|
HC ALTEPLASE RECOMBINANT, PER 1 MG
|
Facility
|
IP
|
$90.20
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
63600144
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.69 |
| Max. Negotiated Rate |
$81.18 |
| Rate for Payer: Aetna American Axle |
$58.63
|
| Rate for Payer: Aetna Commercial |
$76.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.63
|
| Rate for Payer: Cash Price |
$72.16
|
| Rate for Payer: Cofinity Advantage |
$63.14
|
| Rate for Payer: Cofinity Commercial |
$77.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.16
|
| Rate for Payer: Healthscope Commercial |
$81.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$63.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$67.65
|
| Rate for Payer: PHP Commercial |
$76.67
|
| Rate for Payer: Priority Health SBD |
$56.83
|
| Rate for Payer: UMR Bronson Commercial |
$39.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.65
|
|
|
HC ALTEPLASE RECOMBINANT, PER 1 MG
|
Facility
|
OP
|
$90.20
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
63600144
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.37 |
| Max. Negotiated Rate |
$304.26 |
| Rate for Payer: Aetna American Axle |
$58.63
|
| Rate for Payer: Aetna Commercial |
$76.67
|
| Rate for Payer: Aetna Medicare |
$98.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$118.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$118.86
|
| Rate for Payer: BCBS Complete |
$52.22
|
| Rate for Payer: BCBS MAPPO |
$95.09
|
| Rate for Payer: BCBS Trust/PPO |
$304.26
|
| Rate for Payer: BCN Commercial |
$304.26
|
| Rate for Payer: BCN Medicare Advantage |
$95.09
|
| Rate for Payer: Cash Price |
$72.16
|
| Rate for Payer: Cash Price |
$72.16
|
| Rate for Payer: Cofinity Advantage |
$63.14
|
| Rate for Payer: Cofinity Commercial |
$77.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$95.09
|
| Rate for Payer: Healthscope Commercial |
$81.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$63.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.65
|
| Rate for Payer: Mclaren Medicaid |
$95.09
|
| Rate for Payer: Mclaren Medicare |
$95.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$99.84
|
| Rate for Payer: Meridian Medicaid |
$99.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$109.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$104.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.67
|
| Rate for Payer: Nomi Health Commercial |
$285.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$67.65
|
| Rate for Payer: PACE Medicare |
$90.34
|
| Rate for Payer: PACE SWMI |
$95.09
|
| Rate for Payer: PHP Commercial |
$76.67
|
| Rate for Payer: PHP Medicare Advantage |
$95.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$49.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$297.89
|
| Rate for Payer: Priority Health Medicare |
$95.09
|
| Rate for Payer: Priority Health SBD |
$56.83
|
| Rate for Payer: Priority Health Tiered Network |
$238.31
|
| Rate for Payer: Railroad Medicare Medicare |
$95.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$154.82
|
| Rate for Payer: UHC Core |
$154.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$95.09
|
| Rate for Payer: UHC Exchange |
$154.82
|
| Rate for Payer: UHC Medicaid |
$49.73
|
| Rate for Payer: UHCCP Medicaid |
$49.73
|
| Rate for Payer: UMR Bronson Commercial |
$33.37
|
| Rate for Payer: VA VA |
$95.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.65
|
|
|
HC ALTERNARIA IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200027
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna American Axle |
$16.84
|
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| 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 |
$2.87
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$6.04
|
| Rate for Payer: BCN Commercial |
$6.04
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Advantage |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.43
|
| Rate for Payer: Mclaren Medicaid |
$5.22
|
| 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 |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$7.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.22
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$16.32
|
| Rate for Payer: Priority Health Tiered Network |
$4.18
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.83
|
| Rate for Payer: UHC Core |
$7.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.22
|
| Rate for Payer: UHC Exchange |
$7.83
|
| Rate for Payer: UHC Medicaid |
$2.73
|
