|
HC BIL DIAG BONE MARROW ASP AND BX
|
Facility
|
OP
|
$3,158.15
|
|
|
Service Code
|
CPT 38222
|
| Hospital Charge Code |
76100294
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,168.52 |
| Max. Negotiated Rate |
$9,359.82 |
| Rate for Payer: Aetna American Axle |
$2,052.80
|
| Rate for Payer: Aetna Commercial |
$2,684.43
|
| Rate for Payer: Aetna Medicare |
$3,010.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,052.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,617.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,617.84
|
| Rate for Payer: BCBS Complete |
$1,589.53
|
| Rate for Payer: BCBS MAPPO |
$2,894.27
|
| Rate for Payer: BCBS Trust/PPO |
$3,500.30
|
| Rate for Payer: BCN Commercial |
$3,500.30
|
| Rate for Payer: BCN Medicare Advantage |
$2,894.27
|
| Rate for Payer: Cash Price |
$2,526.52
|
| Rate for Payer: Cash Price |
$2,526.52
|
| Rate for Payer: Cash Price |
$2,526.52
|
| Rate for Payer: Cofinity Advantage |
$2,210.70
|
| Rate for Payer: Cofinity Commercial |
$2,716.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,526.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,894.27
|
| Rate for Payer: Healthscope Commercial |
$2,842.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,210.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,368.61
|
| Rate for Payer: Mclaren Medicaid |
$2,894.27
|
| Rate for Payer: Mclaren Medicare |
$2,894.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,038.98
|
| Rate for Payer: Meridian Medicaid |
$3,038.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,328.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,183.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,684.43
|
| Rate for Payer: Nomi Health Commercial |
$8,682.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,368.61
|
| Rate for Payer: PACE Medicare |
$2,749.56
|
| Rate for Payer: PACE SWMI |
$2,894.27
|
| Rate for Payer: PHP Commercial |
$2,684.43
|
| Rate for Payer: PHP Medicare Advantage |
$2,894.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,513.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$9,359.82
|
| Rate for Payer: Priority Health Medicare |
$2,894.27
|
| Rate for Payer: Priority Health SBD |
$1,989.63
|
| Rate for Payer: Priority Health Tiered Network |
$7,487.86
|
| Rate for Payer: Railroad Medicare Medicare |
$2,894.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,052.80
|
| Rate for Payer: UHC Core |
$1,645.40
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,894.27
|
| Rate for Payer: UHC Exchange |
$1,241.15
|
| Rate for Payer: UHC Medicaid |
$1,513.70
|
| Rate for Payer: UHCCP Medicaid |
$1,513.70
|
| Rate for Payer: UMR Bronson Commercial |
$1,168.52
|
| Rate for Payer: VA VA |
$2,894.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,368.61
|
|
|
HC BIL DIAG BONE MARROW BX
|
Facility
|
IP
|
$3,158.15
|
|
|
Service Code
|
CPT 38221
|
| Hospital Charge Code |
76100293
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,389.59 |
| Max. Negotiated Rate |
$2,842.34 |
| Rate for Payer: Aetna American Axle |
$2,052.80
|
| Rate for Payer: Aetna Commercial |
$2,684.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,052.80
|
| Rate for Payer: Cash Price |
$2,526.52
|
| Rate for Payer: Cofinity Advantage |
$2,210.70
|
| Rate for Payer: Cofinity Commercial |
$2,716.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,526.52
|
| Rate for Payer: Healthscope Commercial |
$2,842.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,210.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,368.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,684.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,368.61
|
| Rate for Payer: PHP Commercial |
$2,684.43
|
| Rate for Payer: Priority Health SBD |
$1,989.63
|
| Rate for Payer: UMR Bronson Commercial |
$1,389.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,368.61
|
|
|
HC BIL DIAG BONE MARROW BX
|
Facility
|
OP
|
$3,158.15
|
|
|
Service Code
|
CPT 38221
|
| Hospital Charge Code |
76100293
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$860.68 |
| Max. Negotiated Rate |
$5,321.93 |
| Rate for Payer: Aetna American Axle |
$2,052.80
|
| Rate for Payer: Aetna Commercial |
$2,684.43
|
