|
HC EXTENSION KIT
|
Facility
|
OP
|
$1,992.14
|
|
|
Service Code
|
HCPCS C1883
|
| Hospital Charge Code |
27800052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$737.09 |
| Max. Negotiated Rate |
$1,792.93 |
| Rate for Payer: Aetna American Axle |
$1,294.89
|
| Rate for Payer: Aetna Commercial |
$1,693.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,294.89
|
| Rate for Payer: BCBS Complete |
$796.86
|
| Rate for Payer: Cash Price |
$1,593.71
|
| Rate for Payer: Cofinity Commercial |
$1,394.50
|
| Rate for Payer: Cofinity Commercial |
$1,713.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,593.71
|
| Rate for Payer: Healthscope Commercial |
$1,792.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,394.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,494.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,693.32
|
| Rate for Payer: PHP Commercial |
$1,693.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,394.50
|
| Rate for Payer: Priority Health SBD |
$1,255.05
|
| Rate for Payer: UMR Bronson Commercial |
$737.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,494.10
|
|
|
HC EXTENSION KIT
|
Facility
|
IP
|
$1,992.14
|
|
|
Service Code
|
HCPCS C1883
|
| Hospital Charge Code |
27800052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$876.54 |
| Max. Negotiated Rate |
$1,792.93 |
| Rate for Payer: Aetna American Axle |
$1,294.89
|
| Rate for Payer: Aetna Commercial |
$1,693.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,294.89
|
| Rate for Payer: Cash Price |
$1,593.71
|
| Rate for Payer: Cofinity Commercial |
$1,394.50
|
| Rate for Payer: Cofinity Commercial |
$1,713.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,593.71
|
| Rate for Payer: Healthscope Commercial |
$1,792.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,394.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,494.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,693.32
|
| Rate for Payer: PHP Commercial |
$1,693.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,394.50
|
| Rate for Payer: Priority Health SBD |
$1,255.05
|
| Rate for Payer: UMR Bronson Commercial |
$876.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,494.10
|
|
|
HC EXTENSION ST JUDE
|
Facility
|
IP
|
$2,324.18
|
|
|
Service Code
|
HCPCS C1883
|
| Hospital Charge Code |
27800053
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,022.64 |
| Max. Negotiated Rate |
$2,091.76 |
| Rate for Payer: Aetna American Axle |
$1,510.72
|
| Rate for Payer: Aetna Commercial |
$1,975.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,510.72
|
| Rate for Payer: Cash Price |
$1,859.34
|
| Rate for Payer: Cofinity Commercial |
$1,626.93
|
| Rate for Payer: Cofinity Commercial |
$1,998.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,859.34
|
| Rate for Payer: Healthscope Commercial |
$2,091.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,626.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,743.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,975.55
|
| Rate for Payer: PHP Commercial |
$1,975.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,626.93
|
| Rate for Payer: Priority Health SBD |
$1,464.23
|
| Rate for Payer: UMR Bronson Commercial |
$1,022.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,743.14
|
|
|
HC EXTENSION ST JUDE
|
Facility
|
OP
|
$2,324.18
|
|
|
Service Code
|
HCPCS C1883
|
| Hospital Charge Code |
27800053
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$859.95 |
| Max. Negotiated Rate |
$2,091.76 |
| Rate for Payer: Aetna American Axle |
$1,510.72
|
| Rate for Payer: Aetna Commercial |
$1,975.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,510.72
|
| Rate for Payer: BCBS Complete |
$929.67
|
| Rate for Payer: Cash Price |
$1,859.34
|
| Rate for Payer: Cofinity Commercial |
$1,626.93
|
| Rate for Payer: Cofinity Commercial |
$1,998.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,859.34
|
| Rate for Payer: Healthscope Commercial |
$2,091.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,626.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,743.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,975.55
|
| Rate for Payer: PHP Commercial |
$1,975.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,626.93
|
| Rate for Payer: Priority Health SBD |
$1,464.23
|
| Rate for Payer: UMR Bronson Commercial |
$859.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,743.14
|
|
|