| Rate for Payer: UHCCP Medicaid |
$2.73
|
| Rate for Payer: UMR Bronson Commercial |
$9.58
|
| Rate for Payer: VA VA |
$5.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.43
|
|
|
HC ALTERNARIA IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200027
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.40 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna American Axle |
$16.84
|
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Advantage |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: Priority Health SBD |
$16.32
|
| Rate for Payer: UMR Bronson Commercial |
$11.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.43
|
|
|
HC ALUMINUM
|
Facility
|
IP
|
$57.30
|
|
|
Service Code
|
CPT 82108
|
| Hospital Charge Code |
30100088
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.21 |
| Max. Negotiated Rate |
$51.57 |
| Rate for Payer: Aetna American Axle |
$37.24
|
| Rate for Payer: Aetna Commercial |
$48.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.24
|
| Rate for Payer: Cash Price |
$45.84
|
| Rate for Payer: Cofinity Advantage |
$40.11
|
| Rate for Payer: Cofinity Commercial |
$49.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.84
|
| Rate for Payer: Healthscope Commercial |
$51.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$40.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.98
|
| Rate for Payer: PHP Commercial |
$48.70
|
| Rate for Payer: Priority Health SBD |
$36.10
|
| Rate for Payer: UMR Bronson Commercial |
$25.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.98
|
|
|
HC ALUMINUM
|
Facility
|
OP
|
$57.30
|
|
|
Service Code
|
CPT 82108
|
| Hospital Charge Code |
30100088
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.33 |
| Max. Negotiated Rate |
$51.57 |
| Rate for Payer: Aetna American Axle |
$37.24
|
| Rate for Payer: Aetna Commercial |
$48.70
|
| Rate for Payer: Aetna Medicare |
$26.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.85
|
| Rate for Payer: BCBS Complete |
$13.99
|
| Rate for Payer: BCBS MAPPO |
$25.48
|
| Rate for Payer: BCBS Trust/PPO |
$29.45
|
| Rate for Payer: BCN Commercial |
$29.45
|
| Rate for Payer: BCN Medicare Advantage |
$25.48
|
| Rate for Payer: Cash Price |
$45.84
|
| Rate for Payer: Cash Price |
$45.84
|
| Rate for Payer: Cofinity Advantage |
$40.11
|
| Rate for Payer: Cofinity Commercial |
$49.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.48
|
| Rate for Payer: Healthscope Commercial |
$51.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$40.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.98
|
| Rate for Payer: Mclaren Medicaid |
$25.48
|
| Rate for Payer: Mclaren Medicare |
$25.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.75
|
| Rate for Payer: Meridian Medicaid |
$26.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$28.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.70
|
| Rate for Payer: Nomi Health Commercial |
$38.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.98
|
| Rate for Payer: PACE Medicare |
$24.21
|
| Rate for Payer: PACE SWMI |
$25.48
|
| Rate for Payer: PHP Commercial |
$48.70
|
| Rate for Payer: PHP Medicare Advantage |
$25.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$25.48
|
| Rate for Payer: Priority Health Medicare |
$25.48
|
| Rate for Payer: Priority Health SBD |
$36.10
|
| Rate for Payer: Priority Health Tiered Network |
$20.38
|
| Rate for Payer: Railroad Medicare Medicare |
$25.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.22
|
| Rate for Payer: UHC Core |
$38.22
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$25.48
|
| Rate for Payer: UHC Exchange |
$38.22
|
| Rate for Payer: UHC Medicaid |
$13.33
|
| Rate for Payer: UHCCP Medicaid |
$13.33
|
| Rate for Payer: UMR Bronson Commercial |
$21.20
|
| Rate for Payer: VA VA |
$25.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.98
|
|
|
HC AMBIT PUMP
|
Facility
|
OP
|
$657.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
27200396
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$591.30 |
| Rate for Payer: Aetna American Axle |
$427.05
|
| Rate for Payer: Aetna Commercial |
$558.45
|
| Rate for Payer: Aetna Medicare |
$328.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$427.05
|
| Rate for Payer: BCBS Complete |
$262.80
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$525.60
|
| Rate for Payer: Cash Price |
$525.60
|
| Rate for Payer: Cofinity Advantage |
$459.90
|
| Rate for Payer: Cofinity Commercial |
$565.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$525.60
|