| Rate for Payer: Aetna Medicare |
$1,711.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,052.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,057.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,057.07
|
| Rate for Payer: BCBS Complete |
$903.80
|
| Rate for Payer: BCBS MAPPO |
$1,645.66
|
| Rate for Payer: BCBS Trust/PPO |
$2,031.89
|
| Rate for Payer: BCN Commercial |
$2,031.89
|
| Rate for Payer: BCN Medicare Advantage |
$1,645.66
|
| Rate for Payer: Cash Price |
$2,526.52
|
| Rate for Payer: Cash Price |
$2,526.52
|
| Rate for Payer: Cash Price |
$2,526.52
|
| Rate for Payer: Cofinity Advantage |
$2,210.70
|
| Rate for Payer: Cofinity Commercial |
$2,716.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,526.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,645.66
|
| Rate for Payer: Healthscope Commercial |
$2,842.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,210.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,368.61
|
| Rate for Payer: Mclaren Medicaid |
$1,645.66
|
| Rate for Payer: Mclaren Medicare |
$1,645.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,727.94
|
| Rate for Payer: Meridian Medicaid |
$1,727.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,892.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,810.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,684.43
|
| Rate for Payer: Nomi Health Commercial |
$4,936.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,368.61
|
| Rate for Payer: PACE Medicare |
$1,563.38
|
| Rate for Payer: PACE SWMI |
$1,645.66
|
| Rate for Payer: PHP Commercial |
$2,684.43
|
| Rate for Payer: PHP Medicare Advantage |
$1,645.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$860.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,321.93
|
| Rate for Payer: Priority Health Medicare |
$1,645.66
|
| Rate for Payer: Priority Health SBD |
$1,989.63
|
| Rate for Payer: Priority Health Tiered Network |
$4,257.54
|
| Rate for Payer: Railroad Medicare Medicare |
$1,645.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,052.80
|
| Rate for Payer: UHC Core |
$1,645.40
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,645.66
|
| Rate for Payer: UHC Exchange |
$1,241.15
|
| Rate for Payer: UHC Medicaid |
$860.68
|
| Rate for Payer: UHCCP Medicaid |
$860.68
|
| Rate for Payer: UMR Bronson Commercial |
$1,168.52
|
| Rate for Payer: VA VA |
$1,645.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,368.61
|
|
|
HC BILE ACIDS TOTAL
|
Facility
|
OP
|
$53.06
|
|
|
Service Code
|
CPT 82239
|
| Hospital Charge Code |
30100116
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.95 |
| Max. Negotiated Rate |
$47.75 |
| Rate for Payer: Aetna American Axle |
$34.49
|
| Rate for Payer: Aetna Commercial |
$45.10
|
| Rate for Payer: Aetna Medicare |
$17.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.40
|
| Rate for Payer: BCBS Complete |
$9.40
|
| Rate for Payer: BCBS MAPPO |
$17.12
|
| Rate for Payer: BCBS Trust/PPO |
$19.79
|
| Rate for Payer: BCN Commercial |
$19.79
|
| Rate for Payer: BCN Medicare Advantage |
$17.12
|
| Rate for Payer: Cash Price |
$42.45
|
| Rate for Payer: Cash Price |
$42.45
|
| Rate for Payer: Cofinity Advantage |
$37.14
|
| Rate for Payer: Cofinity Commercial |
$45.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.12
|
| Rate for Payer: Healthscope Commercial |
$47.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.80
|
| Rate for Payer: Mclaren Medicaid |
$17.12
|
| Rate for Payer: Mclaren Medicare |
$17.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.98
|
| Rate for Payer: Meridian Medicaid |
$17.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.69
|
| Rate for Payer: Molina Medicare/Medicaid |
$18.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.10
|
| Rate for Payer: Nomi Health Commercial |
$25.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.80
|
| Rate for Payer: PACE Medicare |
$16.26
|
| Rate for Payer: PACE SWMI |
$17.12
|
| Rate for Payer: PHP Commercial |
$45.10
|
| Rate for Payer: PHP Medicare Advantage |
$17.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$17.12
|
| Rate for Payer: Priority Health Medicare |
$17.12
|
| Rate for Payer: Priority Health SBD |
$33.43
|
| Rate for Payer: Priority Health Tiered Network |
