |
$85.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$145.91
|
|
