|
HALOPERIDOL LACTATE 2 MG/ML ORAL CONCENTRATE
|
Facility
|
IP
|
$249.66
|
|
|
Service Code
|
NDC 54838050140
|
| Hospital Charge Code |
3585
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$109.85 |
| Max. Negotiated Rate |
$224.69 |
| Rate for Payer: Aetna American Axle |
$162.28
|
| Rate for Payer: Aetna Commercial |
$212.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.28
|
| Rate for Payer: Cash Price |
$199.73
|
| Rate for Payer: Cofinity Advantage |
$174.76
|
| Rate for Payer: Cofinity Commercial |
$214.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.73
|
| Rate for Payer: Healthscope Commercial |
$224.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$174.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$187.25
|
| Rate for Payer: PHP Commercial |
$212.21
|
| Rate for Payer: Priority Health SBD |
$157.29
|
| Rate for Payer: UMR Bronson Commercial |
$109.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.25
|
|
|
HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$10.53
|
|
|
Service Code
|
HCPCS J1630
|
| Hospital Charge Code |
3584
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$9.48 |
| Rate for Payer: Aetna American Axle |
$6.84
|
| Rate for Payer: Aetna American Axle |
$154.67
|
| Rate for Payer: Aetna American Axle |
$10.27
|
| Rate for Payer: Aetna American Axle |
$8.37
|
| Rate for Payer: Aetna American Axle |
$15.66
|
| Rate for Payer: Aetna Commercial |
$8.95
|
| Rate for Payer: Aetna Commercial |
$10.95
|
| Rate for Payer: Aetna Commercial |
$20.48
|
| Rate for Payer: Aetna Commercial |
$202.26
|
| Rate for Payer: Aetna Commercial |
$13.43
|
| Rate for Payer: Aetna Medicare |
$12.04
|
| Rate for Payer: Aetna Medicare |
$6.44
|
| Rate for Payer: Aetna Medicare |
$5.26
|
| Rate for Payer: Aetna Medicare |
$7.90
|
| Rate for Payer: Aetna Medicare |
$118.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$154.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.66
|
| Rate for Payer: BCBS Complete |
$95.18
|
| Rate for Payer: BCBS Complete |
$4.21
|
| Rate for Payer: BCBS Complete |
$5.15
|
| Rate for Payer: BCBS Complete |
$6.32
|
| Rate for Payer: BCBS Complete |
$9.64
|
| Rate for Payer: BCBS Trust/PPO |
$2.36
|
| Rate for Payer: BCBS Trust/PPO |
$2.36
|
| Rate for Payer: BCBS Trust/PPO |
$2.36
|
| Rate for Payer: BCBS Trust/PPO |
$2.36
|
| Rate for Payer: BCBS Trust/PPO |
$2.36
|
| Rate for Payer: BCN Commercial |
$2.36
|
| Rate for Payer: BCN Commercial |
$2.36
|
| Rate for Payer: BCN Commercial |
$2.36
|
| Rate for Payer: BCN Commercial |
$2.36
|
| Rate for Payer: BCN Commercial |
$2.36
|
| Rate for Payer: Cash Price |
$190.36
|
| Rate for Payer: Cash Price |
$19.27
|
| Rate for Payer: Cash Price |
$10.30
|
| Rate for Payer: Cash Price |
$8.42
|
| Rate for Payer: Cash Price |
$12.64
|
| Rate for Payer: Cash Price |
$8.42
|
| Rate for Payer: Cash Price |
$12.64
|
| Rate for Payer: Cash Price |
$190.36
|
| Rate for Payer: Cash Price |
$10.30
|
| Rate for Payer: Cash Price |
$19.27
|
| Rate for Payer: Cofinity Advantage |
$166.56
|
| Rate for Payer: Cofinity Advantage |
$9.02
|
| Rate for Payer: Cofinity Advantage |
$11.06
|
| Rate for Payer: Cofinity Advantage |
$16.86
|
| Rate for Payer: Cofinity Advantage |
$7.37
|
| Rate for Payer: Cofinity Commercial |
$204.64
|
| Rate for Payer: Cofinity Commercial |
$9.06
|
| Rate for Payer: Cofinity Commercial |
$11.08
|
| Rate for Payer: Cofinity Commercial |
$13.59
|
| Rate for Payer: Cofinity Commercial |
$20.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.64
|
| Rate for Payer: Healthscope Commercial |
$14.22
|
| Rate for Payer: Healthscope Commercial |
$21.68
|
| Rate for Payer: Healthscope Commercial |
$214.16
|
| Rate for Payer: Healthscope Commercial |
$9.48
|
| Rate for Payer: Healthscope Commercial |
$11.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$166.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$178.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$190.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$202.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$178.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.07
|
| Rate for Payer: PHP Commercial |
$10.95
|
| Rate for Payer: PHP Commercial |
$13.43
|
| Rate for Payer: PHP Commercial |
$20.48
|
| Rate for Payer: PHP Commercial |
$202.26
|
| Rate for Payer: PHP Commercial |
$8.95
|
| Rate for Payer: Priority Health SBD |
$9.95
|
| Rate for Payer: Priority Health SBD |
$6.63
|