$13.70
|
| Rate for Payer: Railroad Medicare Medicare |
$17.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.68
|
| Rate for Payer: UHC Core |
$25.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17.12
|
| Rate for Payer: UHC Exchange |
$25.68
|
| Rate for Payer: UHC Medicaid |
$8.95
|
| Rate for Payer: UHCCP Medicaid |
$8.95
|
| Rate for Payer: UMR Bronson Commercial |
$19.63
|
| Rate for Payer: VA VA |
$17.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.80
|
|
|
HC BILE ACIDS TOTAL
|
Facility
|
IP
|
$53.06
|
|
|
Service Code
|
CPT 82239
|
| Hospital Charge Code |
30100116
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.35 |
| Max. Negotiated Rate |
$47.75 |
| Rate for Payer: Aetna American Axle |
$34.49
|
| Rate for Payer: Aetna Commercial |
$45.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.49
|
| Rate for Payer: Cash Price |
$42.45
|
| Rate for Payer: Cofinity Advantage |
$37.14
|
| Rate for Payer: Cofinity Commercial |
$45.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.45
|
| Rate for Payer: Healthscope Commercial |
$47.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.80
|
| Rate for Payer: PHP Commercial |
$45.10
|
| Rate for Payer: Priority Health SBD |
$33.43
|
| Rate for Payer: UMR Bronson Commercial |
$23.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.80
|
|
|
HC BILE BODY FLUID
|
Facility
|
OP
|
$39.43
|
|
|
Service Code
|
CPT 81005
|
| Hospital Charge Code |
30700007
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$35.49 |
| Rate for Payer: Aetna American Axle |
$25.63
|
| Rate for Payer: Aetna Commercial |
$33.52
|
| Rate for Payer: Aetna Medicare |
$2.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.71
|
| Rate for Payer: BCBS Complete |
$1.19
|
| Rate for Payer: BCBS MAPPO |
$2.17
|
| Rate for Payer: BCBS Trust/PPO |
$2.51
|
| Rate for Payer: BCN Commercial |
$2.51
|
| Rate for Payer: BCN Medicare Advantage |
$2.17
|
| Rate for Payer: Cash Price |
$31.54
|
| Rate for Payer: Cash Price |
$31.54
|
| Rate for Payer: Cofinity Advantage |
$27.60
|
| Rate for Payer: Cofinity Commercial |
$33.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.17
|
| Rate for Payer: Healthscope Commercial |
$35.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.57
|
| Rate for Payer: Mclaren Medicaid |
$2.17
|
| Rate for Payer: Mclaren Medicare |
$2.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.28
|
| Rate for Payer: Meridian Medicaid |
$2.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.52
|
| Rate for Payer: Nomi Health Commercial |
$3.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.57
|
| Rate for Payer: PACE Medicare |
$2.06
|
| Rate for Payer: PACE SWMI |
$2.17
|
| Rate for Payer: PHP Commercial |
$33.52
|
| Rate for Payer: PHP Medicare Advantage |
$2.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2.17
|
| Rate for Payer: Priority Health Medicare |
$2.17
|
| Rate for Payer: Priority Health SBD |
$24.84
|
| Rate for Payer: Priority Health Tiered Network |
$1.74
|
| Rate for Payer: Railroad Medicare Medicare |
$2.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.26
|
| Rate for Payer: UHC Core |
$3.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2.17
|
| Rate for Payer: UHC Exchange |
$3.26
|
| Rate for Payer: UHC Medicaid |
$1.13
|
| Rate for Payer: UHCCP Medicaid |
$1.13
|
| Rate for Payer: UMR Bronson Commercial |
$14.59
|
| Rate for Payer: VA VA |
$2.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.57
|
|
|
HC BILE BODY FLUID
|
Facility
|
IP
|
$39.43
|
|
|
Service Code
|
CPT 81005
|
| Hospital Charge Code |
30700007
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$17.35 |
| Max. Negotiated Rate |
$35.49 |
| Rate for Payer: Aetna American Axle |
$25.63
|
| Rate for Payer: Aetna Commercial |
$33.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.63
|
| Rate for Payer: Cash Price |
$31.54
|
| Rate for Payer: Cofinity Advantage |
$27.60
|
| Rate for Payer: Cofinity Commercial |
$33.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.54
|
| Rate for Payer: Healthscope Commercial |
$35.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.57
|
| Rate for Payer: PHP Commercial |
$33.52
|
| Rate for Payer: Priority Health SBD |