HC EXTERNAL EKG RECORDIN >48 HRS UP TO 7 DAYS
|
Facility
|
IP
|
$89.34
|
|
|
Service Code
|
CPT 93242
|
| Hospital Charge Code |
48000030
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$39.31 |
| Max. Negotiated Rate |
$80.41 |
| Rate for Payer: Aetna American Axle |
$58.07
|
| Rate for Payer: Aetna Commercial |
$75.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.07
|
| Rate for Payer: Cash Price |
$71.47
|
| Rate for Payer: Cofinity Commercial |
$62.54
|
| Rate for Payer: Cofinity Commercial |
$76.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.47
|
| Rate for Payer: Healthscope Commercial |
$80.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$62.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$75.94
|
| Rate for Payer: PHP Commercial |
$75.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.54
|
| Rate for Payer: Priority Health SBD |
$56.28
|
| Rate for Payer: UMR Bronson Commercial |
$39.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.00
|
|
|
HC EXTERNAL EKG RECORDIN >48 HRS UP TO 7 DAYS
|
Facility
|
OP
|
$89.34
|
|
|
Service Code
|
CPT 93242
|
| Hospital Charge Code |
48000030
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$11.79 |
| Max. Negotiated Rate |
$816.00 |
| Rate for Payer: Aetna American Axle |
$58.07
|
| Rate for Payer: Aetna Commercial |
$75.94
|
| Rate for Payer: Aetna Medicare |
$37.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$44.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$44.56
|
| Rate for Payer: BCBS Complete |
$20.48
|
| Rate for Payer: BCBS MAPPO |
$35.65
|
| Rate for Payer: BCBS Trust/PPO |
$47.13
|
| Rate for Payer: BCN Medicare Advantage |
$35.65
|
| Rate for Payer: Cash Price |
$71.47
|
| Rate for Payer: Cash Price |
$71.47
|
| Rate for Payer: Cash Price |
$71.47
|
| Rate for Payer: Cofinity Commercial |
$76.83
|
| Rate for Payer: Cofinity Commercial |
$62.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.65
|
| Rate for Payer: Healthscope Commercial |
$80.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$62.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.00
|
| Rate for Payer: Mclaren Medicaid |
$19.50
|
| Rate for Payer: Mclaren Medicare |
$35.65
|
| Rate for Payer: Meridian Medicaid |
$20.48
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$37.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$75.94
|
| Rate for Payer: PACE Medicare |
$33.87
|
| Rate for Payer: PACE SWMI |
$35.65
|
| Rate for Payer: PHP Commercial |
$75.94
|
| Rate for Payer: PHP Medicare Advantage |
$35.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$112.22
|
| Rate for Payer: Priority Health Medicare |
$35.65
|
| Rate for Payer: Priority Health Narrow Network |
$89.78
|
| Rate for Payer: Priority Health SBD |
$56.28
|
| Rate for Payer: Railroad Medicare Medicare |
$35.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.97
|
| Rate for Payer: UHC Core |
$816.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.65
|
| Rate for Payer: UHC Exchange |
$11.79
|
| Rate for Payer: UHC Medicare Advantage |
$36.72
|
| Rate for Payer: UMR Bronson Commercial |
$33.06
|
| Rate for Payer: VA VA |
$35.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.00
|
|
|
HC EXTERNAL EKG RECORDING >7 DAYS UP TO 15 DAYS
|
Facility
|
IP
|
$134.70
|
|
|
Service Code
|
CPT 93246
|
| Hospital Charge Code |
48000031
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$59.27 |
| Max. Negotiated Rate |
$121.23 |
| Rate for Payer: Aetna American Axle |
$87.56
|
| Rate for Payer: Aetna Commercial |
$114.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.56
|
| Rate for Payer: Cash Price |
$107.76
|
| Rate for Payer: Cofinity Commercial |
$115.84
|
| Rate for Payer: Cofinity Commercial |
$94.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.76
|
| Rate for Payer: Healthscope Commercial |
$121.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$94.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$101.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$114.50
|
| Rate for Payer: PHP Commercial |
$114.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.29
|
| Rate for Payer: Priority Health SBD |
$84.86
|
| Rate for Payer: UMR Bronson Commercial |
$59.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$101.02
|
|
|
HC EXTERNAL EKG RECORDING >7 DAYS UP TO 15 DAYS
|
Facility
|
OP
|
$134.70
|
|
|
Service Code
|
CPT 93246
|
| Hospital Charge Code |
48000031