| Rate for Payer: Priority Health SBD |
$149.91
|
| Rate for Payer: Priority Health SBD |
$15.18
|
| Rate for Payer: Priority Health SBD |
$8.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.20
|
| Rate for Payer: UHC Core |
$1.20
|
| Rate for Payer: UHC Core |
$1.20
|
| Rate for Payer: UHC Core |
$1.20
|
| Rate for Payer: UHC Core |
$1.20
|
| Rate for Payer: UHC Core |
$1.20
|
| Rate for Payer: UHC Exchange |
$1.20
|
| Rate for Payer: UHC Exchange |
$1.20
|
| Rate for Payer: UHC Exchange |
$1.20
|
| Rate for Payer: UHC Exchange |
$1.20
|
| Rate for Payer: UHC Exchange |
$1.20
|
| Rate for Payer: UMR Bronson Commercial |
$3.90
|
| Rate for Payer: UMR Bronson Commercial |
$88.04
|
| Rate for Payer: UMR Bronson Commercial |
$5.85
|
| Rate for Payer: UMR Bronson Commercial |
$8.91
|
| Rate for Payer: UMR Bronson Commercial |
$4.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$178.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.90
|
|
|
HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$237.95
|
|
|
Service Code
|
HCPCS J1630
|
| Hospital Charge Code |
3584
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$104.70 |
| Max. Negotiated Rate |
$214.16 |
| Rate for Payer: Aetna American Axle |
$154.67
|
| Rate for Payer: Aetna American Axle |
$10.27
|
| Rate for Payer: Aetna American Axle |
$15.66
|
| Rate for Payer: Aetna American Axle |
$8.37
|
| Rate for Payer: Aetna American Axle |
$6.84
|
| Rate for Payer: Aetna Commercial |
$8.95
|
| Rate for Payer: Aetna Commercial |
$13.43
|
| Rate for Payer: Aetna Commercial |
$202.26
|
| Rate for Payer: Aetna Commercial |
$20.48
|
| Rate for Payer: Aetna Commercial |
$10.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$154.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.66
|
| Rate for Payer: Cash Price |
$12.64
|
| Rate for Payer: Cash Price |
$10.30
|
| Rate for Payer: Cash Price |
$19.27
|
| Rate for Payer: Cash Price |
$190.36
|
| Rate for Payer: Cash Price |
$8.42
|
| Rate for Payer: Cofinity Advantage |
$7.37
|
| Rate for Payer: Cofinity Advantage |
$16.86
|
| Rate for Payer: Cofinity Advantage |
$9.02
|
| Rate for Payer: Cofinity Advantage |
$166.56
|
| Rate for Payer: Cofinity Advantage |
$11.06
|
| Rate for Payer: Cofinity Commercial |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$9.06
|
| Rate for Payer: Cofinity Commercial |
$11.08
|
| Rate for Payer: Cofinity Commercial |
$13.59
|
| Rate for Payer: Cofinity Commercial |
$204.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.27
|
| Rate for Payer: Healthscope Commercial |
$9.48
|
| Rate for Payer: Healthscope Commercial |
$11.59
|
| Rate for Payer: Healthscope Commercial |
$14.22
|
| Rate for Payer: Healthscope Commercial |
$214.16
|
| Rate for Payer: Healthscope Commercial |
$21.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$166.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$178.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$202.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$178.46
|
| Rate for Payer: PHP Commercial |
$13.43
|
| Rate for Payer: PHP Commercial |
$8.95
|
| Rate for Payer: PHP Commercial |
$202.26
|
| Rate for Payer: PHP Commercial |
$20.48
|
| Rate for Payer: PHP Commercial |
$10.95
|
| Rate for Payer: Priority Health SBD |
$149.91
|
| Rate for Payer: Priority Health SBD |
$15.18
|
| Rate for Payer: Priority Health SBD |
$8.11
|
| Rate for Payer: Priority Health SBD |
$6.63
|
| Rate for Payer: Priority Health SBD |
$9.95
|
| Rate for Payer: UMR Bronson Commercial |
$5.67
|
| Rate for Payer: UMR Bronson Commercial |
$10.60
|
| Rate for Payer: UMR Bronson Commercial |
$6.95
|
| Rate for Payer: UMR Bronson Commercial |
$4.63
|
| Rate for Payer: UMR Bronson Commercial |
$104.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$178.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.66
|
|
|
HAND AND WRIST PROCEDURES
|
Facility
|
IP
|
$12,579.86
|
|
|
Service Code
|
APR-DRG 3163
|
| Min. Negotiated Rate |
$11,980.82 |
| Max. Negotiated Rate |
$12,579.86 |
| Rate for Payer: BCBS Complete |
$12,579.86
|
| Rate for Payer: Mclaren Medicaid |
$11,980.82
|
| Rate for Payer: Meridian Medicaid |
$12,579.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,980.82
|
| Rate for Payer: UHC Medicaid |
$11,980.82
|
| Rate for Payer: UHCCP Medicaid |
$11,980.82
|
|
|
HAND AND WRIST PROCEDURES
|
Facility
|
IP
|
$17,823.19
|
|
|
Service Code
|
APR-DRG 3164
|
| Min. Negotiated Rate |
$16,974.47 |
| Max. Negotiated Rate |
$17,823.19 |