$24.84
|
| Rate for Payer: UMR Bronson Commercial |
$17.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.57
|
|
|
HC BILIARY BRUSH BIOPSY
|
Facility
|
OP
|
$4,149.40
|
|
|
Service Code
|
CPT 47552
|
| Hospital Charge Code |
36100207
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,535.28 |
| Max. Negotiated Rate |
$20,860.47 |
| Rate for Payer: Aetna American Axle |
$2,697.11
|
| Rate for Payer: Aetna Commercial |
$3,526.99
|
| Rate for Payer: Aetna Medicare |
$6,708.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,697.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,063.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,063.18
|
| Rate for Payer: BCBS Complete |
$3,542.64
|
| Rate for Payer: BCBS MAPPO |
$6,450.54
|
| Rate for Payer: BCBS Trust/PPO |
$2,735.91
|
| Rate for Payer: BCN Commercial |
$2,735.91
|
| Rate for Payer: BCN Medicare Advantage |
$6,450.54
|
| Rate for Payer: Cash Price |
$3,319.52
|
| Rate for Payer: Cash Price |
$3,319.52
|
| Rate for Payer: Cash Price |
$3,319.52
|
| Rate for Payer: Cofinity Advantage |
$2,904.58
|
| Rate for Payer: Cofinity Commercial |
$3,568.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,319.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,450.54
|
| Rate for Payer: Healthscope Commercial |
$3,734.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,904.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,112.05
|
| Rate for Payer: Mclaren Medicaid |
$6,450.54
|
| Rate for Payer: Mclaren Medicare |
$6,450.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,773.07
|
| Rate for Payer: Meridian Medicaid |
$6,773.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,418.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,095.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,526.99
|
| Rate for Payer: Nomi Health Commercial |
$19,351.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,112.05
|
| Rate for Payer: PACE Medicare |
$6,128.01
|
| Rate for Payer: PACE SWMI |
$6,450.54
|
| Rate for Payer: PHP Commercial |
$3,526.99
|
| Rate for Payer: PHP Medicare Advantage |
$6,450.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,373.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$20,860.47
|
| Rate for Payer: Priority Health Medicare |
$6,450.54
|
| Rate for Payer: Priority Health SBD |
$2,614.12
|
| Rate for Payer: Priority Health Tiered Network |
$16,688.38
|
| Rate for Payer: Railroad Medicare Medicare |
$6,450.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6,450.54
|
| Rate for Payer: UHC Medicaid |
$3,373.63
|
| Rate for Payer: UHCCP Medicaid |
$3,373.63
|
| Rate for Payer: UMR Bronson Commercial |
$1,535.28
|
| Rate for Payer: VA VA |
$6,450.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,112.05
|
|
|
HC BILIARY BRUSH BIOPSY
|
Facility
|
IP
|
$4,149.40
|
|
|
Service Code
|
CPT 47552
|
| Hospital Charge Code |
36100207
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,825.74 |
| Max. Negotiated Rate |
$3,734.46 |
| Rate for Payer: Aetna American Axle |
$2,697.11
|
| Rate for Payer: Aetna Commercial |
$3,526.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,697.11
|
| Rate for Payer: Cash Price |
$3,319.52
|
| Rate for Payer: Cofinity Advantage |
$2,904.58
|
| Rate for Payer: Cofinity Commercial |
$3,568.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,319.52
|
| Rate for Payer: Healthscope Commercial |
$3,734.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,904.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,112.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,526.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,112.05
|
| Rate for Payer: PHP Commercial |
$3,526.99
|
| Rate for Payer: Priority Health SBD |
$2,614.12
|
| Rate for Payer: UMR Bronson Commercial |
$1,825.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,112.05
|
|
|
HC BILIARY DRAINAGE
|
Facility
|
IP
|
$478.47
|
|
| Hospital Charge Code |
36000010
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$210.53 |
| Max. Negotiated Rate |
$430.62 |
| Rate for Payer: Aetna American Axle |
$311.01
|
| Rate for Payer: Aetna Commercial |
$406.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$311.01
|
| Rate for Payer: Cash Price |
$382.78
