|
HC PEANUT IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200054
|
|
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 |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| 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: 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 Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$16.00
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$9.98
|
| 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 PEANUT IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200054
|
|
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 PECAN NUT IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200117
|
|
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 PECAN NUT IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200117
|
|
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 |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| 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: 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 Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$16.00
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$9.98
|
| 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 PED MINOR TREATMENT RM
|
Facility
|
IP
|
$129.02
|
|
| Hospital Charge Code |
51000044
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$56.77 |
| Max. Negotiated Rate |
$116.12 |
| Rate for Payer: Aetna American Axle |
$83.86
|
| Rate for Payer: Aetna Commercial |
$109.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.86
|
| Rate for Payer: Cash Price |
$103.22
|
| Rate for Payer: Cofinity Commercial |
$110.96
|
| Rate for Payer: Cofinity Commercial |
$90.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$90.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.22
|
| Rate for Payer: Healthscope Commercial |
$116.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$90.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.67
|
| Rate for Payer: PHP Commercial |
$109.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.86
|
| Rate for Payer: Priority Health SBD |
$81.28
|
| Rate for Payer: UMR Bronson Commercial |
$56.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.77
|
|
|
HC PED MINOR TREATMENT RM
|
Facility
|
OP
|
$129.02
|
|
| Hospital Charge Code |
51000044
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$47.74 |
| Max. Negotiated Rate |
$116.12 |
| Rate for Payer: Aetna American Axle |
$83.86
|
| Rate for Payer: Aetna Commercial |
$109.67
|
| Rate for Payer: Aetna Medicare |
$64.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.86
|
| Rate for Payer: BCBS Complete |
$51.61
|
| Rate for Payer: Cash Price |
$103.22
|
| Rate for Payer: Cofinity Commercial |
$110.96
|
| Rate for Payer: Cofinity Commercial |
$90.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$90.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.22
|
| Rate for Payer: Healthscope Commercial |
$116.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$90.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.67
|
| Rate for Payer: PHP Commercial |
$109.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.86
|
| Rate for Payer: Priority Health SBD |
$81.28
|
| Rate for Payer: UMR Bronson Commercial |
$47.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.77
|
|
|
HC PED OBSERVATION PER HOUR
|
Facility
|
IP
|
$165.57
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200014
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$72.85 |
| Max. Negotiated Rate |
$149.01 |
| Rate for Payer: Aetna American Axle |
$107.62
|
| Rate for Payer: Aetna Commercial |
$140.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.62
|
| Rate for Payer: Cash Price |
$132.46
|
| Rate for Payer: Cofinity Commercial |
$115.90
|
| Rate for Payer: Cofinity Commercial |
$142.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$115.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.46
|
| Rate for Payer: Healthscope Commercial |
$149.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$115.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$124.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.73
|
| Rate for Payer: PHP Commercial |
$140.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.62
|
| Rate for Payer: Priority Health SBD |
$104.31
|
| Rate for Payer: UMR Bronson Commercial |
$72.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$124.18
|
|
|
HC PED OBSERVATION PER HOUR
|
Facility
|
OP
|
$165.57
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200014
