|
HC DSDNA AB WITH REFLEX, IGG, S
|
Facility
|
IP
|
$38.74
|
|
|
Service Code
|
CPT 86225
|
| Hospital Charge Code |
30200505
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.05 |
| Max. Negotiated Rate |
$34.87 |
| Rate for Payer: Aetna American Axle |
$25.18
|
| Rate for Payer: Aetna Commercial |
$32.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.18
|
| Rate for Payer: Cash Price |
$30.99
|
| Rate for Payer: Cofinity Commercial |
$27.12
|
| Rate for Payer: Cofinity Commercial |
$33.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.99
|
| Rate for Payer: Healthscope Commercial |
$34.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.93
|
| Rate for Payer: PHP Commercial |
$32.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.12
|
| Rate for Payer: Priority Health SBD |
$24.41
|
| Rate for Payer: UMR Bronson Commercial |
$17.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.06
|
|
|
HC DSDNA AB WITH REFLEX, IGG, S
|
Facility
|
OP
|
$38.74
|
|
|
Service Code
|
CPT 86225
|
| Hospital Charge Code |
30200505
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.52 |
| Max. Negotiated Rate |
$34.87 |
| Rate for Payer: Aetna American Axle |
$25.18
|
| Rate for Payer: Aetna Commercial |
$32.93
|
| Rate for Payer: Aetna Medicare |
$14.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.18
|
| Rate for Payer: BCBS Complete |
$7.89
|
| Rate for Payer: BCBS MAPPO |
$13.74
|
| Rate for Payer: BCBS Trust/PPO |
$12.36
|
| Rate for Payer: BCN Medicare Advantage |
$13.74
|
| Rate for Payer: Cash Price |
$30.99
|
| Rate for Payer: Cash Price |
$30.99
|
| Rate for Payer: Cofinity Commercial |
$33.32
|
| Rate for Payer: Cofinity Commercial |
$27.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.74
|
| Rate for Payer: Healthscope Commercial |
$34.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.06
|
| Rate for Payer: Mclaren Medicaid |
$7.52
|
| Rate for Payer: Mclaren Medicare |
$13.74
|
| Rate for Payer: Meridian Medicaid |
$7.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.93
|
| Rate for Payer: PACE Medicare |
$13.05
|
| Rate for Payer: PACE SWMI |
$13.74
|
| Rate for Payer: PHP Commercial |
$32.93
|
| Rate for Payer: PHP Medicare Advantage |
$13.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.97
|
| Rate for Payer: Priority Health Medicare |
$13.74
|
| Rate for Payer: Priority Health Narrow Network |
$12.78
|
| Rate for Payer: Priority Health SBD |
$24.41
|
| Rate for Payer: Railroad Medicare Medicare |
$13.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.49
|
| Rate for Payer: UHC Core |
$22.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.74
|
| Rate for Payer: UHC Exchange |
$13.74
|
| Rate for Payer: UHC Medicare Advantage |
$14.15
|
| Rate for Payer: UMR Bronson Commercial |
$14.33
|
| Rate for Payer: VA VA |
$13.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.06
|
|
|
HC DSMA TC 99M PER STUDY
|
Facility
|
OP
|
$381.09
|
|
|
Service Code
|
HCPCS A9551
|
| Hospital Charge Code |
34300004
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$141.00 |
| Max. Negotiated Rate |
$342.98 |
| Rate for Payer: Aetna American Axle |
$247.71
|
| Rate for Payer: Aetna Commercial |
$323.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$247.71
|
| Rate for Payer: BCBS Complete |
$152.44
|
| Rate for Payer: BCBS Trust/PPO |
$187.65
|
| Rate for Payer: Cash Price |
$304.87
|
| Rate for Payer: Cash Price |
$304.87
|
| Rate for Payer: Cofinity Commercial |
$266.76
|
| Rate for Payer: Cofinity Commercial |
$327.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.87
|
| Rate for Payer: Healthscope Commercial |
$342.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$266.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$285.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$323.93
|
| Rate for Payer: PHP Commercial |
$323.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.76
|
| Rate for Payer: Priority Health SBD |
$240.09
|
| Rate for Payer: UMR Bronson Commercial |
$141.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$285.82
|
|
|
HC DSMA TC 99M PER STUDY
|
Facility
|
IP
|
$381.09
|
|
|
Service Code
|
HCPCS A9551
|
| Hospital Charge Code |
34300004
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$167.68 |
| Max. Negotiated Rate |
$342.98 |
| Rate for Payer: Aetna American Axle |
$247.71
|
| Rate for Payer: Aetna Commercial |
$323.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$247.71
|
| Rate for Payer: Cash Price |
$304.87
|
| Rate for Payer: Cofinity Commercial |
$266.76
|
| Rate for Payer: Cofinity Commercial |
$327.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.87
|
| Rate for Payer: Healthscope Commercial |