| Rate for Payer: BCBS Complete |
$17,823.19
|
| Rate for Payer: Mclaren Medicaid |
$16,974.47
|
| Rate for Payer: Meridian Medicaid |
$17,823.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$16,974.47
|
| Rate for Payer: UHC Medicaid |
$16,974.47
|
| Rate for Payer: UHCCP Medicaid |
$16,974.47
|
|
|
HAND AND WRIST PROCEDURES
|
Facility
|
IP
|
$8,121.04
|
|
|
Service Code
|
APR-DRG 3162
|
| Min. Negotiated Rate |
$7,734.32 |
| Max. Negotiated Rate |
$8,121.04 |
| Rate for Payer: BCBS Complete |
$8,121.04
|
| Rate for Payer: Mclaren Medicaid |
$7,734.32
|
| Rate for Payer: Meridian Medicaid |
$8,121.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,734.32
|
| Rate for Payer: UHC Medicaid |
$7,734.32
|
| Rate for Payer: UHCCP Medicaid |
$7,734.32
|
|
|
HAND AND WRIST PROCEDURES
|
Facility
|
IP
|
$7,405.55
|
|
|
Service Code
|
APR-DRG 3161
|
| Min. Negotiated Rate |
$7,052.90 |
| Max. Negotiated Rate |
$7,405.55 |
| Rate for Payer: BCBS Complete |
$7,405.55
|
| Rate for Payer: Mclaren Medicaid |
$7,052.90
|
| Rate for Payer: Meridian Medicaid |
$7,405.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,052.90
|
| Rate for Payer: UHC Medicaid |
$7,052.90
|
| Rate for Payer: UHCCP Medicaid |
$7,052.90
|
|
|
HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$28,700.02
|
|
|
Service Code
|
MSDRG 513
|
| Min. Negotiated Rate |
$13,070.43 |
| Max. Negotiated Rate |
$28,700.02 |
| Rate for Payer: Aetna Medicare |
$14,308.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17,197.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17,197.94
|
| Rate for Payer: BCBS MAPPO |
$13,758.35
|
| Rate for Payer: BCBS Trust/PPO |
$28,700.02
|
| Rate for Payer: BCN Commercial |
$28,700.02
|
| Rate for Payer: BCN Medicare Advantage |
$13,758.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,758.35
|
| Rate for Payer: Mclaren Medicare |
$13,758.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14,446.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,822.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$15,134.18
|
| Rate for Payer: Nomi Health Commercial |
$20,308.47
|
| Rate for Payer: PACE Medicare |
$13,070.43
|
| Rate for Payer: PACE SWMI |
$13,758.35
|
| Rate for Payer: PHP Medicare Advantage |
$13,758.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$25,381.09
|
| Rate for Payer: Priority Health Medicare |
$13,758.35
|
| Rate for Payer: Priority Health Tiered Network |
$20,304.86
|
| Rate for Payer: Railroad Medicare Medicare |
$13,758.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25,661.09
|
| Rate for Payer: UHC Core |
$21,468.73
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13,758.35
|
| Rate for Payer: UHC Exchange |
$17,532.98
|
| Rate for Payer: VA VA |
$13,758.35
|
|
|
HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$20,195.70
|
|
|
Service Code
|
MSDRG 514
|
| Min. Negotiated Rate |
$8,685.06 |
| Max. Negotiated Rate |
$20,195.70 |
| Rate for Payer: Aetna Medicare |
$9,507.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,427.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,427.71
|
| Rate for Payer: BCBS MAPPO |
$9,142.17
|
| Rate for Payer: BCBS Trust/PPO |
$20,195.70
|
| Rate for Payer: BCN Commercial |
$20,195.70
|
| Rate for Payer: BCN Medicare Advantage |
$9,142.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,142.17
|
| Rate for Payer: Mclaren Medicare |
$9,142.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9,599.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,513.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$10,056.39
|
| Rate for Payer: Nomi Health Commercial |
$13,187.67
|
| Rate for Payer: PACE Medicare |
$8,685.06
|
| Rate for Payer: PACE SWMI |
$9,142.17
|
| Rate for Payer: PHP Medicare Advantage |
$9,142.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$16,481.66
|
| Rate for Payer: Priority Health Medicare |
$9,142.17
|
| Rate for Payer: Priority Health Tiered Network |
$13,185.33
|
| Rate for Payer: Railroad Medicare Medicare |
$9,142.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,663.49
|
| Rate for Payer: UHC Core |
$13,941.11
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9,142.17
|
| Rate for Payer: UHC Exchange |
$11,385.36
|
| Rate for Payer: VA VA |
$9,142.17
|
|
|
HAND PROCEDURES FOR INJURIES
|
Facility
|
IP
|
$43,394.54
|
|
|
Service Code
|
MSDRG 906
|
| Min. Negotiated Rate |
$16,168.82 |
| Max. Negotiated Rate |
$43,394.54 |
| Rate for Payer: Aetna Medicare |