| Rate for Payer: Healthscope Commercial |
$591.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$459.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$492.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$525.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$558.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$492.75
|
| Rate for Payer: PHP Commercial |
$558.45
|
| Rate for Payer: Priority Health SBD |
$413.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$427.05
|
| Rate for Payer: UHC Core |
$342.30
|
| Rate for Payer: UHC Exchange |
$258.20
|
| Rate for Payer: UMR Bronson Commercial |
$243.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$492.75
|
|
|
HC AMBIT PUMP
|
Facility
|
IP
|
$657.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
27200396
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$289.08 |
| Max. Negotiated Rate |
$591.30 |
| Rate for Payer: Aetna American Axle |
$427.05
|
| Rate for Payer: Aetna Commercial |
$558.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$427.05
|
| Rate for Payer: Cash Price |
$525.60
|
| Rate for Payer: Cofinity Advantage |
$459.90
|
| Rate for Payer: Cofinity Commercial |
$565.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$525.60
|
| Rate for Payer: Healthscope Commercial |
$591.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$459.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$492.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$558.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$492.75
|
| Rate for Payer: PHP Commercial |
$558.45
|
| Rate for Payer: Priority Health SBD |
$413.91
|
| Rate for Payer: UMR Bronson Commercial |
$289.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$492.75
|
|
|
HC AMIKACIN LEVEL
|
Facility
|
OP
|
$80.02
|
|
|
Service Code
|
CPT 80150
|
| Hospital Charge Code |
30100006
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.89 |
| Max. Negotiated Rate |
$72.02 |
| Rate for Payer: Aetna American Axle |
$52.01
|
| Rate for Payer: Aetna Commercial |
$68.02
|
| Rate for Payer: Aetna Medicare |
$15.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.85
|
| Rate for Payer: BCBS Complete |
$8.28
|
| Rate for Payer: BCBS MAPPO |
$15.08
|
| Rate for Payer: BCBS Trust/PPO |
$17.43
|
| Rate for Payer: BCN Commercial |
$17.43
|
| Rate for Payer: BCN Medicare Advantage |
$15.08
|
| Rate for Payer: Cash Price |
$64.02
|
| Rate for Payer: Cash Price |
$64.02
|
| Rate for Payer: Cofinity Advantage |
$56.01
|
| Rate for Payer: Cofinity Commercial |
$68.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.08
|
| Rate for Payer: Healthscope Commercial |
$72.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.02
|
| Rate for Payer: Mclaren Medicaid |
$15.08
|
| Rate for Payer: Mclaren Medicare |
$15.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.83
|
| Rate for Payer: Meridian Medicaid |
$15.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.34
|
| Rate for Payer: Molina Medicare/Medicaid |
$16.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.02
|
| Rate for Payer: Nomi Health Commercial |
$22.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.02
|
| Rate for Payer: PACE Medicare |
$14.33
|
| Rate for Payer: PACE SWMI |
$15.08
|
| Rate for Payer: PHP Commercial |
$68.02
|
| Rate for Payer: PHP Medicare Advantage |
$15.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$15.08
|
| Rate for Payer: Priority Health Medicare |
$15.08
|
| Rate for Payer: Priority Health SBD |
$50.41
|
| Rate for Payer: Priority Health Tiered Network |
$12.06
|
| Rate for Payer: Railroad Medicare Medicare |
$15.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.62
|
| Rate for Payer: UHC Core |
$22.62
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$15.08
|
| Rate for Payer: UHC Exchange |
$22.62
|
| Rate for Payer: UHC Medicaid |
$7.89
|
| Rate for Payer: UHCCP Medicaid |
$7.89
|
| Rate for Payer: UMR Bronson Commercial |
$29.61
|
| Rate for Payer: VA VA |
$15.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.02
|
|
|
HC AMIKACIN LEVEL
|
Facility
|
IP
|
$80.02
|
|
|
Service Code
|
CPT 80150
|
| Hospital Charge Code |
30100006
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.21 |
| Max. Negotiated Rate |
$72.02 |
| Rate for Payer: Aetna American Axle |
$52.01
|
| Rate for Payer: Aetna Commercial |
$68.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.01
|
| Rate for Payer: Cash Price |
$64.02
|
| Rate for Payer: Cofinity Advantage |
$56.01
|
| Rate for Payer: Cofinity Commercial |