$342.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$266.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$285.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$323.93
|
| Rate for Payer: PHP Commercial |
$323.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.76
|
| Rate for Payer: Priority Health SBD |
$240.09
|
| Rate for Payer: UMR Bronson Commercial |
$167.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$285.82
|
|
|
HC DTAP HEPB IPV VACCINE INTRAMUSCULAR
|
Facility
|
OP
|
$172.74
|
|
|
Service Code
|
CPT 90723
|
| Hospital Charge Code |
63600137
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$63.91 |
| Max. Negotiated Rate |
$285.20 |
| Rate for Payer: Aetna American Axle |
$112.28
|
| Rate for Payer: Aetna Commercial |
$146.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.28
|
| Rate for Payer: BCBS Complete |
$69.10
|
| Rate for Payer: BCBS Trust/PPO |
$285.20
|
| Rate for Payer: Cash Price |
$138.19
|
| Rate for Payer: Cash Price |
$138.19
|
| Rate for Payer: Cofinity Commercial |
$148.56
|
| Rate for Payer: Cofinity Commercial |
$120.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.19
|
| Rate for Payer: Healthscope Commercial |
$155.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$120.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$129.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$146.83
|
| Rate for Payer: PHP Commercial |
$146.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$101.94
|
| Rate for Payer: Priority Health Narrow Network |
$81.55
|
| Rate for Payer: Priority Health SBD |
$108.83
|
| Rate for Payer: UMR Bronson Commercial |
$63.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$129.56
|
|
|
HC DTAP HEPB IPV VACCINE INTRAMUSCULAR
|
Facility
|
IP
|
$172.74
|
|
|
Service Code
|
CPT 90723
|
| Hospital Charge Code |
63600137
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$76.01 |
| Max. Negotiated Rate |
$155.47 |
| Rate for Payer: Aetna American Axle |
$112.28
|
| Rate for Payer: Aetna Commercial |
$146.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.28
|
| Rate for Payer: Cash Price |
$138.19
|
| Rate for Payer: Cofinity Commercial |
$120.92
|
| Rate for Payer: Cofinity Commercial |
$148.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.19
|
| Rate for Payer: Healthscope Commercial |
$155.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$120.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$129.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$146.83
|
| Rate for Payer: PHP Commercial |
$146.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.92
|
| Rate for Payer: Priority Health SBD |
$108.83
|
| Rate for Payer: UMR Bronson Commercial |
$76.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$129.56
|
|
|
HC DTAP-IPV VACCINE 4-6 YEARS IM
|
Facility
|
IP
|
$75.17
|
|
|
Service Code
|
CPT 90696
|
| Hospital Charge Code |
63600120
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.07 |
| Max. Negotiated Rate |
$67.65 |
| Rate for Payer: Aetna American Axle |
$48.86
|
| Rate for Payer: Aetna Commercial |
$63.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.86
|
| Rate for Payer: Cash Price |
$60.14
|
| Rate for Payer: Cofinity Commercial |
$64.65
|
| Rate for Payer: Cofinity Commercial |
$52.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.14
|
| Rate for Payer: Healthscope Commercial |
$67.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.89
|
| Rate for Payer: PHP Commercial |
$63.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.62
|
| Rate for Payer: Priority Health SBD |
$47.36
|
| Rate for Payer: UMR Bronson Commercial |
$33.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.38
|
|
|
HC DTAP-IPV VACCINE 4-6 YEARS IM
|
Facility
|
OP
|
$75.17
|
|
|
Service Code
|
CPT 90696
|
| Hospital Charge Code |
63600120
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.81 |
| Max. Negotiated Rate |
$190.02 |
| Rate for Payer: Aetna American Axle |
$48.86
|
| Rate for Payer: Aetna Commercial |
$63.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.86
|
| Rate for Payer: BCBS Complete |
$30.07
|
| Rate for Payer: BCBS Trust/PPO |
$190.02
|
| Rate for Payer: Cash Price |
$60.14
|
| Rate for Payer: Cash Price |
$60.14
|
| Rate for Payer: Cofinity Commercial |
$52.62
|
| Rate for Payer: Cofinity Commercial |
$64.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.14
|
| Rate for Payer: Healthscope Commercial |
$67.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.89
|
| Rate for Payer: PHP Commercial |
$63.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.62
|
| Rate for Payer: Priority Health SBD |
$47.36
|
| Rate for Payer: UMR Bronson Commercial |
$27.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.38
|
|
|
HC DTAP-IVP-HIB-HEPB INTRAMUSCULAR
|
Facility
|
OP
|