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$11.79 |
| Max. Negotiated Rate |
$816.00 |
| Rate for Payer: Aetna American Axle |
$87.56
|
| Rate for Payer: Aetna Commercial |
$114.50
|
| Rate for Payer: Aetna Medicare |
$37.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$44.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$44.56
|
| Rate for Payer: BCBS Complete |
$20.48
|
| Rate for Payer: BCBS MAPPO |
$35.65
|
| Rate for Payer: BCBS Trust/PPO |
$47.13
|
| Rate for Payer: BCN Medicare Advantage |
$35.65
|
| Rate for Payer: Cash Price |
$107.76
|
| Rate for Payer: Cash Price |
$107.76
|
| Rate for Payer: Cash Price |
$107.76
|
| Rate for Payer: Cofinity Commercial |
$115.84
|
| Rate for Payer: Cofinity Commercial |
$94.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.65
|
| Rate for Payer: Healthscope Commercial |
$121.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$94.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$101.02
|
| Rate for Payer: Mclaren Medicaid |
$19.50
|
| Rate for Payer: Mclaren Medicare |
$35.65
|
| Rate for Payer: Meridian Medicaid |
$20.48
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$37.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$114.50
|
| Rate for Payer: PACE Medicare |
$33.87
|
| Rate for Payer: PACE SWMI |
$35.65
|
| Rate for Payer: PHP Commercial |
$114.50
|
| Rate for Payer: PHP Medicare Advantage |
$35.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$112.22
|
| Rate for Payer: Priority Health Medicare |
$35.65
|
| Rate for Payer: Priority Health Narrow Network |
$89.78
|
| Rate for Payer: Priority Health SBD |
$84.86
|
| Rate for Payer: Railroad Medicare Medicare |
$35.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.97
|
| Rate for Payer: UHC Core |
$816.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.65
|
| Rate for Payer: UHC Exchange |
$11.79
|
| Rate for Payer: UHC Medicare Advantage |
$36.72
|
| Rate for Payer: UMR Bronson Commercial |
$49.84
|
| Rate for Payer: VA VA |
$35.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$101.02
|
|
|
HC EXTERNAL PACER
|
Facility
|
OP
|
$565.13
|
|
|
Service Code
|
CPT 92953
|
| Hospital Charge Code |
48000001
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$1,821.15 |
| Rate for Payer: Aetna American Axle |
$367.33
|
| Rate for Payer: Aetna Commercial |
$480.36
|
| Rate for Payer: Aetna Medicare |
$601.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$367.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$723.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$723.12
|
| Rate for Payer: BCBS Complete |
$332.29
|
| Rate for Payer: BCBS MAPPO |
$578.50
|
| Rate for Payer: BCBS Trust/PPO |
$1.68
|
| Rate for Payer: BCN Medicare Advantage |
$578.50
|
| Rate for Payer: Cash Price |
$452.10
|
| Rate for Payer: Cash Price |
$452.10
|
| Rate for Payer: Cash Price |
$452.10
|
| Rate for Payer: Cofinity Commercial |
$486.01
|
| Rate for Payer: Cofinity Commercial |
$395.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$452.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$578.50
|
| Rate for Payer: Healthscope Commercial |
$508.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$395.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$423.85
|
| Rate for Payer: Mclaren Medicaid |
$316.44
|
| Rate for Payer: Mclaren Medicare |
$578.50
|
| Rate for Payer: Meridian Medicaid |
$332.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$607.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$665.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$480.36
|
| Rate for Payer: PACE Medicare |
$549.58
|
| Rate for Payer: PACE SWMI |
$578.50
|
| Rate for Payer: PHP Commercial |
$480.36
|
| Rate for Payer: PHP Medicare Advantage |
$578.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$316.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$395.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,821.15
|
| Rate for Payer: Priority Health Medicare |
$578.50
|
| Rate for Payer: Priority Health Narrow Network |
$1,456.92
|
| Rate for Payer: Priority Health SBD |
$356.03
|
| Rate for Payer: Railroad Medicare Medicare |
$578.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.08
|
| Rate for Payer: UHC Core |
$816.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$578.50
|
| Rate for Payer: UHC Exchange |
$0.98
|
| Rate for Payer: UHC Medicare Advantage |
$595.86
|
| Rate for Payer: UMR Bronson Commercial |
$209.10