$68.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.02
|
| Rate for Payer: Healthscope Commercial |
$72.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.02
|
| Rate for Payer: PHP Commercial |
$68.02
|
| Rate for Payer: Priority Health SBD |
$50.41
|
| Rate for Payer: UMR Bronson Commercial |
$35.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.02
|
|
|
HC AMINO ACID FRACTIONATION
|
Facility
|
IP
|
$161.30
|
|
|
Service Code
|
CPT 82139
|
| Hospital Charge Code |
30100091
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$70.97 |
| Max. Negotiated Rate |
$145.17 |
| Rate for Payer: Aetna American Axle |
$104.84
|
| Rate for Payer: Aetna Commercial |
$137.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.84
|
| Rate for Payer: Cash Price |
$129.04
|
| Rate for Payer: Cofinity Advantage |
$112.91
|
| Rate for Payer: Cofinity Commercial |
$138.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.04
|
| Rate for Payer: Healthscope Commercial |
$145.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$112.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$120.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.97
|
| Rate for Payer: PHP Commercial |
$137.10
|
| Rate for Payer: Priority Health SBD |
$101.62
|
| Rate for Payer: UMR Bronson Commercial |
$70.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$120.97
|
|
|
HC AMINO ACID FRACTIONATION
|
Facility
|
OP
|
$161.30
|
|
|
Service Code
|
CPT 82139
|
| Hospital Charge Code |
30100091
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.82 |
| Max. Negotiated Rate |
$145.17 |
| Rate for Payer: Aetna American Axle |
$104.84
|
| Rate for Payer: Aetna Commercial |
$137.10
|
| Rate for Payer: Aetna Medicare |
$17.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.09
|
| Rate for Payer: BCBS Complete |
$9.27
|
| Rate for Payer: BCBS MAPPO |
$16.87
|
| Rate for Payer: BCBS Trust/PPO |
$19.50
|
| Rate for Payer: BCN Commercial |
$19.50
|
| Rate for Payer: BCN Medicare Advantage |
$16.87
|
| Rate for Payer: Cash Price |
$129.04
|
| Rate for Payer: Cash Price |
$129.04
|
| Rate for Payer: Cofinity Advantage |
$112.91
|
| Rate for Payer: Cofinity Commercial |
$138.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.87
|
| Rate for Payer: Healthscope Commercial |
$145.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$112.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$120.97
|
| Rate for Payer: Mclaren Medicaid |
$16.87
|
| Rate for Payer: Mclaren Medicare |
$16.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.71
|
| Rate for Payer: Meridian Medicaid |
$17.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$18.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.10
|
| Rate for Payer: Nomi Health Commercial |
$25.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.97
|
| Rate for Payer: PACE Medicare |
$16.03
|
| Rate for Payer: PACE SWMI |
$16.87
|
| Rate for Payer: PHP Commercial |
$137.10
|
| Rate for Payer: PHP Medicare Advantage |
$16.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$16.87
|
| Rate for Payer: Priority Health Medicare |
$16.87
|
| Rate for Payer: Priority Health SBD |
$101.62
|
| Rate for Payer: Priority Health Tiered Network |
$13.50
|
| Rate for Payer: Railroad Medicare Medicare |
$16.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.31
|
| Rate for Payer: UHC Core |
$25.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$16.87
|
| Rate for Payer: UHC Exchange |
$25.31
|
| Rate for Payer: UHC Medicaid |
$8.82
|
| Rate for Payer: UHCCP Medicaid |
$8.82
|
| Rate for Payer: UMR Bronson Commercial |
$59.68
|
| Rate for Payer: VA VA |
$16.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$120.97
|
|
|
HC AMINO ACID QUANT CSF
|
Facility
|
OP
|
$238.77
|
|
|
Service Code
|
CPT 82139
|
| Hospital Charge Code |
30100093
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.82 |
| Max. Negotiated Rate |
$214.89 |
| Rate for Payer: Aetna American Axle |
$155.20
|
| Rate for Payer: Aetna Commercial |
$202.95
|
| Rate for Payer: Aetna Medicare |
$17.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.09
|
| Rate for Payer: BCBS Complete |
$9.27
|
| Rate for Payer: BCBS MAPPO |
$16.87
|
| Rate for Payer: BCBS Trust/PPO |
$19.50
|
| Rate for Payer: BCN Commercial |
$19.50
|
| Rate for Payer: BCN Medicare Advantage |
$16.87
|
| Rate for Payer: Cash Price |
$191.02
|
| Rate for Payer: Cash Price |
$191.02
|
| Rate for Payer: Cofinity Advantage |
$167.14
|
| Rate for Payer: Cofinity Commercial |