|
| Rate for Payer: Cofinity Advantage |
$334.93
|
| Rate for Payer: Cofinity Commercial |
$411.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$382.78
|
| Rate for Payer: Healthscope Commercial |
$430.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$334.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$358.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$406.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$358.85
|
| Rate for Payer: PHP Commercial |
$406.70
|
| Rate for Payer: Priority Health SBD |
$301.44
|
| Rate for Payer: UMR Bronson Commercial |
$210.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$358.85
|
|
|
HC BILIARY DRAINAGE
|
Facility
|
OP
|
$478.47
|
|
| Hospital Charge Code |
36000010
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$177.03 |
| Max. Negotiated Rate |
$430.62 |
| Rate for Payer: Aetna American Axle |
$311.01
|
| Rate for Payer: Aetna Commercial |
$406.70
|
| Rate for Payer: Aetna Medicare |
$239.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$311.01
|
| Rate for Payer: BCBS Complete |
$191.39
|
| Rate for Payer: Cash Price |
$382.78
|
| Rate for Payer: Cofinity Advantage |
$334.93
|
| Rate for Payer: Cofinity Commercial |
$411.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$382.78
|
| Rate for Payer: Healthscope Commercial |
$430.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$334.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$358.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$382.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$406.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$358.85
|
| Rate for Payer: PHP Commercial |
$406.70
|
| Rate for Payer: Priority Health SBD |
$301.44
|
| Rate for Payer: UMR Bronson Commercial |
$177.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$358.85
|
|
|
HC BILIARY DUCT BALLOON DILATATIO
|
Facility
|
IP
|
$1,892.73
|
|
| Hospital Charge Code |
36000011
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$832.80 |
| Max. Negotiated Rate |
$1,703.46 |
| Rate for Payer: Aetna American Axle |
$1,230.27
|
| Rate for Payer: Aetna Commercial |
$1,608.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,230.27
|
| Rate for Payer: Cash Price |
$1,514.18
|
| Rate for Payer: Cofinity Advantage |
$1,324.91
|
| Rate for Payer: Cofinity Commercial |
$1,627.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,514.18
|
| Rate for Payer: Healthscope Commercial |
$1,703.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,324.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,419.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,608.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,419.55
|
| Rate for Payer: PHP Commercial |
$1,608.82
|
| Rate for Payer: Priority Health SBD |
$1,192.42
|
| Rate for Payer: UMR Bronson Commercial |
$832.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,419.55
|
|
|
HC BILIARY DUCT BALLOON DILATATIO
|
Facility
|
OP
|
$1,892.73
|
|
| Hospital Charge Code |
36000011
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$700.31 |
| Max. Negotiated Rate |
$1,703.46 |
| Rate for Payer: Aetna American Axle |
$1,230.27
|
| Rate for Payer: Aetna Commercial |
$1,608.82
|
| Rate for Payer: Aetna Medicare |
$946.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,230.27
|
| Rate for Payer: BCBS Complete |
$757.09
|
| Rate for Payer: Cash Price |
$1,514.18
|
| Rate for Payer: Cofinity Advantage |
$1,324.91
|
| Rate for Payer: Cofinity Commercial |
$1,627.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,514.18
|
| Rate for Payer: Healthscope Commercial |
$1,703.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,324.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,419.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,514.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,608.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,419.55
|
| Rate for Payer: PHP Commercial |
$1,608.82
|
| Rate for Payer: Priority Health SBD |
$1,192.42
|
| Rate for Payer: UMR Bronson Commercial |
$700.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,419.55
|
|
|
HC BILIARY ENDO PERC VIA T-TUBE/OTHER TRACT W BX REMV CALCULI
|
Facility
|
IP
|
$29,386.20
|
|
|
Service Code
|