|
| Rate for Payer: VA VA |
$578.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$423.85
|
|
|
HC EXTERNAL PACER
|
Facility
|
IP
|
$565.13
|
|
|
Service Code
|
CPT 92953
|
| Hospital Charge Code |
48000001
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$248.66 |
| Max. Negotiated Rate |
$508.62 |
| Rate for Payer: Aetna American Axle |
$367.33
|
| Rate for Payer: Aetna Commercial |
$480.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$367.33
|
| Rate for Payer: Cash Price |
$452.10
|
| Rate for Payer: Cofinity Commercial |
$395.59
|
| Rate for Payer: Cofinity Commercial |
$486.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$452.10
|
| Rate for Payer: Healthscope Commercial |
$508.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$395.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$423.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$480.36
|
| Rate for Payer: PHP Commercial |
$480.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$395.59
|
| Rate for Payer: Priority Health SBD |
$356.03
|
| Rate for Payer: UMR Bronson Commercial |
$248.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$423.85
|
|
|
HC EXTERNAL VERSION
|
Facility
|
OP
|
$2,782.67
|
|
|
Service Code
|
CPT 59412
|
| Hospital Charge Code |
36100121
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$101.18 |
| Max. Negotiated Rate |
$8,748.29 |
| Rate for Payer: Aetna American Axle |
$1,808.74
|
| Rate for Payer: Aetna Commercial |
$2,365.27
|
| Rate for Payer: Aetna Medicare |
$2,890.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,808.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,473.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,473.69
|
| Rate for Payer: BCBS Complete |
$1,596.23
|
| Rate for Payer: BCBS MAPPO |
$2,778.95
|
| Rate for Payer: BCBS Trust/PPO |
$771.37
|
| Rate for Payer: BCN Medicare Advantage |
$2,778.95
|
| Rate for Payer: Cash Price |
$2,226.14
|
| Rate for Payer: Cash Price |
$2,226.14
|
| Rate for Payer: Cofinity Commercial |
$1,947.87
|
| Rate for Payer: Cofinity Commercial |
$2,393.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,226.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,778.95
|
| Rate for Payer: Healthscope Commercial |
$2,504.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,947.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,087.00
|
| Rate for Payer: Mclaren Medicaid |
$1,520.09
|
| Rate for Payer: Mclaren Medicare |
$2,778.95
|
| Rate for Payer: Meridian Medicaid |
$1,596.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,917.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,195.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,365.27
|
| Rate for Payer: PACE Medicare |
$2,640.00
|
| Rate for Payer: PACE SWMI |
$2,778.95
|
| Rate for Payer: PHP Commercial |
$2,365.27
|
| Rate for Payer: PHP Medicare Advantage |
$2,778.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,520.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,947.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,748.29
|
| Rate for Payer: Priority Health Medicare |
$2,778.95
|
| Rate for Payer: Priority Health Narrow Network |
$6,998.63
|
| Rate for Payer: Priority Health SBD |
$1,753.08
|
| Rate for Payer: Railroad Medicare Medicare |
$2,778.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$111.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,778.95
|
| Rate for Payer: UHC Exchange |
$101.18
|
| Rate for Payer: UHC Medicare Advantage |
$2,862.32
|
| Rate for Payer: UMR Bronson Commercial |
$1,029.59
|
| Rate for Payer: VA VA |
$2,778.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,087.00
|
|
|
HC EXTERNAL VERSION
|
Facility
|
IP
|
$2,782.67
|
|
|
Service Code
|
CPT 59412
|
| Hospital Charge Code |
36100121
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,224.37 |
| Max. Negotiated Rate |
$2,504.40 |
| Rate for Payer: Aetna American Axle |
$1,808.74
|
| Rate for Payer: Aetna Commercial |
$2,365.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,808.74
|
| Rate for Payer: Cash Price |
$2,226.14
|
| Rate for Payer: Cofinity Commercial |
$1,947.87
|
| Rate for Payer: Cofinity Commercial |
$2,393.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,226.14
|
| Rate for Payer: Healthscope Commercial |
$2,504.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,947.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,087.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,365.27