$163.20
|
|
|
Service Code
|
CPT 90697
|
| Hospital Charge Code |
63600207
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$60.38 |
| Max. Negotiated Rate |
$555.08 |
| Rate for Payer: Aetna American Axle |
$106.08
|
| Rate for Payer: Aetna Commercial |
$138.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.08
|
| Rate for Payer: BCBS Complete |
$65.28
|
| Rate for Payer: BCBS Trust/PPO |
$555.08
|
| Rate for Payer: Cash Price |
$130.56
|
| Rate for Payer: Cash Price |
$130.56
|
| Rate for Payer: Cofinity Commercial |
$114.24
|
| Rate for Payer: Cofinity Commercial |
$140.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.56
|
| Rate for Payer: Healthscope Commercial |
$146.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$114.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$122.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$138.72
|
| Rate for Payer: PHP Commercial |
$138.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$166.26
|
| Rate for Payer: Priority Health Narrow Network |
$133.01
|
| Rate for Payer: Priority Health SBD |
$102.82
|
| Rate for Payer: UMR Bronson Commercial |
$60.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$122.40
|
|
|
HC DTAP-IVP-HIB-HEPB INTRAMUSCULAR
|
Facility
|
IP
|
$163.20
|
|
|
Service Code
|
CPT 90697
|
| Hospital Charge Code |
63600207
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$71.81 |
| Max. Negotiated Rate |
$146.88 |
| Rate for Payer: Aetna American Axle |
$106.08
|
| Rate for Payer: Aetna Commercial |
$138.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.08
|
| Rate for Payer: Cash Price |
$130.56
|
| Rate for Payer: Cofinity Commercial |
$114.24
|
| Rate for Payer: Cofinity Commercial |
$140.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.56
|
| Rate for Payer: Healthscope Commercial |
$146.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$114.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$122.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$138.72
|
| Rate for Payer: PHP Commercial |
$138.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.24
|
| Rate for Payer: Priority Health SBD |
$102.82
|
| Rate for Payer: UMR Bronson Commercial |
$71.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$122.40
|
|
|
HC DTPA PER STUDY
|
Facility
|
OP
|
$166.83
|
|
|
Service Code
|
HCPCS A9539
|
| Hospital Charge Code |
34300005
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$61.73 |
| Max. Negotiated Rate |
$150.15 |
| Rate for Payer: Aetna American Axle |
$108.44
|
| Rate for Payer: Aetna Commercial |
$141.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.44
|
| Rate for Payer: BCBS Complete |
$66.73
|
| Rate for Payer: BCBS Trust/PPO |
$68.67
|
| Rate for Payer: Cash Price |
$133.46
|
| Rate for Payer: Cash Price |
$133.46
|
| Rate for Payer: Cofinity Commercial |
$116.78
|
| Rate for Payer: Cofinity Commercial |
$143.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.46
|
| Rate for Payer: Healthscope Commercial |
$150.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$116.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$125.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$141.81
|
| Rate for Payer: PHP Commercial |
$141.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.78
|
| Rate for Payer: Priority Health SBD |
$105.10
|
| Rate for Payer: UMR Bronson Commercial |
$61.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$125.12
|
|
|
HC DTPA PER STUDY
|
Facility
|
IP
|
$166.83
|
|
|
Service Code
|
HCPCS A9539
|
| Hospital Charge Code |
34300005
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$73.41 |
| Max. Negotiated Rate |
$150.15 |
| Rate for Payer: Aetna American Axle |
$108.44
|
| Rate for Payer: Aetna Commercial |
$141.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.44
|
| Rate for Payer: Cash Price |
$133.46
|
| Rate for Payer: Cofinity Commercial |
$116.78
|
| Rate for Payer: Cofinity Commercial |
$143.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.46
|
| Rate for Payer: Healthscope Commercial |
$150.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$116.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$125.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$141.81
|
| Rate for Payer: PHP Commercial |
$141.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.78
|
| Rate for Payer: Priority Health SBD |
$105.10
|
| Rate for Payer: UMR Bronson Commercial |
$73.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$125.12
|
|
|
HC DUAL LEAD INSERTION
|
Facility
|
OP
|
$12,461.13
|
|
|
Service Code
|
CPT 33217
|
| Hospital Charge Code |
36100066
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$356.91 |
| Max. Negotiated Rate |
$23,772.84 |
| Rate for Payer: Aetna American Axle |