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$61.26 |
| Max. Negotiated Rate |
$4,092.00 |
| Rate for Payer: Aetna American Axle |
$107.62
|
| Rate for Payer: Aetna Commercial |
$140.73
|
| Rate for Payer: Aetna Medicare |
$82.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.62
|
| Rate for Payer: BCBS Complete |
$66.23
|
| Rate for Payer: Cash Price |
$132.46
|
| Rate for Payer: Cash Price |
$132.46
|
| Rate for Payer: Cofinity Commercial |
$142.39
|
| Rate for Payer: Cofinity Commercial |
$115.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$115.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.46
|
| Rate for Payer: Healthscope Commercial |
$149.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$115.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$124.18
|
| Rate for Payer: Meridian Medicaid |
$1,000.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.73
|
| Rate for Payer: PHP Commercial |
$140.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.62
|
| Rate for Payer: Priority Health SBD |
$104.31
|
| Rate for Payer: UHC Core |
$4,092.00
|
| Rate for Payer: UMR Bronson Commercial |
$61.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$124.18
|
|
|
HC PED OR PICU MED SURG R&B
|
Facility
|
IP
|
$5,325.60
|
|
| Hospital Charge Code |
11300001
|
|
Hospital Revenue Code
|
113
|
| Min. Negotiated Rate |
$2,343.26 |
| Max. Negotiated Rate |
$4,793.04 |
| Rate for Payer: Aetna American Axle |
$3,461.64
|
| Rate for Payer: Aetna Commercial |
$4,526.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,461.64
|
| Rate for Payer: Cash Price |
$4,260.48
|
| Rate for Payer: Cofinity Commercial |
$3,727.92
|
| Rate for Payer: Cofinity Commercial |
$4,580.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,727.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,260.48
|
| Rate for Payer: Healthscope Commercial |
$4,793.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,727.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,994.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,526.76
|
| Rate for Payer: PHP Commercial |
$4,526.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,461.64
|
| Rate for Payer: Priority Health SBD |
$3,355.13
|
| Rate for Payer: UMR Bronson Commercial |
$2,343.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,994.20
|
|
|
HC PED OR PICU ROOM & BOARD
|
Facility
|
IP
|
$5,325.60
|
|
| Hospital Charge Code |
12300001
|
|
Hospital Revenue Code
|
123
|
| Min. Negotiated Rate |
$2,343.26 |
| Max. Negotiated Rate |
$4,793.04 |
| Rate for Payer: Aetna American Axle |
$3,461.64
|
| Rate for Payer: Aetna Commercial |
$4,526.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,461.64
|
| Rate for Payer: Cash Price |
$4,260.48
|
| Rate for Payer: Cofinity Commercial |
$3,727.92
|
| Rate for Payer: Cofinity Commercial |
$4,580.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,727.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,260.48
|
| Rate for Payer: Healthscope Commercial |
$4,793.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,727.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,994.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,526.76
|
| Rate for Payer: PHP Commercial |
$4,526.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,461.64
|
| Rate for Payer: Priority Health SBD |
$3,355.13
|
| Rate for Payer: UMR Bronson Commercial |
$2,343.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,994.20
|
|
|
HC PED POUCH W/WAFER
|
Facility
|
IP
|
$22.45
|
|
| Hospital Charge Code |
27000133
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.88 |
| Max. Negotiated Rate |
$20.20 |
| Rate for Payer: Aetna American Axle |
$14.59
|
| Rate for Payer: Aetna Commercial |
$19.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.59
|
| Rate for Payer: Cash Price |
$17.96
|
| Rate for Payer: Cofinity Commercial |
$15.71
|
| Rate for Payer: Cofinity Commercial |
$19.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.96
|
| Rate for Payer: Healthscope Commercial |
$20.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.08
|
| Rate for Payer: PHP Commercial |
$19.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.59
|
| Rate for Payer: Priority Health SBD |
$14.14
|
| Rate for Payer: UMR Bronson Commercial |
$9.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.84
|
|
|
HC PED POUCH W/WAFER
|
Facility
|
OP
|
$22.45
|
|
| Hospital Charge Code |
27000133
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.31 |