$205.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.87
|
| Rate for Payer: Healthscope Commercial |
$214.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$167.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$179.08
|
| Rate for Payer: Mclaren Medicaid |
$16.87
|
| Rate for Payer: Mclaren Medicare |
$16.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.71
|
| Rate for Payer: Meridian Medicaid |
$17.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$18.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$202.95
|
| Rate for Payer: Nomi Health Commercial |
$25.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$179.08
|
| Rate for Payer: PACE Medicare |
$16.03
|
| Rate for Payer: PACE SWMI |
$16.87
|
| Rate for Payer: PHP Commercial |
$202.95
|
| Rate for Payer: PHP Medicare Advantage |
$16.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$16.87
|
| Rate for Payer: Priority Health Medicare |
$16.87
|
| Rate for Payer: Priority Health SBD |
$150.43
|
| Rate for Payer: Priority Health Tiered Network |
$13.50
|
| Rate for Payer: Railroad Medicare Medicare |
$16.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.31
|
| Rate for Payer: UHC Core |
$25.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$16.87
|
| Rate for Payer: UHC Exchange |
$25.31
|
| Rate for Payer: UHC Medicaid |
$8.82
|
| Rate for Payer: UHCCP Medicaid |
$8.82
|
| Rate for Payer: UMR Bronson Commercial |
$88.34
|
| Rate for Payer: VA VA |
$16.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$179.08
|
|
|
HC AMINO ACID QUANT CSF
|
Facility
|
IP
|
$238.77
|
|
|
Service Code
|
CPT 82139
|
| Hospital Charge Code |
30100093
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$105.06 |
| Max. Negotiated Rate |
$214.89 |
| Rate for Payer: Aetna American Axle |
$155.20
|
| Rate for Payer: Aetna Commercial |
$202.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.20
|
| Rate for Payer: Cash Price |
$191.02
|
| Rate for Payer: Cofinity Advantage |
$167.14
|
| Rate for Payer: Cofinity Commercial |
$205.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.02
|
| Rate for Payer: Healthscope Commercial |
$214.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$167.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$179.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$202.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$179.08
|
| Rate for Payer: PHP Commercial |
$202.95
|
| Rate for Payer: Priority Health SBD |
$150.43
|
| Rate for Payer: UMR Bronson Commercial |
$105.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$179.08
|
|
|
HC AMINO ACID QUANT RANDOM URINE
|
Facility
|
IP
|
$217.55
|
|
|
Service Code
|
CPT 82139
|
| Hospital Charge Code |
30100092
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$95.72 |
| Max. Negotiated Rate |
$195.79 |
| Rate for Payer: Aetna American Axle |
$141.41
|
| Rate for Payer: Aetna Commercial |
$184.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.41
|
| Rate for Payer: Cash Price |
$174.04
|
| Rate for Payer: Cofinity Advantage |
$152.28
|
| Rate for Payer: Cofinity Commercial |
$187.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.04
|
| Rate for Payer: Healthscope Commercial |
$195.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$152.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$163.16
|
| Rate for Payer: PHP Commercial |
$184.92
|
| Rate for Payer: Priority Health SBD |
$137.06
|
| Rate for Payer: UMR Bronson Commercial |
$95.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.16
|
|
|
HC AMINO ACID QUANT RANDOM URINE
|
Facility
|
OP
|
$217.55
|
|
|
Service Code
|
CPT 82139
|
| Hospital Charge Code |
30100092
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.82 |
| Max. Negotiated Rate |
$195.79 |
| Rate for Payer: Aetna American Axle |
$141.41
|
| Rate for Payer: Aetna Commercial |
$184.92
|
| Rate for Payer: Aetna Medicare |
$17.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.09
|
| Rate for Payer: BCBS Complete |
$9.27
|
| Rate for Payer: BCBS MAPPO |
$16.87
|
| Rate for Payer: BCBS Trust/PPO |
$19.50
|
| Rate for Payer: BCN Commercial |
$19.50
|
| Rate for Payer: BCN Medicare Advantage |
$16.87
|
| Rate for Payer: Cash Price |
$174.04
|
| Rate for Payer: Cash Price |
$174.04
|
| Rate for Payer: Cofinity Advantage |
$152.28
|
| Rate for Payer: Cofinity Commercial |
$187.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.87
|
| Rate for Payer: Healthscope Commercial |
$195.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$152.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.16