|
| Rate for Payer: PHP Commercial |
$2,365.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,947.87
|
| Rate for Payer: Priority Health SBD |
$1,753.08
|
| Rate for Payer: UMR Bronson Commercial |
$1,224.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,087.00
|
|
|
HC EXTRAORAL INC AND DRAIN ABSC, CYST, HEMATOMA FLOOR OF MOUTH SUBLING
|
Facility
|
OP
|
$383.03
|
|
|
Service Code
|
CPT 41015
|
| Hospital Charge Code |
76100137
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$141.72 |
| Max. Negotiated Rate |
$1,539.60 |
| Rate for Payer: Aetna American Axle |
$248.97
|
| Rate for Payer: Aetna Commercial |
$325.58
|
| Rate for Payer: Aetna Medicare |
$508.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$248.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$611.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$611.32
|
| Rate for Payer: BCBS Complete |
$280.92
|
| Rate for Payer: BCBS MAPPO |
$489.06
|
| Rate for Payer: BCBS Trust/PPO |
$355.19
|
| Rate for Payer: BCN Medicare Advantage |
$489.06
|
| Rate for Payer: Cash Price |
$306.42
|
| Rate for Payer: Cash Price |
$306.42
|
| Rate for Payer: Cofinity Commercial |
$329.41
|
| Rate for Payer: Cofinity Commercial |
$268.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$306.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$489.06
|
| Rate for Payer: Healthscope Commercial |
$344.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$268.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$287.27
|
| Rate for Payer: Mclaren Medicaid |
$267.52
|
| Rate for Payer: Mclaren Medicare |
$489.06
|
| Rate for Payer: Meridian Medicaid |
$280.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$513.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$562.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$325.58
|
| Rate for Payer: PACE Medicare |
$464.61
|
| Rate for Payer: PACE SWMI |
$489.06
|
| Rate for Payer: PHP Commercial |
$325.58
|
| Rate for Payer: PHP Medicare Advantage |
$489.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$267.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$268.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,539.60
|
| Rate for Payer: Priority Health Medicare |
$489.06
|
| Rate for Payer: Priority Health Narrow Network |
$1,231.68
|
| Rate for Payer: Priority Health SBD |
$241.31
|
| Rate for Payer: Railroad Medicare Medicare |
$489.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$323.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$489.06
|
| Rate for Payer: UHC Exchange |
$294.04
|
| Rate for Payer: UHC Medicare Advantage |
$503.73
|
| Rate for Payer: UMR Bronson Commercial |
$141.72
|
| Rate for Payer: VA VA |
$489.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$287.27
|
|
|
HC EXTRAORAL INC AND DRAIN ABSC, CYST, HEMATOMA FLOOR OF MOUTH SUBLING
|
Facility
|
IP
|
$383.03
|
|
|
Service Code
|
CPT 41015
|
| Hospital Charge Code |
76100137
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$168.53 |
| Max. Negotiated Rate |
$344.73 |
| Rate for Payer: Aetna American Axle |
$248.97
|
| Rate for Payer: Aetna Commercial |
$325.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$248.97
|
| Rate for Payer: Cash Price |
$306.42
|
| Rate for Payer: Cofinity Commercial |
$268.12
|
| Rate for Payer: Cofinity Commercial |
$329.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$306.42
|
| Rate for Payer: Healthscope Commercial |
$344.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$268.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$287.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$325.58
|
| Rate for Payer: PHP Commercial |
$325.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$268.12
|
| Rate for Payer: Priority Health SBD |
$241.31
|
| Rate for Payer: UMR Bronson Commercial |
$168.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$287.27
|
|
|
HC EZPAP SUPPLY
|
Facility
|
OP
|
$125.48
|
|
| Hospital Charge Code |
27000072
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$46.43 |
| Max. Negotiated Rate |
$112.93 |
| Rate for Payer: Aetna American Axle |
$81.56
|
| Rate for Payer: Aetna Commercial |
$106.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.56
|
| Rate for Payer: BCBS Complete |
$50.19
|
| Rate for Payer: Cash Price |
$100.38
|
| Rate for Payer: Cofinity Commercial |
$107.91
|
| Rate for Payer: Cofinity Commercial |