$8,099.73
|
| Rate for Payer: Aetna Commercial |
$10,591.96
|
| Rate for Payer: Aetna Medicare |
$7,853.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,099.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,439.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,439.52
|
| Rate for Payer: BCBS Complete |
$4,337.65
|
| Rate for Payer: BCBS MAPPO |
$7,551.62
|
| Rate for Payer: BCBS Trust/PPO |
$8,111.94
|
| Rate for Payer: BCN Medicare Advantage |
$7,551.62
|
| Rate for Payer: Cash Price |
$9,968.90
|
| Rate for Payer: Cash Price |
$9,968.90
|
| Rate for Payer: Cofinity Commercial |
$8,722.79
|
| Rate for Payer: Cofinity Commercial |
$10,716.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,968.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,551.62
|
| Rate for Payer: Healthscope Commercial |
$11,215.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8,722.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,345.85
|
| Rate for Payer: Mclaren Medicaid |
$4,130.74
|
| Rate for Payer: Mclaren Medicare |
$7,551.62
|
| Rate for Payer: Meridian Medicaid |
$4,337.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,929.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,684.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10,591.96
|
| Rate for Payer: PACE Medicare |
$7,174.04
|
| Rate for Payer: PACE SWMI |
$7,551.62
|
| Rate for Payer: PHP Commercial |
$10,591.96
|
| Rate for Payer: PHP Medicare Advantage |
$7,551.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,130.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,722.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23,772.84
|
| Rate for Payer: Priority Health Medicare |
$7,551.62
|
| Rate for Payer: Priority Health Narrow Network |
$19,018.27
|
| Rate for Payer: Priority Health SBD |
$7,850.51
|
| Rate for Payer: Railroad Medicare Medicare |
$7,551.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$392.60
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,551.62
|
| Rate for Payer: UHC Exchange |
$356.91
|
| Rate for Payer: UHC Medicare Advantage |
$7,778.17
|
| Rate for Payer: UMR Bronson Commercial |
$4,610.62
|
| Rate for Payer: VA VA |
$7,551.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,345.85
|
|
|
HC DUAL LEAD INSERTION
|
Facility
|
IP
|
$12,461.13
|
|
|
Service Code
|
CPT 33217
|
| Hospital Charge Code |
36100066
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,482.90 |
| Max. Negotiated Rate |
$11,215.02 |
| Rate for Payer: Aetna American Axle |
$8,099.73
|
| Rate for Payer: Aetna Commercial |
$10,591.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,099.73
|
| Rate for Payer: Cash Price |
$9,968.90
|
| Rate for Payer: Cofinity Commercial |
$10,716.57
|
| Rate for Payer: Cofinity Commercial |
$8,722.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,968.90
|
| Rate for Payer: Healthscope Commercial |
$11,215.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8,722.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,345.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10,591.96
|
| Rate for Payer: PHP Commercial |
$10,591.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,722.79
|
| Rate for Payer: Priority Health SBD |
$7,850.51
|
| Rate for Payer: UMR Bronson Commercial |
$5,482.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,345.85
|
|
|
HC DUCK FEATHERS IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200083
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.95 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna American Axle |
$16.18
|
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.18
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$17.42
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health SBD |
$15.68
|
| Rate for Payer: UMR Bronson Commercial |
$10.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.67
|
|
|
HC DUCK FEATHERS IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200083
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna American Axle |
$16.18
|
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.18
|
| 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 |
$3.00
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$4.70
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$17.42
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.67
|
| Rate for Payer: Mclaren Medicaid |
$2.86
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Medicaid |
$3.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7.16
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$5.73
|
| Rate for Payer: Priority Health SBD |
$15.68
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.26
|
| Rate for Payer: UHC Core |
$8.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$5.22