|
| Rate for Payer: Mclaren Medicaid |
$16.87
|
| Rate for Payer: Mclaren Medicare |
$16.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.71
|
| Rate for Payer: Meridian Medicaid |
$17.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$18.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.92
|
| Rate for Payer: Nomi Health Commercial |
$25.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$163.16
|
| Rate for Payer: PACE Medicare |
$16.03
|
| Rate for Payer: PACE SWMI |
$16.87
|
| Rate for Payer: PHP Commercial |
$184.92
|
| Rate for Payer: PHP Medicare Advantage |
$16.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$16.87
|
| Rate for Payer: Priority Health Medicare |
$16.87
|
| Rate for Payer: Priority Health SBD |
$137.06
|
| Rate for Payer: Priority Health Tiered Network |
$13.50
|
| Rate for Payer: Railroad Medicare Medicare |
$16.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.31
|
| Rate for Payer: UHC Core |
$25.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$16.87
|
| Rate for Payer: UHC Exchange |
$25.31
|
| Rate for Payer: UHC Medicaid |
$8.82
|
| Rate for Payer: UHCCP Medicaid |
$8.82
|
| Rate for Payer: UMR Bronson Commercial |
$80.49
|
| Rate for Payer: VA VA |
$16.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.16
|
|
|
HC AMINOLEVULINIC ACID URINE
|
Facility
|
OP
|
$89.47
|
|
|
Service Code
|
CPT 82135
|
| Hospital Charge Code |
30100089
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.60 |
| Max. Negotiated Rate |
$80.52 |
| Rate for Payer: Aetna American Axle |
$58.16
|
| Rate for Payer: Aetna Commercial |
$76.05
|
| Rate for Payer: Aetna Medicare |
$17.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.56
|
| Rate for Payer: BCBS Complete |
$9.03
|
| Rate for Payer: BCBS MAPPO |
$16.45
|
| Rate for Payer: BCBS Trust/PPO |
$19.02
|
| Rate for Payer: BCN Commercial |
$19.02
|
| Rate for Payer: BCN Medicare Advantage |
$16.45
|
| Rate for Payer: Cash Price |
$71.58
|
| Rate for Payer: Cash Price |
$71.58
|
| Rate for Payer: Cofinity Advantage |
$62.63
|
| Rate for Payer: Cofinity Commercial |
$76.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.45
|
| Rate for Payer: Healthscope Commercial |
$80.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$62.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.10
|
| Rate for Payer: Mclaren Medicaid |
$16.45
|
| Rate for Payer: Mclaren Medicare |
$16.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.27
|
| Rate for Payer: Meridian Medicaid |
$17.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$18.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.05
|
| Rate for Payer: Nomi Health Commercial |
$24.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$67.10
|
| Rate for Payer: PACE Medicare |
$15.63
|
| Rate for Payer: PACE SWMI |
$16.45
|
| Rate for Payer: PHP Commercial |
$76.05
|
| Rate for Payer: PHP Medicare Advantage |
$16.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$16.45
|
| Rate for Payer: Priority Health Medicare |
$16.45
|
| Rate for Payer: Priority Health SBD |
$56.37
|
| Rate for Payer: Priority Health Tiered Network |
$13.16
|
| Rate for Payer: Railroad Medicare Medicare |
$16.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.68
|
| Rate for Payer: UHC Core |
$24.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$16.45
|
| Rate for Payer: UHC Exchange |
$24.68
|
| Rate for Payer: UHC Medicaid |
$8.60
|
| Rate for Payer: UHCCP Medicaid |
$8.60
|
| Rate for Payer: UMR Bronson Commercial |
$33.10
|
| Rate for Payer: VA VA |
$16.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.10
|
|
|
HC AMINOLEVULINIC ACID URINE
|
Facility
|
IP
|
$89.47
|
|
|
Service Code
|
CPT 82135
|
| Hospital Charge Code |
30100089
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$39.37 |
| Max. Negotiated Rate |
$80.52 |
| Rate for Payer: Aetna American Axle |
$58.16
|
| Rate for Payer: Aetna Commercial |
$76.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.16
|
| Rate for Payer: Cash Price |
$71.58
|
| Rate for Payer: Cofinity Advantage |
$62.63
|
| Rate for Payer: Cofinity Commercial |
$76.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.58
|
| Rate for Payer: Healthscope Commercial |
$80.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$62.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$67.10
|
| Rate for Payer: PHP Commercial |
$76.05
|
| Rate for Payer: Priority Health SBD |
$56.37
|
| Rate for Payer: UMR Bronson Commercial |