$17,700.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,274.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,274.76
|
| Rate for Payer: BCBS MAPPO |
$17,019.81
|
| Rate for Payer: BCBS Trust/PPO |
$43,394.54
|
| Rate for Payer: BCN Commercial |
$43,394.54
|
| Rate for Payer: BCN Medicare Advantage |
$17,019.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,019.81
|
| Rate for Payer: Mclaren Medicare |
$17,019.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17,870.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,572.78
|
| Rate for Payer: Molina Medicare/Medicaid |
$18,721.79
|
| Rate for Payer: Nomi Health Commercial |
$22,734.96
|
| Rate for Payer: PACE Medicare |
$16,168.82
|
| Rate for Payer: PACE SWMI |
$17,019.81
|
| Rate for Payer: PHP Medicare Advantage |
$17,019.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$31,668.72
|
| Rate for Payer: Priority Health Medicare |
$17,019.81
|
| Rate for Payer: Priority Health Tiered Network |
$25,334.97
|
| Rate for Payer: Railroad Medicare Medicare |
$17,019.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28,727.12
|
| Rate for Payer: UHC Core |
$24,033.85
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17,019.81
|
| Rate for Payer: UHC Exchange |
$19,627.85
|
| Rate for Payer: VA VA |
$17,019.81
|
|
|
HC 11 DEOXYCORTISOL
|
Facility
|
IP
|
$66.86
|
|
|
Service Code
|
CPT 82634
|
| Hospital Charge Code |
30100189
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.42 |
| Max. Negotiated Rate |
$60.17 |
| Rate for Payer: Aetna American Axle |
$43.46
|
| Rate for Payer: Aetna Commercial |
$56.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.46
|
| Rate for Payer: Cash Price |
$53.49
|
| Rate for Payer: Cofinity Advantage |
$46.80
|
| Rate for Payer: Cofinity Commercial |
$57.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.49
|
| Rate for Payer: Healthscope Commercial |
$60.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.15
|
| Rate for Payer: PHP Commercial |
$56.83
|
| Rate for Payer: Priority Health SBD |
$42.12
|
| Rate for Payer: UMR Bronson Commercial |
$29.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.15
|
|
|
HC 11 DEOXYCORTISOL
|
Facility
|
OP
|
$66.86
|
|
|
Service Code
|
CPT 82634
|
| Hospital Charge Code |
30100189
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.31 |
| Max. Negotiated Rate |
$60.17 |
| Rate for Payer: Aetna American Axle |
$43.46
|
| Rate for Payer: Aetna Commercial |
$56.83
|
| Rate for Payer: Aetna Medicare |
$30.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.60
|
| Rate for Payer: BCBS Complete |
$16.08
|
| Rate for Payer: BCBS MAPPO |
$29.28
|
| Rate for Payer: BCBS Trust/PPO |
$33.85
|
| Rate for Payer: BCN Commercial |
$33.85
|
| Rate for Payer: BCN Medicare Advantage |
$29.28
|
| Rate for Payer: Cash Price |
$53.49
|
| Rate for Payer: Cash Price |
$53.49
|
| Rate for Payer: Cofinity Advantage |
$46.80
|
| Rate for Payer: Cofinity Commercial |
$57.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.28
|
| Rate for Payer: Healthscope Commercial |
$60.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.15
|
| Rate for Payer: Mclaren Medicaid |
$29.28
|
| Rate for Payer: Mclaren Medicare |
$29.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.74
|
| Rate for Payer: Meridian Medicaid |
$30.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$32.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.83
|
| Rate for Payer: Nomi Health Commercial |
$43.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.15
|
| Rate for Payer: PACE Medicare |
$27.82
|
| Rate for Payer: PACE SWMI |
$29.28
|
| Rate for Payer: PHP Commercial |
$56.83
|
| Rate for Payer: PHP Medicare Advantage |
$29.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$29.28
|
| Rate for Payer: Priority Health Medicare |
$29.28
|
| Rate for Payer: Priority Health SBD |
$42.12
|
| Rate for Payer: Priority Health Tiered Network |
$23.42
|
| Rate for Payer: Railroad Medicare Medicare |
$29.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.92
|
| Rate for Payer: UHC Core |
$43.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$29.28
|
| Rate for Payer: UHC Exchange |
$43.92
|
| Rate for Payer: UHC Medicaid |
$15.31
|
| Rate for Payer: UHCCP Medicaid |
$15.31
|
| Rate for Payer: UMR Bronson Commercial |
$24.74
|
| Rate for Payer: VA VA |
$29.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.15
|
|
|
HC 1/2 X 1/2 STERILE W/LL
|
Facility
|
IP
|
$7.03
|
|