$87.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.38
|
| Rate for Payer: Healthscope Commercial |
$112.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$87.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$94.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$106.66
|
| Rate for Payer: PHP Commercial |
$106.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.84
|
| Rate for Payer: Priority Health SBD |
$79.05
|
| Rate for Payer: UMR Bronson Commercial |
$46.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$94.11
|
|
|
HC EZPAP SUPPLY
|
Facility
|
IP
|
$125.48
|
|
| Hospital Charge Code |
27000072
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$55.21 |
| Max. Negotiated Rate |
$112.93 |
| Rate for Payer: Aetna American Axle |
$81.56
|
| Rate for Payer: Aetna Commercial |
$106.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.56
|
| Rate for Payer: Cash Price |
$100.38
|
| Rate for Payer: Cofinity Commercial |
$107.91
|
| Rate for Payer: Cofinity Commercial |
$87.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.38
|
| Rate for Payer: Healthscope Commercial |
$112.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$87.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$94.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$106.66
|
| Rate for Payer: PHP Commercial |
$106.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.84
|
| Rate for Payer: Priority Health SBD |
$79.05
|
| Rate for Payer: UMR Bronson Commercial |
$55.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$94.11
|
|
|
HC F-18 SODIUM FLUORIDE <=30MCI
|
Facility
|
OP
|
$475.24
|
|
|
Service Code
|
HCPCS A9580
|
| Hospital Charge Code |
34300028
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$175.84 |
| Max. Negotiated Rate |
$672.70 |
| Rate for Payer: Aetna American Axle |
$308.91
|
| Rate for Payer: Aetna Commercial |
$403.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$308.91
|
| Rate for Payer: BCBS Complete |
$190.10
|
| Rate for Payer: BCBS Trust/PPO |
$672.70
|
| Rate for Payer: Cash Price |
$380.19
|
| Rate for Payer: Cash Price |
$380.19
|
| Rate for Payer: Cofinity Commercial |
$332.67
|
| Rate for Payer: Cofinity Commercial |
$408.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$380.19
|
| Rate for Payer: Healthscope Commercial |
$427.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$332.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$356.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$403.95
|
| Rate for Payer: PHP Commercial |
$403.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$332.67
|
| Rate for Payer: Priority Health SBD |
$299.40
|
| Rate for Payer: UMR Bronson Commercial |
$175.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$356.43
|
|
|
HC F-18 SODIUM FLUORIDE <=30MCI
|
Facility
|
IP
|
$475.24
|
|
|
Service Code
|
HCPCS A9580
|
| Hospital Charge Code |
34300028
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$209.11 |
| Max. Negotiated Rate |
$427.72 |
| Rate for Payer: Aetna American Axle |
$308.91
|
| Rate for Payer: Aetna Commercial |
$403.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$308.91
|
| Rate for Payer: Cash Price |
$380.19
|
| Rate for Payer: Cofinity Commercial |
$332.67
|
| Rate for Payer: Cofinity Commercial |
$408.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$380.19
|
| Rate for Payer: Healthscope Commercial |
$427.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$332.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$356.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$403.95
|
| Rate for Payer: PHP Commercial |
$403.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$332.67
|
| Rate for Payer: Priority Health SBD |
$299.40
|
| Rate for Payer: UMR Bronson Commercial |
$209.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$356.43
|
|
|
HC F232 OVALBUMIN
|
Facility
|
OP
|
$28.18
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
30200439
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.81 |
| Max. Negotiated Rate |
$26.57 |
| Rate for Payer: Aetna American Axle |
$18.32
|
| Rate for Payer: Aetna Commercial |
$23.95
|
| Rate for Payer: Aetna Medicare |
$18.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.41
|
| Rate for Payer: BCBS Complete |
$10.30
|
| Rate for Payer: BCBS MAPPO |
$17.93
|
| Rate for Payer: BCBS Trust/PPO |
$16.13
|
| Rate for Payer: BCN Medicare Advantage |
$17.93
|
| Rate for Payer: Cash Price |