| Max. Negotiated Rate |
$20.20 |
| Rate for Payer: Aetna American Axle |
$14.59
|
| Rate for Payer: Aetna Commercial |
$19.08
|
| Rate for Payer: Aetna Medicare |
$11.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.59
|
| Rate for Payer: BCBS Complete |
$8.98
|
| Rate for Payer: Cash Price |
$17.96
|
| Rate for Payer: Cofinity Commercial |
$15.71
|
| Rate for Payer: Cofinity Commercial |
$19.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.96
|
| Rate for Payer: Healthscope Commercial |
$20.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.08
|
| Rate for Payer: PHP Commercial |
$19.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.59
|
| Rate for Payer: Priority Health SBD |
$14.14
|
| Rate for Payer: UMR Bronson Commercial |
$8.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.84
|
|
|
HC PEDS AUTOIMM ENCEPH CNS, CMPT 1
|
Facility
|
IP
|
$165.29
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
30200497
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$72.73 |
| Max. Negotiated Rate |
$148.76 |
| Rate for Payer: Aetna American Axle |
$107.44
|
| Rate for Payer: Aetna Commercial |
$140.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.44
|
| Rate for Payer: Cash Price |
$132.23
|
| Rate for Payer: Cofinity Commercial |
$115.70
|
| Rate for Payer: Cofinity Commercial |
$142.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$115.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.23
|
| Rate for Payer: Healthscope Commercial |
$148.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$115.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.50
|
| Rate for Payer: PHP Commercial |
$140.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.44
|
| Rate for Payer: Priority Health SBD |
$104.13
|
| Rate for Payer: UMR Bronson Commercial |
$72.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.97
|
|
|
HC PEDS AUTOIMM ENCEPH CNS, CMPT 1
|
Facility
|
OP
|
$165.29
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
30200497
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.63 |
| Max. Negotiated Rate |
$148.76 |
| Rate for Payer: Aetna American Axle |
$107.44
|
| Rate for Payer: Aetna Commercial |
$140.50
|
| Rate for Payer: Aetna Medicare |
$24.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.46
|
| Rate for Payer: BCBS Complete |
$13.27
|
| Rate for Payer: BCBS MAPPO |
$23.57
|
| Rate for Payer: BCN Medicare Advantage |
$23.57
|
| Rate for Payer: Cash Price |
$132.23
|
| Rate for Payer: Cash Price |
$132.23
|
| Rate for Payer: Cofinity Commercial |
$142.15
|
| Rate for Payer: Cofinity Commercial |
$115.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$115.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.57
|
| Rate for Payer: Healthscope Commercial |
$148.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$115.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.97
|
| Rate for Payer: Mclaren Medicaid |
$12.63
|
| Rate for Payer: Mclaren Medicare |
$23.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.75
|
| Rate for Payer: Meridian Medicaid |
$13.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.50
|
| Rate for Payer: PACE Medicare |
$22.39
|
| Rate for Payer: PACE SWMI |
$23.57
|
| Rate for Payer: PHP Commercial |
$140.50
|
| Rate for Payer: PHP Medicare Advantage |
$23.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.44
|
| Rate for Payer: Priority Health Medicare |
$23.57
|
| Rate for Payer: Priority Health SBD |
$104.13
|
| Rate for Payer: Railroad Medicare Medicare |
$23.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.57
|
| Rate for Payer: UHC Exchange |
$45.04
|
| Rate for Payer: UHC Medicare Advantage |
$23.57
|
| Rate for Payer: UHCCP Medicaid |
$12.63
|
| Rate for Payer: UMR Bronson Commercial |
$61.16
|
| Rate for Payer: VA VA |
$23.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.97
|
|
|
HC PEDS AUTOIMM ENCEPH CNS, CMPT 2
|
Facility
|
IP
|
$90.11
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200498
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$39.65 |
| Max. Negotiated Rate |
$81.10 |
| Rate for Payer: Aetna American Axle |
$58.57
|
| Rate for Payer: Aetna Commercial |
$76.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.57
|
| Rate for Payer: Cash Price |
$72.09
|
| Rate for Payer: Cofinity Commercial |
$63.08
|
| Rate for Payer: Cofinity Commercial |
$77.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$63.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.09