| Hospital Charge Code |
27000680
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.09 |
| Max. Negotiated Rate |
$6.33 |
| Rate for Payer: Aetna American Axle |
$4.57
|
| Rate for Payer: Aetna Commercial |
$5.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.57
|
| Rate for Payer: Cash Price |
$5.62
|
| Rate for Payer: Cofinity Advantage |
$4.92
|
| Rate for Payer: Cofinity Commercial |
$6.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.62
|
| Rate for Payer: Healthscope Commercial |
$6.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.27
|
| Rate for Payer: PHP Commercial |
$5.98
|
| Rate for Payer: Priority Health SBD |
$4.43
|
| Rate for Payer: UMR Bronson Commercial |
$3.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.27
|
|
|
HC 1/2 X 1/2 STERILE W/LL
|
Facility
|
OP
|
$7.03
|
|
| Hospital Charge Code |
27000680
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.60 |
| Max. Negotiated Rate |
$6.33 |
| Rate for Payer: Aetna American Axle |
$4.57
|
| Rate for Payer: Aetna Commercial |
$5.98
|
| Rate for Payer: Aetna Medicare |
$3.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.57
|
| Rate for Payer: BCBS Complete |
$2.81
|
| Rate for Payer: Cash Price |
$5.62
|
| Rate for Payer: Cofinity Advantage |
$4.92
|
| Rate for Payer: Cofinity Commercial |
$6.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.62
|
| Rate for Payer: Healthscope Commercial |
$6.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.27
|
| Rate for Payer: PHP Commercial |
$5.98
|
| Rate for Payer: Priority Health SBD |
$4.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.57
|
| Rate for Payer: UHC Core |
$3.66
|
| Rate for Payer: UHC Exchange |
$2.76
|
| Rate for Payer: UMR Bronson Commercial |
$2.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.27
|
|
|
HC 20CM TL CATHETER
|
Facility
|
OP
|
$283.98
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200007
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$105.07 |
| Max. Negotiated Rate |
$255.58 |
| Rate for Payer: Aetna American Axle |
$184.59
|
| Rate for Payer: Aetna Commercial |
$241.38
|
| Rate for Payer: Aetna Medicare |
$141.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.59
|
| Rate for Payer: BCBS Complete |
$113.59
|
| Rate for Payer: Cash Price |
$227.18
|
| Rate for Payer: Cofinity Advantage |
$198.79
|
| Rate for Payer: Cofinity Commercial |
$244.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.18
|
| Rate for Payer: Healthscope Commercial |
$255.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$198.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$212.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$227.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$212.99
|
| Rate for Payer: PHP Commercial |
$241.38
|
| Rate for Payer: Priority Health SBD |
$178.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$184.59
|
| Rate for Payer: UHC Core |
$147.95
|
| Rate for Payer: UHC Exchange |
$111.60
|
| Rate for Payer: UMR Bronson Commercial |
$105.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$212.99
|
|
|
HC 20CM TL CATHETER
|
Facility
|
IP
|
$283.98
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200007
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$124.95 |
| Max. Negotiated Rate |
$255.58 |
| Rate for Payer: Aetna American Axle |
$184.59
|
| Rate for Payer: Aetna Commercial |
$241.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.59
|
| Rate for Payer: Cash Price |
$227.18
|
| Rate for Payer: Cofinity Advantage |
$198.79
|
| Rate for Payer: Cofinity Commercial |
$244.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.18
|
| Rate for Payer: Healthscope Commercial |
$255.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$198.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$212.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$212.99
|
| Rate for Payer: PHP Commercial |
$241.38
|
| Rate for Payer: Priority Health SBD |
$178.91
|
| Rate for Payer: UMR Bronson Commercial |
$124.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$212.99
|
|
|
HC 23BPG, U
|
Facility
|
IP
|
$76.41
|
|
|
Service Code
|
CPT 84150
|
| Hospital Charge Code |
30100714
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.62 |
| Max. Negotiated Rate |
$68.77 |
| Rate for Payer: Aetna American Axle |
$49.67
|
| Rate for Payer: Aetna Commercial |
$64.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.67
|
| Rate for Payer: Cash Price |
$61.13
|
| Rate for Payer: Cofinity Advantage |