CPT 47554
|
| Hospital Charge Code |
36100633
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$12,929.93 |
| Max. Negotiated Rate |
$26,447.58 |
| Rate for Payer: Aetna American Axle |
$19,101.03
|
| Rate for Payer: Aetna Commercial |
$24,978.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19,101.03
|
| Rate for Payer: Cash Price |
$23,508.96
|
| Rate for Payer: Cofinity Advantage |
$20,570.34
|
| Rate for Payer: Cofinity Commercial |
$25,272.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,508.96
|
| Rate for Payer: Healthscope Commercial |
$26,447.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20,570.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22,039.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,978.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22,039.65
|
| Rate for Payer: PHP Commercial |
$24,978.27
|
| Rate for Payer: Priority Health SBD |
$18,513.31
|
| Rate for Payer: UMR Bronson Commercial |
$12,929.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22,039.65
|
|
|
HC BILIARY ENDO PERC VIA T-TUBE/OTHER TRACT W BX REMV CALCULI
|
Facility
|
OP
|
$29,386.20
|
|
|
Service Code
|
CPT 47554
|
| Hospital Charge Code |
36100633
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,836.44 |
| Max. Negotiated Rate |
$34,252.33 |
| Rate for Payer: Aetna American Axle |
$19,101.03
|
| Rate for Payer: Aetna Commercial |
$24,978.27
|
| Rate for Payer: Aetna Medicare |
$11,015.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19,101.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,239.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,239.51
|
| Rate for Payer: BCBS Complete |
$5,816.91
|
| Rate for Payer: BCBS MAPPO |
$10,591.61
|
| Rate for Payer: BCBS Trust/PPO |
$3,836.44
|
| Rate for Payer: BCN Commercial |
$3,836.44
|
| Rate for Payer: BCN Medicare Advantage |
$10,591.61
|
| Rate for Payer: Cash Price |
$23,508.96
|
| Rate for Payer: Cash Price |
$23,508.96
|
| Rate for Payer: Cash Price |
$23,508.96
|
| Rate for Payer: Cofinity Advantage |
$20,570.34
|
| Rate for Payer: Cofinity Commercial |
$25,272.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,508.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,591.61
|
| Rate for Payer: Healthscope Commercial |
$26,447.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20,570.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22,039.65
|
| Rate for Payer: Mclaren Medicaid |
$10,591.61
|
| Rate for Payer: Mclaren Medicare |
$10,591.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11,121.19
|
| Rate for Payer: Meridian Medicaid |
$11,121.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,180.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$11,650.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,978.27
|
| Rate for Payer: Nomi Health Commercial |
$31,774.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22,039.65
|
| Rate for Payer: PACE Medicare |
$10,062.03
|
| Rate for Payer: PACE SWMI |
$10,591.61
|
| Rate for Payer: PHP Commercial |
$24,978.27
|
| Rate for Payer: PHP Medicare Advantage |
$10,591.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,539.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$34,252.33
|
| Rate for Payer: Priority Health Medicare |
$10,591.61
|
| Rate for Payer: Priority Health SBD |
$18,513.31
|
| Rate for Payer: Priority Health Tiered Network |
$27,401.86
|
| Rate for Payer: Railroad Medicare Medicare |
$10,591.61
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10,591.61
|
| Rate for Payer: UHC Medicaid |
$5,539.41
|
| Rate for Payer: UHCCP Medicaid |
$5,539.41
|
| Rate for Payer: UMR Bronson Commercial |
$10,872.89
|
| Rate for Payer: VA VA |
$10,591.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22,039.65
|
|
|
HC BILIARY ENDO PERC VIA T-TUBE/OTHER TRACT W BX SING OR MULTI
|
Facility
|
IP
|
$21,624.00
|
|
|
Service Code
|
CPT 47553
|
| Hospital Charge Code |
36100632
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$9,514.56 |
| Max. Negotiated Rate |
$19,461.60 |
| Rate for Payer: Aetna American Axle |
$14,055.60
|
| Rate for Payer: Aetna Commercial |
$18,380.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14,055.60
|
| Rate for Payer: Cash Price |
$17,299.20
|