|
| Rate for Payer: Healthscope Commercial |
$81.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$63.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.59
|
| Rate for Payer: PHP Commercial |
$76.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.57
|
| Rate for Payer: Priority Health SBD |
$56.77
|
| Rate for Payer: UMR Bronson Commercial |
$39.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.58
|
|
|
HC PEDS AUTOIMM ENCEPH CNS, CMPT 2
|
Facility
|
OP
|
$90.11
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200498
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.46 |
| Max. Negotiated Rate |
$81.10 |
| Rate for Payer: Aetna American Axle |
$58.57
|
| Rate for Payer: Aetna Commercial |
$76.59
|
| Rate for Payer: Aetna Medicare |
$12.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: BCBS Complete |
$6.78
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$72.09
|
| Rate for Payer: Cash Price |
$72.09
|
| Rate for Payer: Cofinity Commercial |
$77.49
|
| Rate for Payer: Cofinity Commercial |
$63.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$63.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$81.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$63.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.58
|
| Rate for Payer: Mclaren Medicaid |
$6.46
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: Meridian Medicaid |
$6.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.59
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$76.59
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.57
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health SBD |
$56.77
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.05
|
| Rate for Payer: UHC Exchange |
$23.03
|
| Rate for Payer: UHC Medicare Advantage |
$12.05
|
| Rate for Payer: UHCCP Medicaid |
$6.46
|
| Rate for Payer: UMR Bronson Commercial |
$33.34
|
| Rate for Payer: VA VA |
$12.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.58
|
|
|
HC PEDS AUTOIMM ENCEPH CNS, CMPT 3
|
Facility
|
IP
|
$269.08
|
|
|
Service Code
|
CPT 86053
|
| Hospital Charge Code |
30200499
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$118.40 |
| Max. Negotiated Rate |
$242.17 |
| Rate for Payer: Aetna American Axle |
$174.90
|
| Rate for Payer: Aetna Commercial |
$228.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.90
|
| Rate for Payer: Cash Price |
$215.26
|
| Rate for Payer: Cofinity Commercial |
$188.36
|
| Rate for Payer: Cofinity Commercial |
$231.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$188.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.26
|
| Rate for Payer: Healthscope Commercial |
$242.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$188.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$201.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$228.72
|
| Rate for Payer: PHP Commercial |
$228.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.90
|
| Rate for Payer: Priority Health SBD |
$169.52
|
| Rate for Payer: UMR Bronson Commercial |
$118.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$201.81
|
|
|
HC PEDS AUTOIMM ENCEPH CNS, CMPT 3
|
Facility
|
OP
|
$269.08
|
|
|
Service Code
|
CPT 86053
|
| Hospital Charge Code |
30200499
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.22 |
| Max. Negotiated Rate |
$242.17 |
| Rate for Payer: Aetna American Axle |
$174.90
|
| Rate for Payer: Aetna Commercial |
$228.72
|
| Rate for Payer: Aetna Medicare |
$39.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47.16
|
| Rate for Payer: BCBS Complete |
$21.23
|
| Rate for Payer: BCBS MAPPO |
$37.73
|
| Rate for Payer: BCN Medicare Advantage |
$37.73
|
| Rate for Payer: Cash Price |
$215.26
|
| Rate for Payer: Cash Price |
$215.26
|
| Rate for Payer: Cofinity Commercial |
$231.41
|
| Rate for Payer: Cofinity Commercial |
$188.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$188.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.73
|
| Rate for Payer: Healthscope Commercial |
$242.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$188.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$201.81
|
| Rate for Payer: Mclaren Medicaid |
$20.22
|
| Rate for Payer: Mclaren Medicare |
$37.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.62
|
| Rate for Payer: Meridian Medicaid |
$21.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$228.72
|
| Rate for Payer: PACE Medicare |
$35.84
|
| Rate for Payer: PACE SWMI |
$37.73
|
| Rate for Payer: PHP Commercial |
$228.72