$53.49
|
| Rate for Payer: Cofinity Commercial |
$65.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.13
|
| Rate for Payer: Healthscope Commercial |
$68.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$53.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.31
|
| Rate for Payer: PHP Commercial |
$64.95
|
| Rate for Payer: Priority Health SBD |
$48.14
|
| Rate for Payer: UMR Bronson Commercial |
$33.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.31
|
|
|
HC 23BPG, U
|
Facility
|
OP
|
$76.41
|
|
|
Service Code
|
CPT 84150
|
| Hospital Charge Code |
30100714
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.85 |
| Max. Negotiated Rate |
$68.77 |
| Rate for Payer: Aetna American Axle |
$49.67
|
| Rate for Payer: Aetna Commercial |
$64.95
|
| Rate for Payer: Aetna Medicare |
$43.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52.21
|
| Rate for Payer: BCBS Complete |
$22.94
|
| Rate for Payer: BCBS MAPPO |
$41.77
|
| Rate for Payer: BCBS Trust/PPO |
$48.29
|
| Rate for Payer: BCN Commercial |
$48.29
|
| Rate for Payer: BCN Medicare Advantage |
$41.77
|
| Rate for Payer: Cash Price |
$61.13
|
| Rate for Payer: Cash Price |
$61.13
|
| Rate for Payer: Cofinity Advantage |
$53.49
|
| Rate for Payer: Cofinity Commercial |
$65.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.77
|
| Rate for Payer: Healthscope Commercial |
$68.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$53.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.31
|
| Rate for Payer: Mclaren Medicaid |
$41.77
|
| Rate for Payer: Mclaren Medicare |
$41.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43.86
|
| Rate for Payer: Meridian Medicaid |
$43.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$45.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.95
|
| Rate for Payer: Nomi Health Commercial |
$62.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.31
|
| Rate for Payer: PACE Medicare |
$39.68
|
| Rate for Payer: PACE SWMI |
$41.77
|
| Rate for Payer: PHP Commercial |
$64.95
|
| Rate for Payer: PHP Medicare Advantage |
$41.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$41.77
|
| Rate for Payer: Priority Health Medicare |
$41.77
|
| Rate for Payer: Priority Health SBD |
$48.14
|
| Rate for Payer: Priority Health Tiered Network |
$33.42
|
| Rate for Payer: Railroad Medicare Medicare |
$41.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.66
|
| Rate for Payer: UHC Core |
$62.66
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$41.77
|
| Rate for Payer: UHC Exchange |
$62.66
|
| Rate for Payer: UHC Medicaid |
$21.85
|
| Rate for Payer: UHCCP Medicaid |
$21.85
|
| Rate for Payer: UMR Bronson Commercial |
$28.27
|
| Rate for Payer: VA VA |
$41.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.31
|
|
|
HC 23BPR URINE
|
Facility
|
OP
|
$88.65
|
|
|
Service Code
|
CPT 84150
|
| Hospital Charge Code |
30100735
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.85 |
| Max. Negotiated Rate |
$79.78 |
| Rate for Payer: Aetna American Axle |
$57.62
|
| Rate for Payer: Aetna Commercial |
$75.35
|
| Rate for Payer: Aetna Medicare |
$43.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52.21
|
| Rate for Payer: BCBS Complete |
$22.94
|
| Rate for Payer: BCBS MAPPO |
$41.77
|
| Rate for Payer: BCBS Trust/PPO |
$48.29
|
| Rate for Payer: BCN Commercial |
$48.29
|
| Rate for Payer: BCN Medicare Advantage |
$41.77
|
| Rate for Payer: Cash Price |
$70.92
|
| Rate for Payer: Cash Price |
$70.92
|
| Rate for Payer: Cofinity Advantage |
$62.05
|
| Rate for Payer: Cofinity Commercial |
$76.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.77
|
| Rate for Payer: Healthscope Commercial |
$79.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$62.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.49
|
| Rate for Payer: Mclaren Medicaid |
$41.77
|
| Rate for Payer: Mclaren Medicare |
$41.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43.86
|
| Rate for Payer: Meridian Medicaid |
$43.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$45.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.35
|
| Rate for Payer: Nomi Health Commercial |
$62.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.49
|
| Rate for Payer: PACE Medicare |
$39.68
|
| Rate for Payer: PACE SWMI |
$41.77
|
| Rate for Payer: PHP Commercial |
$75.35
|
| Rate for Payer: PHP Medicare Advantage |
$41.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$41.77
|
| Rate for Payer: Priority Health Medicare |