| Rate for Payer: Cofinity Advantage |
$15,136.80
|
| Rate for Payer: Cofinity Commercial |
$18,596.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17,299.20
|
| Rate for Payer: Healthscope Commercial |
$19,461.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15,136.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16,218.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18,380.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16,218.00
|
| Rate for Payer: PHP Commercial |
$18,380.40
|
| Rate for Payer: Priority Health SBD |
$13,623.12
|
| Rate for Payer: UMR Bronson Commercial |
$9,514.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16,218.00
|
|
|
HC BILIARY ENDO PERC VIA T-TUBE/OTHER TRACT W BX SING OR MULTI
|
Facility
|
OP
|
$21,624.00
|
|
|
Service Code
|
CPT 47553
|
| Hospital Charge Code |
36100632
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,373.63 |
| Max. Negotiated Rate |
$20,860.47 |
| Rate for Payer: Aetna American Axle |
$14,055.60
|
| Rate for Payer: Aetna Commercial |
$18,380.40
|
| Rate for Payer: Aetna Medicare |
$6,708.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14,055.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,063.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,063.18
|
| Rate for Payer: BCBS Complete |
$3,542.64
|
| Rate for Payer: BCBS MAPPO |
$6,450.54
|
| Rate for Payer: BCBS Trust/PPO |
$3,771.32
|
| Rate for Payer: BCN Commercial |
$3,771.32
|
| Rate for Payer: BCN Medicare Advantage |
$6,450.54
|
| Rate for Payer: Cash Price |
$17,299.20
|
| Rate for Payer: Cash Price |
$17,299.20
|
| Rate for Payer: Cash Price |
$17,299.20
|
| Rate for Payer: Cofinity Advantage |
$15,136.80
|
| Rate for Payer: Cofinity Commercial |
$18,596.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17,299.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,450.54
|
| Rate for Payer: Healthscope Commercial |
$19,461.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15,136.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16,218.00
|
| Rate for Payer: Mclaren Medicaid |
$6,450.54
|
| Rate for Payer: Mclaren Medicare |
$6,450.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,773.07
|
| Rate for Payer: Meridian Medicaid |
$6,773.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,418.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,095.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18,380.40
|
| Rate for Payer: Nomi Health Commercial |
$19,351.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16,218.00
|
| Rate for Payer: PACE Medicare |
$6,128.01
|
| Rate for Payer: PACE SWMI |
$6,450.54
|
| Rate for Payer: PHP Commercial |
$18,380.40
|
| Rate for Payer: PHP Medicare Advantage |
$6,450.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,373.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$20,860.47
|
| Rate for Payer: Priority Health Medicare |
$6,450.54
|
| Rate for Payer: Priority Health SBD |
$13,623.12
|
| Rate for Payer: Priority Health Tiered Network |
$16,688.38
|
| Rate for Payer: Railroad Medicare Medicare |
$6,450.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6,450.54
|
| Rate for Payer: UHC Medicaid |
$3,373.63
|
| Rate for Payer: UHCCP Medicaid |
$3,373.63
|
| Rate for Payer: UMR Bronson Commercial |
$8,000.88
|
| Rate for Payer: VA VA |
$6,450.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16,218.00
|
|
|
HC BILIARY ENDO PERC VIA T-TUBE/OTHER TRACT W DIL OF BIL STRICT WO STENT
|
Facility
|
IP
|
$9,894.00
|
|
|
Service Code
|
CPT 47555
|
| Hospital Charge Code |
36100634
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,353.36 |
| Max. Negotiated Rate |
$8,904.60 |
| Rate for Payer: Aetna American Axle |
$6,431.10
|
| Rate for Payer: Aetna Commercial |
$8,409.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,431.10
|
| Rate for Payer: Cash Price |
$7,915.20
|
| Rate for Payer: Cofinity Advantage |
$6,925.80
|
| Rate for Payer: Cofinity Commercial |
$8,508.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,915.20
|
| Rate for Payer: Healthscope Commercial |
$8,904.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,925.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,420.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,409.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,420.50