|
| Rate for Payer: PHP Medicare Advantage |
$37.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.90
|
| Rate for Payer: Priority Health Medicare |
$37.73
|
| Rate for Payer: Priority Health SBD |
$169.52
|
| Rate for Payer: Railroad Medicare Medicare |
$37.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$106.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$37.73
|
| Rate for Payer: UHC Exchange |
$72.11
|
| Rate for Payer: UHC Medicare Advantage |
$37.73
|
| Rate for Payer: UHCCP Medicaid |
$20.22
|
| Rate for Payer: UMR Bronson Commercial |
$99.56
|
| Rate for Payer: VA VA |
$37.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$201.81
|
|
|
HC PEDS AUTOIMM ENCEPH CNS, CMPT 4
|
Facility
|
IP
|
$269.08
|
|
|
Service Code
|
CPT 86363
|
| Hospital Charge Code |
30200500
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$118.40 |
| Max. Negotiated Rate |
$242.17 |
| Rate for Payer: Aetna American Axle |
$174.90
|
| Rate for Payer: Aetna Commercial |
$228.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.90
|
| Rate for Payer: Cash Price |
$215.26
|
| Rate for Payer: Cofinity Commercial |
$188.36
|
| Rate for Payer: Cofinity Commercial |
$231.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$188.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.26
|
| Rate for Payer: Healthscope Commercial |
$242.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$188.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$201.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$228.72
|
| Rate for Payer: PHP Commercial |
$228.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.90
|
| Rate for Payer: Priority Health SBD |
$169.52
|
| Rate for Payer: UMR Bronson Commercial |
$118.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$201.81
|
|
|
HC PEDS AUTOIMM ENCEPH CNS, CMPT 4
|
Facility
|
OP
|
$269.08
|
|
|
Service Code
|
CPT 86363
|
| Hospital Charge Code |
30200500
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.22 |
| Max. Negotiated Rate |
$242.17 |
| Rate for Payer: Aetna American Axle |
$174.90
|
| Rate for Payer: Aetna Commercial |
$228.72
|
| Rate for Payer: Aetna Medicare |
$39.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47.16
|
| Rate for Payer: BCBS Complete |
$21.23
|
| Rate for Payer: BCBS MAPPO |
$37.73
|
| Rate for Payer: BCN Medicare Advantage |
$37.73
|
| Rate for Payer: Cash Price |
$215.26
|
| Rate for Payer: Cash Price |
$215.26
|
| Rate for Payer: Cofinity Commercial |
$231.41
|
| Rate for Payer: Cofinity Commercial |
$188.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$188.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.73
|
| Rate for Payer: Healthscope Commercial |
$242.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$188.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$201.81
|
| Rate for Payer: Mclaren Medicaid |
$20.22
|
| Rate for Payer: Mclaren Medicare |
$37.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.62
|
| Rate for Payer: Meridian Medicaid |
$21.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$228.72
|
| Rate for Payer: PACE Medicare |
$35.84
|
| Rate for Payer: PACE SWMI |
$37.73
|
| Rate for Payer: PHP Commercial |
$228.72
|
| Rate for Payer: PHP Medicare Advantage |
$37.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.90
|
| Rate for Payer: Priority Health Medicare |
$37.73
|
| Rate for Payer: Priority Health SBD |
$169.52
|
| Rate for Payer: Railroad Medicare Medicare |
$37.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$106.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$37.73
|
| Rate for Payer: UHC Exchange |
$72.11
|
| Rate for Payer: UHC Medicare Advantage |
$37.73
|
| Rate for Payer: UHCCP Medicaid |
$20.22
|
| Rate for Payer: UMR Bronson Commercial |
$99.56
|
| Rate for Payer: VA VA |
$37.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$201.81
|
|
|
HC PEDS ECHO COMPLETE
|
Facility
|
IP
|
$2,008.38
|
|
|
Service Code
|
CPT 93306
|
| Hospital Charge Code |
48300005
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$883.69 |
| Max. Negotiated Rate |
$1,807.54 |
| Rate for Payer: Aetna American Axle |
$1,305.45
|
| Rate for Payer: Aetna Commercial |
$1,707.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,305.45
|
| Rate for Payer: Cash Price |
$1,606.70
|
| Rate for Payer: Cofinity Commercial |
$1,405.87
|
| Rate for Payer: Cofinity Commercial |
$1,727.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,405.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,606.70