$41.77
|
| Rate for Payer: Priority Health SBD |
$55.85
|
| Rate for Payer: Priority Health Tiered Network |
$33.42
|
| Rate for Payer: Railroad Medicare Medicare |
$41.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.66
|
| Rate for Payer: UHC Core |
$62.66
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$41.77
|
| Rate for Payer: UHC Exchange |
$62.66
|
| Rate for Payer: UHC Medicaid |
$21.85
|
| Rate for Payer: UHCCP Medicaid |
$21.85
|
| Rate for Payer: UMR Bronson Commercial |
$32.80
|
| Rate for Payer: VA VA |
$41.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.49
|
|
|
HC 23BPR URINE
|
Facility
|
IP
|
$88.65
|
|
|
Service Code
|
CPT 84150
|
| Hospital Charge Code |
30100735
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$39.01 |
| Max. Negotiated Rate |
$79.78 |
| Rate for Payer: Aetna American Axle |
$57.62
|
| Rate for Payer: Aetna Commercial |
$75.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.62
|
| Rate for Payer: Cash Price |
$70.92
|
| Rate for Payer: Cofinity Advantage |
$62.05
|
| Rate for Payer: Cofinity Commercial |
$76.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.92
|
| Rate for Payer: Healthscope Commercial |
$79.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$62.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.49
|
| Rate for Payer: PHP Commercial |
$75.35
|
| Rate for Payer: Priority Health SBD |
$55.85
|
| Rate for Payer: UMR Bronson Commercial |
$39.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.49
|
|
|
HC 24 HOUR PH MONITOR
|
Facility
|
OP
|
$1,583.18
|
|
|
Service Code
|
CPT 91034
|
| Hospital Charge Code |
75000001
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$194.46 |
| Max. Negotiated Rate |
$1,424.86 |
| Rate for Payer: Aetna American Axle |
$1,029.07
|
| Rate for Payer: Aetna Commercial |
$1,345.70
|
| Rate for Payer: Aetna Medicare |
$386.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,029.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$464.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$464.77
|
| Rate for Payer: BCBS Complete |
$204.20
|
| Rate for Payer: BCBS MAPPO |
$371.82
|
| Rate for Payer: BCBS Trust/PPO |
$584.69
|
| Rate for Payer: BCN Commercial |
$584.69
|
| Rate for Payer: BCN Medicare Advantage |
$371.82
|
| Rate for Payer: Cash Price |
$1,266.54
|
| Rate for Payer: Cash Price |
$1,266.54
|
| Rate for Payer: Cofinity Advantage |
$1,108.23
|
| Rate for Payer: Cofinity Commercial |
$1,361.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,266.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$371.82
|
| Rate for Payer: Healthscope Commercial |
$1,424.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,108.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,187.38
|
| Rate for Payer: Mclaren Medicaid |
$371.82
|
| Rate for Payer: Mclaren Medicare |
$371.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$390.41
|
| Rate for Payer: Meridian Medicaid |
$390.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$427.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$409.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,345.70
|
| Rate for Payer: Nomi Health Commercial |
$1,115.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,187.38
|
| Rate for Payer: PACE Medicare |
$353.23
|
| Rate for Payer: PACE SWMI |
$371.82
|
| Rate for Payer: PHP Commercial |
$1,345.70
|
| Rate for Payer: PHP Medicare Advantage |
$371.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$194.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,202.41
|
| Rate for Payer: Priority Health Medicare |
$371.82
|
| Rate for Payer: Priority Health SBD |
$997.40
|
| Rate for Payer: Priority Health Tiered Network |
$961.93
|
| Rate for Payer: Railroad Medicare Medicare |
$371.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$371.82
|
| Rate for Payer: UHC Medicaid |
$194.46
|
| Rate for Payer: UHCCP Medicaid |
$194.46
|
| Rate for Payer: UMR Bronson Commercial |
$585.78
|
| Rate for Payer: VA VA |
$371.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,187.38
|
|
|
HC 24 HOUR PH MONITOR
|
Facility
|
IP
|
$1,583.18
|
|
|
Service Code
|
CPT 91034
|
| Hospital Charge Code |
75000001
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$696.60 |
| Max. Negotiated Rate |
$1,424.86 |
| Rate for Payer: Aetna American Axle |
$1,029.07
|
| Rate for Payer: Aetna Commercial |
$1,345.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,029.07
|