|
| Rate for Payer: UHC Medicare Advantage |
$5.38
|
| Rate for Payer: UMR Bronson Commercial |
$9.21
|
| Rate for Payer: VA VA |
$5.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.67
|
|
|
HC DUODENOSCOPY/COLONOSCOPY
|
Facility
|
OP
|
$4,313.50
|
|
| Hospital Charge Code |
36000033
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,596.00 |
| Max. Negotiated Rate |
$3,882.15 |
| Rate for Payer: Aetna American Axle |
$2,803.78
|
| Rate for Payer: Aetna Commercial |
$3,666.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,803.78
|
| Rate for Payer: BCBS Complete |
$1,725.40
|
| Rate for Payer: Cash Price |
$3,450.80
|
| Rate for Payer: Cofinity Commercial |
$3,019.45
|
| Rate for Payer: Cofinity Commercial |
$3,709.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,450.80
|
| Rate for Payer: Healthscope Commercial |
$3,882.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,019.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,235.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,666.48
|
| Rate for Payer: PHP Commercial |
$3,666.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,019.45
|
| Rate for Payer: Priority Health SBD |
$2,717.50
|
| Rate for Payer: UMR Bronson Commercial |
$1,596.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,235.12
|
|
|
HC DUODENOSCOPY/COLONOSCOPY
|
Facility
|
IP
|
$4,313.50
|
|
| Hospital Charge Code |
36000033
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,897.94 |
| Max. Negotiated Rate |
$3,882.15 |
| Rate for Payer: Aetna American Axle |
$2,803.78
|
| Rate for Payer: Aetna Commercial |
$3,666.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,803.78
|
| Rate for Payer: Cash Price |
$3,450.80
|
| Rate for Payer: Cofinity Commercial |
$3,019.45
|
| Rate for Payer: Cofinity Commercial |
$3,709.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,450.80
|
| Rate for Payer: Healthscope Commercial |
$3,882.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,019.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,235.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,666.48
|
| Rate for Payer: PHP Commercial |
$3,666.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,019.45
|
| Rate for Payer: Priority Health SBD |
$2,717.50
|
| Rate for Payer: UMR Bronson Commercial |
$1,897.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,235.12
|
|
|
HC DUODENOSCOPY (EGD)
|
Facility
|
IP
|
$2,150.57
|
|
| Hospital Charge Code |
36000029
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$946.25 |
| Max. Negotiated Rate |
$1,935.51 |
| Rate for Payer: Aetna American Axle |
$1,397.87
|
| Rate for Payer: Aetna Commercial |
$1,827.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,397.87
|
| Rate for Payer: Cash Price |
$1,720.46
|
| Rate for Payer: Cofinity Commercial |
$1,505.40
|
| Rate for Payer: Cofinity Commercial |
$1,849.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,720.46
|
| Rate for Payer: Healthscope Commercial |
$1,935.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,505.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,612.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,827.98
|
| Rate for Payer: PHP Commercial |
$1,827.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,505.40
|
| Rate for Payer: Priority Health SBD |
$1,354.86
|
| Rate for Payer: UMR Bronson Commercial |
$946.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,612.93
|
|
|
HC DUODENOSCOPY (EGD)
|
Facility
|
OP
|
$2,150.57
|
|
| Hospital Charge Code |
36000029
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$795.71 |
| Max. Negotiated Rate |
$1,935.51 |
| Rate for Payer: Aetna American Axle |
$1,397.87
|
| Rate for Payer: Aetna Commercial |
$1,827.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,397.87
|
| Rate for Payer: BCBS Complete |
$860.23
|
| Rate for Payer: Cash Price |
$1,720.46
|
| Rate for Payer: Cofinity Commercial |
$1,505.40
|
| Rate for Payer: Cofinity Commercial |
$1,849.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,720.46
|
| Rate for Payer: Healthscope Commercial |
$1,935.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,505.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,612.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,827.98
|
| Rate for Payer: PHP Commercial |
$1,827.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,505.40
|
| Rate for Payer: Priority Health SBD |
$1,354.86
|
| Rate for Payer: UMR Bronson Commercial |
$795.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,612.93
|
|
|
HC DUODENUM/FLEX SIGMOID
|
Facility
|
IP
|
$1,679.56
|
|
| Hospital Charge Code |
36000034
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$739.01 |
| Max. Negotiated Rate |
$1,511.60 |