|
| Rate for Payer: Healthscope Commercial |
$1,807.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,405.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,506.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,707.12
|
| Rate for Payer: PHP Commercial |
$1,707.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,305.45
|
| Rate for Payer: Priority Health SBD |
$1,265.28
|
| Rate for Payer: UMR Bronson Commercial |
$883.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,506.29
|
|
|
HC PEDS ECHO COMPLETE
|
Facility
|
OP
|
$2,008.38
|
|
|
Service Code
|
CPT 93306
|
| Hospital Charge Code |
48300005
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$286.63 |
| Max. Negotiated Rate |
$1,807.54 |
| Rate for Payer: Aetna American Axle |
$1,305.45
|
| Rate for Payer: Aetna Commercial |
$1,707.12
|
| Rate for Payer: Aetna Medicare |
$556.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,305.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$668.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$668.44
|
| Rate for Payer: BCBS Complete |
$300.96
|
| Rate for Payer: BCBS MAPPO |
$534.75
|
| Rate for Payer: BCN Medicare Advantage |
$534.75
|
| Rate for Payer: Cash Price |
$1,606.70
|
| Rate for Payer: Cash Price |
$1,606.70
|
| Rate for Payer: Cash Price |
$1,606.70
|
| Rate for Payer: Cofinity Commercial |
$1,405.87
|
| Rate for Payer: Cofinity Commercial |
$1,727.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,405.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,606.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$534.75
|
| Rate for Payer: Healthscope Commercial |
$1,807.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,405.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,506.29
|
| Rate for Payer: Mclaren Medicaid |
$286.63
|
| Rate for Payer: Mclaren Medicare |
$534.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$561.49
|
| Rate for Payer: Meridian Medicaid |
$300.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$614.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,707.12
|
| Rate for Payer: PACE Medicare |
$508.01
|
| Rate for Payer: PACE SWMI |
$534.75
|
| Rate for Payer: PHP Commercial |
$1,707.12
|
| Rate for Payer: PHP Medicare Advantage |
$534.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$286.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,305.45
|
| Rate for Payer: Priority Health Medicare |
$534.75
|
| Rate for Payer: Priority Health SBD |
$1,265.28
|
| Rate for Payer: Railroad Medicare Medicare |
$534.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,505.27
|
| Rate for Payer: UHC Core |
$816.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$534.75
|
| Rate for Payer: UHC Exchange |
$1,021.96
|
| Rate for Payer: UHC Medicare Advantage |
$534.75
|
| Rate for Payer: UHCCP Medicaid |
$286.63
|
| Rate for Payer: UMR Bronson Commercial |
$743.10
|
| Rate for Payer: VA VA |
$534.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,506.29
|
|
|
HC PEDS ECHO LIMITED
|
Facility
|
OP
|
$825.55
|
|
|
Service Code
|
CPT 93308
|
| Hospital Charge Code |
48300006
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$126.36 |
| Max. Negotiated Rate |
$816.00 |
| Rate for Payer: Aetna American Axle |
$536.61
|
| Rate for Payer: Aetna Commercial |
$701.72
|
| Rate for Payer: Aetna Medicare |
$245.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$536.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$294.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$294.68
|
| Rate for Payer: BCBS Complete |
$132.67
|
| Rate for Payer: BCBS MAPPO |
$235.74
|
| Rate for Payer: BCN Medicare Advantage |
$235.74
|
| Rate for Payer: Cash Price |
$660.44
|
| Rate for Payer: Cash Price |
$660.44
|
| Rate for Payer: Cash Price |
$660.44
|
| Rate for Payer: Cofinity Commercial |
$577.88
|
| Rate for Payer: Cofinity Commercial |
$709.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$577.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$660.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.74
|
| Rate for Payer: Healthscope Commercial |
$743.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$577.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$619.16
|
| Rate for Payer: Mclaren Medicaid |
$126.36
|
| Rate for Payer: Mclaren Medicare |
$235.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$247.53
|
| Rate for Payer: Meridian Medicaid |
$132.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$271.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$701.72