$39.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.10
|
|
|
HC AMIODARONE/CORDARONE LEVEL
|
Facility
|
OP
|
$43.13
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
30100287
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.60 |
| Max. Negotiated Rate |
$38.82 |
| Rate for Payer: Aetna American Axle |
$28.03
|
| Rate for Payer: Aetna Commercial |
$36.66
|
| Rate for Payer: Aetna Medicare |
$25.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.11
|
| Rate for Payer: BCBS Complete |
$13.23
|
| Rate for Payer: BCBS MAPPO |
$24.09
|
| Rate for Payer: BCBS Trust/PPO |
$27.85
|
| Rate for Payer: BCN Commercial |
$27.85
|
| Rate for Payer: BCN Medicare Advantage |
$24.09
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cofinity Advantage |
$30.19
|
| Rate for Payer: Cofinity Commercial |
$37.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.09
|
| Rate for Payer: Healthscope Commercial |
$38.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.35
|
| Rate for Payer: Mclaren Medicaid |
$24.09
|
| Rate for Payer: Mclaren Medicare |
$24.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.29
|
| Rate for Payer: Meridian Medicaid |
$25.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$26.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.66
|
| Rate for Payer: Nomi Health Commercial |
$36.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.35
|
| Rate for Payer: PACE Medicare |
$22.89
|
| Rate for Payer: PACE SWMI |
$24.09
|
| Rate for Payer: PHP Commercial |
$36.66
|
| Rate for Payer: PHP Medicare Advantage |
$24.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$24.09
|
| Rate for Payer: Priority Health Medicare |
$24.09
|
| Rate for Payer: Priority Health SBD |
$27.17
|
| Rate for Payer: Priority Health Tiered Network |
$19.27
|
| Rate for Payer: Railroad Medicare Medicare |
$24.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.14
|
| Rate for Payer: UHC Core |
$36.14
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$24.09
|
| Rate for Payer: UHC Exchange |
$36.14
|
| Rate for Payer: UHC Medicaid |
$12.60
|
| Rate for Payer: UHCCP Medicaid |
$12.60
|
| Rate for Payer: UMR Bronson Commercial |
$15.96
|
| Rate for Payer: VA VA |
$24.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.35
|
|
|
HC AMIODARONE/CORDARONE LEVEL
|
Facility
|
IP
|
$43.13
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
30100287
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.98 |
| Max. Negotiated Rate |
$38.82 |
| Rate for Payer: Aetna American Axle |
$28.03
|
| Rate for Payer: Aetna Commercial |
$36.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.03
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cofinity Advantage |
$30.19
|
| Rate for Payer: Cofinity Commercial |
$37.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.50
|
| Rate for Payer: Healthscope Commercial |
$38.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.35
|
| Rate for Payer: PHP Commercial |
$36.66
|
| Rate for Payer: Priority Health SBD |
$27.17
|
| Rate for Payer: UMR Bronson Commercial |
$18.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.35
|
|
|
HC AMITRIPTYLINE
|
Facility
|
OP
|
$44.74
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
30100563
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.55 |
| Max. Negotiated Rate |
$40.27 |
| Rate for Payer: Aetna American Axle |
$29.08
|
| Rate for Payer: Aetna Commercial |
$38.03
|
| Rate for Payer: Aetna Medicare |
$22.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.08
|
| Rate for Payer: BCBS Complete |
$17.90
|
| Rate for Payer: Cash Price |
$35.79
|
| Rate for Payer: Cofinity Advantage |
$31.32
|
| Rate for Payer: Cofinity Commercial |
$38.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.79
|
| Rate for Payer: Healthscope Commercial |
$40.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.55
|
| Rate for Payer: PHP Commercial |
$38.03
|
| Rate for Payer: Priority Health SBD |
$28.19
|
| Rate for Payer: UMR Bronson Commercial |
$16.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.55
|
|
|
HC AMITRIPTYLINE
|
Facility
|
IP
|
$44.74
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
30100563
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.69 |
| Max. Negotiated Rate |
$40.27 |
| Rate for Payer: Aetna American Axle |
$29.08
|
| Rate for Payer: Aetna Commercial |
$38.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.08
|
| Rate for Payer: Cash Price |
$35.79
|
| Rate for Payer: Cofinity Advantage |
$31.32
|
| Rate for Payer: Cofinity Commercial |