| Rate for Payer: Cash Price |
$1,266.54
|
| Rate for Payer: Cofinity Advantage |
$1,108.23
|
| Rate for Payer: Cofinity Commercial |
$1,361.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,266.54
|
| Rate for Payer: Healthscope Commercial |
$1,424.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,108.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,187.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,345.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,187.38
|
| Rate for Payer: PHP Commercial |
$1,345.70
|
| Rate for Payer: Priority Health SBD |
$997.40
|
| Rate for Payer: UMR Bronson Commercial |
$696.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,187.38
|
|
|
HC 2D ECHOCARDIOGRAM LIMITED STUDY
|
Facility
|
IP
|
$842.06
|
|
|
Service Code
|
CPT 93308
|
| Hospital Charge Code |
48300002
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$370.51 |
| Max. Negotiated Rate |
$757.85 |
| Rate for Payer: Aetna American Axle |
$547.34
|
| Rate for Payer: Aetna Commercial |
$715.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$547.34
|
| Rate for Payer: Cash Price |
$673.65
|
| Rate for Payer: Cofinity Advantage |
$589.44
|
| Rate for Payer: Cofinity Commercial |
$724.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$673.65
|
| Rate for Payer: Healthscope Commercial |
$757.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$589.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$631.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$715.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$631.54
|
| Rate for Payer: PHP Commercial |
$715.75
|
| Rate for Payer: Priority Health SBD |
$530.50
|
| Rate for Payer: UMR Bronson Commercial |
$370.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$631.54
|
|
|
HC 2D ECHOCARDIOGRAM LIMITED STUDY
|
Facility
|
OP
|
$842.06
|
|
|
Service Code
|
CPT 93308
|
| Hospital Charge Code |
48300002
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$124.34 |
| Max. Negotiated Rate |
$768.83 |
| Rate for Payer: Aetna American Axle |
$547.34
|
| Rate for Payer: Aetna Commercial |
$715.75
|
| Rate for Payer: Aetna Medicare |
$247.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$547.34
|
| 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 |
$308.55
|
| Rate for Payer: BCN Commercial |
$308.55
|
| Rate for Payer: BCN Medicare Advantage |
$237.74
|
| Rate for Payer: Cash Price |
$673.65
|
| Rate for Payer: Cash Price |
$673.65
|
| Rate for Payer: Cofinity Advantage |
$589.44
|
| Rate for Payer: Cofinity Commercial |
$724.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$673.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$237.74
|
| Rate for Payer: Healthscope Commercial |
$757.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$589.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$631.54
|
| 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 |
$715.75
|
| Rate for Payer: Nomi Health Commercial |
$713.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$631.54
|
| Rate for Payer: PACE Medicare |
$225.85
|
| Rate for Payer: PACE SWMI |
$237.74
|
| Rate for Payer: PHP Commercial |
$715.75
|
| 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 |
$530.50
|
| 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) |
$547.34
|
| Rate for Payer: UHC Core |
$438.71
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$237.74
|
| Rate for Payer: UHC Exchange |
$330.93
|
| Rate for Payer: UHC Medicaid |
$124.34
|
| Rate for Payer: UHCCP Medicaid |
$124.34
|
| Rate for Payer: UMR Bronson Commercial |
$311.56
|
| Rate for Payer: VA VA |
$237.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$631.54
|
|
|
HC 2 PIECE WAFER
|
Facility
|
IP
|
$13.69
|
|
| Hospital Charge Code |
27100001
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$6.02 |
| Max. Negotiated Rate |
$12.32 |
| Rate for Payer: Aetna American Axle |
$8.90
|
| Rate for Payer: Aetna Commercial |
$11.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.90
|
| Rate for Payer: Cash Price |
$10.95
|
| Rate for Payer: Cofinity Advantage |
$9.58
|
| Rate for Payer: Cofinity Commercial |
$11.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.95
|
| Rate for Payer: Healthscope Commercial |
$12.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.27
|
| Rate for Payer: PHP Commercial |
$11.64
|
| Rate for Payer: Priority Health SBD |
$8.62
|
| Rate for Payer: UMR Bronson Commercial |
$6.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.27
|
|