|
| Rate for Payer: PACE Medicare |
$223.95
|
| Rate for Payer: PACE SWMI |
$235.74
|
| Rate for Payer: PHP Commercial |
$701.72
|
| Rate for Payer: PHP Medicare Advantage |
$235.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$536.61
|
| Rate for Payer: Priority Health Medicare |
$235.74
|
| Rate for Payer: Priority Health SBD |
$520.10
|
| Rate for Payer: Railroad Medicare Medicare |
$235.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$663.58
|
| Rate for Payer: UHC Core |
$816.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.74
|
| Rate for Payer: UHC Exchange |
$450.52
|
| Rate for Payer: UHC Medicare Advantage |
$235.74
|
| Rate for Payer: UHCCP Medicaid |
$126.36
|
| Rate for Payer: UMR Bronson Commercial |
$305.45
|
| Rate for Payer: VA VA |
$235.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$619.16
|
|
|
HC PEDS ECHO LIMITED
|
Facility
|
IP
|
$825.55
|
|
|
Service Code
|
CPT 93308
|
| Hospital Charge Code |
48300006
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$363.24 |
| Max. Negotiated Rate |
$743.00 |
| Rate for Payer: Aetna American Axle |
$536.61
|
| Rate for Payer: Aetna Commercial |
$701.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$536.61
|
| Rate for Payer: Cash Price |
$660.44
|
| Rate for Payer: Cofinity Commercial |
$577.88
|
| Rate for Payer: Cofinity Commercial |
$709.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$577.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$660.44
|
| Rate for Payer: Healthscope Commercial |
$743.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$577.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$619.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$701.72
|
| Rate for Payer: PHP Commercial |
$701.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$536.61
|
| Rate for Payer: Priority Health SBD |
$520.10
|
| Rate for Payer: UMR Bronson Commercial |
$363.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$619.16
|
|
|
HC PEDS ECHO W/DEFINITY
|
Facility
|
OP
|
$1,663.84
|
|
|
Service Code
|
HCPCS C8921
|
| Hospital Charge Code |
48000028
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$413.00 |
| Max. Negotiated Rate |
$2,168.96 |
| Rate for Payer: Aetna American Axle |
$1,081.50
|
| Rate for Payer: Aetna Commercial |
$1,414.26
|
| Rate for Payer: Aetna Medicare |
$801.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,081.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$963.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$963.16
|
| Rate for Payer: BCBS Complete |
$433.65
|
| Rate for Payer: BCBS MAPPO |
$770.53
|
| Rate for Payer: BCN Medicare Advantage |
$770.53
|
| Rate for Payer: Cash Price |
$1,331.07
|
| Rate for Payer: Cash Price |
$1,331.07
|
| Rate for Payer: Cash Price |
$1,331.07
|
| Rate for Payer: Cofinity Commercial |
$1,164.69
|
| Rate for Payer: Cofinity Commercial |
$1,430.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,164.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,331.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$770.53
|
| Rate for Payer: Healthscope Commercial |
$1,497.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,164.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,247.88
|
| Rate for Payer: Mclaren Medicaid |
$413.00
|
| Rate for Payer: Mclaren Medicare |
$770.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$809.06
|
| Rate for Payer: Meridian Medicaid |
$433.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$886.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,414.26
|
| Rate for Payer: PACE Medicare |
$732.00
|
| Rate for Payer: PACE SWMI |
$770.53
|
| Rate for Payer: PHP Commercial |
$1,414.26
|
| Rate for Payer: PHP Medicare Advantage |
$770.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$413.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,081.50
|
| Rate for Payer: Priority Health Medicare |
$770.53
|
| Rate for Payer: Priority Health SBD |
$1,048.22
|
| Rate for Payer: Railroad Medicare Medicare |
$770.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,168.96
|
| Rate for Payer: UHC Core |
$816.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$770.53
|
| Rate for Payer: UHC Exchange |
$1,472.56
|
| Rate for Payer: UHC Medicare Advantage |
$770.53
|
| Rate for Payer: UHCCP Medicaid |
$413.00
|
| Rate for Payer: UMR Bronson Commercial |
$615.62
|
| Rate for Payer: VA VA |
$770.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,247.88
|
|