$22.54
|
| Rate for Payer: Cash Price |
$22.54
|
| Rate for Payer: Cofinity Commercial |
$24.23
|
| Rate for Payer: Cofinity Commercial |
$19.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.93
|
| Rate for Payer: Healthscope Commercial |
$25.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.14
|
| Rate for Payer: Mclaren Medicaid |
$9.81
|
| Rate for Payer: Mclaren Medicare |
$17.93
|
| Rate for Payer: Meridian Medicaid |
$10.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.95
|
| Rate for Payer: PACE Medicare |
$17.03
|
| Rate for Payer: PACE SWMI |
$17.93
|
| Rate for Payer: PHP Commercial |
$23.95
|
| Rate for Payer: PHP Medicare Advantage |
$17.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.91
|
| Rate for Payer: Priority Health Medicare |
$17.93
|
| Rate for Payer: Priority Health Narrow Network |
$15.93
|
| Rate for Payer: Priority Health SBD |
$17.75
|
| Rate for Payer: Railroad Medicare Medicare |
$17.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.52
|
| Rate for Payer: UHC Core |
$26.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.93
|
| Rate for Payer: UHC Exchange |
$17.93
|
| Rate for Payer: UHC Medicare Advantage |
$18.47
|
| Rate for Payer: UMR Bronson Commercial |
$10.43
|
| Rate for Payer: VA VA |
$17.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.14
|
|
|
HC F232 OVALBUMIN
|
Facility
|
IP
|
$28.18
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
30200439
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.40 |
| Max. Negotiated Rate |
$25.36 |
| Rate for Payer: Aetna American Axle |
$18.32
|
| Rate for Payer: Aetna Commercial |
$23.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.32
|
| Rate for Payer: Cash Price |
$22.54
|
| Rate for Payer: Cofinity Commercial |
$24.23
|
| Rate for Payer: Cofinity Commercial |
$19.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.54
|
| Rate for Payer: Healthscope Commercial |
$25.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.95
|
| Rate for Payer: PHP Commercial |
$23.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.73
|
| Rate for Payer: Priority Health SBD |
$17.75
|
| Rate for Payer: UMR Bronson Commercial |
$12.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.14
|
|
|
HC F233 OVOMUCOID
|
Facility
|
OP
|
$28.18
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
30200440
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.81 |
| Max. Negotiated Rate |
$26.57 |
| Rate for Payer: Aetna American Axle |
$18.32
|
| Rate for Payer: Aetna Commercial |
$23.95
|
| Rate for Payer: Aetna Medicare |
$18.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.41
|
| Rate for Payer: BCBS Complete |
$10.30
|
| Rate for Payer: BCBS MAPPO |
$17.93
|
| Rate for Payer: BCBS Trust/PPO |
$16.13
|
| Rate for Payer: BCN Medicare Advantage |
$17.93
|
| Rate for Payer: Cash Price |
$22.54
|
| Rate for Payer: Cash Price |
$22.54
|
| Rate for Payer: Cofinity Commercial |
$19.73
|
| Rate for Payer: Cofinity Commercial |
$24.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.93
|
| Rate for Payer: Healthscope Commercial |
$25.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.14
|
| Rate for Payer: Mclaren Medicaid |
$9.81
|
| Rate for Payer: Mclaren Medicare |
$17.93
|
| Rate for Payer: Meridian Medicaid |
$10.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.95
|
| Rate for Payer: PACE Medicare |
$17.03
|
| Rate for Payer: PACE SWMI |
$17.93
|
| Rate for Payer: PHP Commercial |
$23.95
|
| Rate for Payer: PHP Medicare Advantage |
$17.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.91
|
| Rate for Payer: Priority Health Medicare |
$17.93
|
| Rate for Payer: Priority Health Narrow Network |
$15.93
|
| Rate for Payer: Priority Health SBD |
$17.75
|
| Rate for Payer: Railroad Medicare Medicare |
$17.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.52
|
| Rate for Payer: UHC Core |
$26.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.93
|
| Rate for Payer: UHC Exchange |
$17.93
|
| Rate for Payer: UHC Medicare Advantage |
$18.47
|
| Rate for Payer: UMR Bronson Commercial |
$10.43
|
| Rate for Payer: VA VA |
$17.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.14
|
|
|
HC F233 OVOMUCOID
|
Facility
|
IP
|
$28.18
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
30200440
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.40 |
| Max. Negotiated Rate |
$25.36 |
| Rate for Payer: Aetna American Axle |
$18.32
|