$38.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.79
|
| Rate for Payer: Healthscope Commercial |
$40.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.55
|
| Rate for Payer: PHP Commercial |
$38.03
|
| Rate for Payer: Priority Health SBD |
$28.19
|
| Rate for Payer: UMR Bronson Commercial |
$19.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.55
|
|
|
HC AMMONIA LEVEL
|
Facility
|
OP
|
$50.94
|
|
|
Service Code
|
CPT 82140
|
| Hospital Charge Code |
30100094
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.62 |
| Max. Negotiated Rate |
$45.85 |
| Rate for Payer: Aetna American Axle |
$33.11
|
| Rate for Payer: Aetna Commercial |
$43.30
|
| Rate for Payer: Aetna Medicare |
$15.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.21
|
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: BCBS MAPPO |
$14.57
|
| Rate for Payer: BCBS Trust/PPO |
$16.85
|
| Rate for Payer: BCN Commercial |
$16.85
|
| Rate for Payer: BCN Medicare Advantage |
$14.57
|
| Rate for Payer: Cash Price |
$40.75
|
| Rate for Payer: Cash Price |
$40.75
|
| Rate for Payer: Cofinity Advantage |
$35.66
|
| Rate for Payer: Cofinity Commercial |
$43.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.57
|
| Rate for Payer: Healthscope Commercial |
$45.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.20
|
| Rate for Payer: Mclaren Medicaid |
$14.57
|
| Rate for Payer: Mclaren Medicare |
$14.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.30
|
| Rate for Payer: Meridian Medicaid |
$15.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$16.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.30
|
| Rate for Payer: Nomi Health Commercial |
$21.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.20
|
| Rate for Payer: PACE Medicare |
$13.84
|
| Rate for Payer: PACE SWMI |
$14.57
|
| Rate for Payer: PHP Commercial |
$43.30
|
| Rate for Payer: PHP Medicare Advantage |
$14.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$14.57
|
| Rate for Payer: Priority Health Medicare |
$14.57
|
| Rate for Payer: Priority Health SBD |
$32.09
|
| Rate for Payer: Priority Health Tiered Network |
$11.66
|
| Rate for Payer: Railroad Medicare Medicare |
$14.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.86
|
| Rate for Payer: UHC Core |
$21.86
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14.57
|
| Rate for Payer: UHC Exchange |
$21.86
|
| Rate for Payer: UHC Medicaid |
$7.62
|
| Rate for Payer: UHCCP Medicaid |
$7.62
|
| Rate for Payer: UMR Bronson Commercial |
$18.85
|
| Rate for Payer: VA VA |
$14.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.20
|
|
|
HC AMMONIA LEVEL
|
Facility
|
IP
|
$50.94
|
|
|
Service Code
|
CPT 82140
|
| Hospital Charge Code |
30100094
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.41 |
| Max. Negotiated Rate |
$45.85 |
| Rate for Payer: Aetna American Axle |
$33.11
|
| Rate for Payer: Aetna Commercial |
$43.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.11
|
| Rate for Payer: Cash Price |
$40.75
|
| Rate for Payer: Cofinity Advantage |
$35.66
|
| Rate for Payer: Cofinity Commercial |
$43.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.75
|
| Rate for Payer: Healthscope Commercial |
$45.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.20
|
| Rate for Payer: PHP Commercial |
$43.30
|
| Rate for Payer: Priority Health SBD |
$32.09
|
| Rate for Payer: UMR Bronson Commercial |
$22.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.20
|
|
|
HC AMNIOCENTESIS
|
Facility
|
IP
|
$832.87
|
|
|
Service Code
|
CPT 59001
|
| Hospital Charge Code |
76100006
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$366.46 |
| Max. Negotiated Rate |
$749.58 |
| Rate for Payer: Aetna American Axle |
$541.37
|
| Rate for Payer: Aetna Commercial |
$707.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$541.37
|
| Rate for Payer: Cash Price |
$666.30
|
| Rate for Payer: Cofinity Advantage |
$583.01
|
| Rate for Payer: Cofinity Commercial |
$716.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$666.30
|
| Rate for Payer: Healthscope Commercial |
$749.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$583.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$624.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$707.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$624.65
|
| Rate for Payer: PHP Commercial |
$707.94
|
| Rate for Payer: Priority Health SBD |
$524.71
|
| Rate for Payer: UMR Bronson Commercial |
$366.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$624.65
|
|