| Rate for Payer: Aetna American Axle |
$1,091.71
|
| Rate for Payer: Aetna Commercial |
$1,427.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,091.71
|
| Rate for Payer: Cash Price |
$1,343.65
|
| Rate for Payer: Cofinity Commercial |
$1,175.69
|
| Rate for Payer: Cofinity Commercial |
$1,444.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,343.65
|
| Rate for Payer: Healthscope Commercial |
$1,511.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,175.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,259.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,427.63
|
| Rate for Payer: PHP Commercial |
$1,427.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,175.69
|
| Rate for Payer: Priority Health SBD |
$1,058.12
|
| Rate for Payer: UMR Bronson Commercial |
$739.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,259.67
|
|
|
HC DUODENUM/FLEX SIGMOID
|
Facility
|
OP
|
$1,679.56
|
|
| Hospital Charge Code |
36000034
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$621.44 |
| Max. Negotiated Rate |
$1,511.60 |
| Rate for Payer: Aetna American Axle |
$1,091.71
|
| Rate for Payer: Aetna Commercial |
$1,427.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,091.71
|
| Rate for Payer: BCBS Complete |
$671.82
|
| Rate for Payer: Cash Price |
$1,343.65
|
| Rate for Payer: Cofinity Commercial |
$1,175.69
|
| Rate for Payer: Cofinity Commercial |
$1,444.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,343.65
|
| Rate for Payer: Healthscope Commercial |
$1,511.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,175.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,259.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,427.63
|
| Rate for Payer: PHP Commercial |
$1,427.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,175.69
|
| Rate for Payer: Priority Health SBD |
$1,058.12
|
| Rate for Payer: UMR Bronson Commercial |
$621.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,259.67
|
|
|
HC DUODERM CGF 4X4
|
Facility
|
IP
|
$46.79
|
|
| Hospital Charge Code |
27100010
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$20.59 |
| Max. Negotiated Rate |
$42.11 |
| Rate for Payer: Aetna American Axle |
$30.41
|
| Rate for Payer: Aetna Commercial |
$39.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.41
|
| Rate for Payer: Cash Price |
$37.43
|
| Rate for Payer: Cofinity Commercial |
$32.75
|
| Rate for Payer: Cofinity Commercial |
$40.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.43
|
| Rate for Payer: Healthscope Commercial |
$42.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.77
|
| Rate for Payer: PHP Commercial |
$39.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.75
|
| Rate for Payer: Priority Health SBD |
$29.48
|
| Rate for Payer: UMR Bronson Commercial |
$20.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.09
|
|
|
HC DUODERM CGF 4X4
|
Facility
|
OP
|
$46.79
|
|
| Hospital Charge Code |
27100010
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$17.31 |
| Max. Negotiated Rate |
$42.11 |
| Rate for Payer: Aetna American Axle |
$30.41
|
| Rate for Payer: Aetna Commercial |
$39.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.41
|
| Rate for Payer: BCBS Complete |
$18.72
|
| Rate for Payer: Cash Price |
$37.43
|
| Rate for Payer: Cofinity Commercial |
$32.75
|
| Rate for Payer: Cofinity Commercial |
$40.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.43
|
| Rate for Payer: Healthscope Commercial |
$42.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.77
|
| Rate for Payer: PHP Commercial |
$39.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.75
|
| Rate for Payer: Priority Health SBD |
$29.48
|
| Rate for Payer: UMR Bronson Commercial |
$17.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.09
|
|
|
HC DUODERM CGF 6X6
|
Facility
|
OP
|
$74.12
|
|
| Hospital Charge Code |
27100011
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$27.42 |
| Max. Negotiated Rate |
$66.71 |
| Rate for Payer: Aetna American Axle |
$48.18
|
| Rate for Payer: Aetna Commercial |
$63.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.18
|
| Rate for Payer: BCBS Complete |
$29.65
|
| Rate for Payer: Cash Price |
$59.30
|
| Rate for Payer: Cofinity Commercial |
$51.88
|
| Rate for Payer: Cofinity Commercial |
$63.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.30
|
| Rate for Payer: Healthscope Commercial |
$66.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$51.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.00
|
| Rate for Payer: PHP Commercial |
$63.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.88
|
| Rate for Payer: Priority Health SBD |
$46.70
|
| Rate for Payer: UMR Bronson Commercial |
$27.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.59
|
|