| Rate for Payer: Aetna Commercial |
$23.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.32
|
| Rate for Payer: Cash Price |
$22.54
|
| Rate for Payer: Cofinity Commercial |
$19.73
|
| Rate for Payer: Cofinity Commercial |
$24.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.54
|
| Rate for Payer: Healthscope Commercial |
$25.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.95
|
| Rate for Payer: PHP Commercial |
$23.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.73
|
| Rate for Payer: Priority Health SBD |
$17.75
|
| Rate for Payer: UMR Bronson Commercial |
$12.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.14
|
|
|
HC F352 RARA H8 PR-10 PEANUT
|
Facility
|
IP
|
$30.87
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
30200450
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.58 |
| Max. Negotiated Rate |
$27.78 |
| Rate for Payer: Aetna American Axle |
$20.07
|
| Rate for Payer: Aetna Commercial |
$26.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.07
|
| Rate for Payer: Cash Price |
$24.70
|
| Rate for Payer: Cofinity Commercial |
$21.61
|
| Rate for Payer: Cofinity Commercial |
$26.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.70
|
| Rate for Payer: Healthscope Commercial |
$27.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.24
|
| Rate for Payer: PHP Commercial |
$26.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.61
|
| Rate for Payer: Priority Health SBD |
$19.45
|
| Rate for Payer: UMR Bronson Commercial |
$13.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.15
|
|
|
HC F352 RARA H8 PR-10 PEANUT
|
Facility
|
OP
|
$30.87
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
30200450
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.81 |
| Max. Negotiated Rate |
$27.78 |
| Rate for Payer: Aetna American Axle |
$20.07
|
| Rate for Payer: Aetna Commercial |
$26.24
|
| Rate for Payer: Aetna Medicare |
$18.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.41
|
| Rate for Payer: BCBS Complete |
$10.30
|
| Rate for Payer: BCBS MAPPO |
$17.93
|
| Rate for Payer: BCBS Trust/PPO |
$16.13
|
| Rate for Payer: BCN Medicare Advantage |
$17.93
|
| Rate for Payer: Cash Price |
$24.70
|
| Rate for Payer: Cash Price |
$24.70
|
| Rate for Payer: Cofinity Commercial |
$26.55
|
| Rate for Payer: Cofinity Commercial |
$21.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.93
|
| Rate for Payer: Healthscope Commercial |
$27.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.15
|
| Rate for Payer: Mclaren Medicaid |
$9.81
|
| Rate for Payer: Mclaren Medicare |
$17.93
|
| Rate for Payer: Meridian Medicaid |
$10.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.24
|
| Rate for Payer: PACE Medicare |
$17.03
|
| Rate for Payer: PACE SWMI |
$17.93
|
| Rate for Payer: PHP Commercial |
$26.24
|
| Rate for Payer: PHP Medicare Advantage |
$17.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.91
|
| Rate for Payer: Priority Health Medicare |
$17.93
|
| Rate for Payer: Priority Health Narrow Network |
$15.93
|
| Rate for Payer: Priority Health SBD |
$19.45
|
| Rate for Payer: Railroad Medicare Medicare |
$17.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.52
|
| Rate for Payer: UHC Core |
$26.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.93
|
| Rate for Payer: UHC Exchange |
$17.93
|
| Rate for Payer: UHC Medicare Advantage |
$18.47
|
| Rate for Payer: UMR Bronson Commercial |
$11.42
|
| Rate for Payer: VA VA |
$17.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.15
|
|
|
HC F422 RARA H1 PEANUT
|
Facility
|
IP
|
$30.87
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
30200446
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.58 |
| Max. Negotiated Rate |
$27.78 |
| Rate for Payer: Aetna American Axle |
$20.07
|
| Rate for Payer: Aetna Commercial |
$26.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.07
|
| Rate for Payer: Cash Price |
$24.70
|
| Rate for Payer: Cofinity Commercial |
$26.55
|
| Rate for Payer: Cofinity Commercial |
$21.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.70
|
| Rate for Payer: Healthscope Commercial |
$27.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.24
|
| Rate for Payer: PHP Commercial |
$26.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.61
|
| Rate for Payer: Priority Health SBD |
$19.45
|
| Rate for Payer: UMR Bronson Commercial |
$13.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.15
|
|