|
| Rate for Payer: PHP Commercial |
$8,409.90
|
| Rate for Payer: Priority Health SBD |
$6,233.22
|
| Rate for Payer: UMR Bronson Commercial |
$4,353.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,420.50
|
|
|
HC BILIARY ENDO PERC VIA T-TUBE/OTHER TRACT W DIL OF BIL STRICT WO STENT
|
Facility
|
OP
|
$9,894.00
|
|
|
Service Code
|
CPT 47555
|
| Hospital Charge Code |
36100634
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,098.64 |
| Max. Negotiated Rate |
$20,860.47 |
| Rate for Payer: Aetna American Axle |
$6,431.10
|
| Rate for Payer: Aetna Commercial |
$8,409.90
|
| Rate for Payer: Aetna Medicare |
$6,708.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,431.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,063.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,063.18
|
| Rate for Payer: BCBS Complete |
$3,542.64
|
| Rate for Payer: BCBS MAPPO |
$6,450.54
|
| Rate for Payer: BCBS Trust/PPO |
$2,098.64
|
| Rate for Payer: BCN Commercial |
$2,098.64
|
| Rate for Payer: BCN Medicare Advantage |
$6,450.54
|
| Rate for Payer: Cash Price |
$7,915.20
|
| Rate for Payer: Cash Price |
$7,915.20
|
| Rate for Payer: Cash Price |
$7,915.20
|
| Rate for Payer: Cofinity Advantage |
$6,925.80
|
| Rate for Payer: Cofinity Commercial |
$8,508.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,915.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,450.54
|
| Rate for Payer: Healthscope Commercial |
$8,904.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,925.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,420.50
|
| Rate for Payer: Mclaren Medicaid |
$6,450.54
|
| Rate for Payer: Mclaren Medicare |
$6,450.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,773.07
|
| Rate for Payer: Meridian Medicaid |
$6,773.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,418.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,095.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,409.90
|
| Rate for Payer: Nomi Health Commercial |
$19,351.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,420.50
|
| Rate for Payer: PACE Medicare |
$6,128.01
|
| Rate for Payer: PACE SWMI |
$6,450.54
|
| Rate for Payer: PHP Commercial |
$8,409.90
|
| Rate for Payer: PHP Medicare Advantage |
$6,450.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,373.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$20,860.47
|
| Rate for Payer: Priority Health Medicare |
$6,450.54
|
| Rate for Payer: Priority Health SBD |
$6,233.22
|
| Rate for Payer: Priority Health Tiered Network |
$16,688.38
|
| Rate for Payer: Railroad Medicare Medicare |
$6,450.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6,450.54
|
| Rate for Payer: UHC Medicaid |
$3,373.63
|
| Rate for Payer: UHCCP Medicaid |
$3,373.63
|
| Rate for Payer: UMR Bronson Commercial |
$3,660.78
|
| Rate for Payer: VA VA |
$6,450.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,420.50
|
|
|
HC BILIRUBIN DIRECT
|
Facility
|
IP
|
$21.23
|
|
|
Service Code
|
CPT 82248
|
| Hospital Charge Code |
30100118
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.34 |
| Max. Negotiated Rate |
$19.11 |
| Rate for Payer: Aetna American Axle |
$13.80
|
| Rate for Payer: Aetna Commercial |
$18.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.80
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cofinity Advantage |
$14.86
|
| Rate for Payer: Cofinity Commercial |
$18.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.98
|
| Rate for Payer: Healthscope Commercial |
$19.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.92
|
| Rate for Payer: PHP Commercial |
$18.05
|
| Rate for Payer: Priority Health SBD |
$13.37
|
| Rate for Payer: UMR Bronson Commercial |
$9.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.92
|
|
|
HC BILIRUBIN DIRECT
|
Facility
|
OP
|
$21.23
|
|
|
Service Code
|
CPT 82248
|
| Hospital Charge Code |
30100118
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.63 |
| Max. Negotiated Rate |
$19.11 |
| Rate for Payer: Aetna American Axle |
$13.80
|
| Rate for Payer: Aetna Commercial |
$18.05
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.28
|
| Rate for Payer: BCBS Complete |
$2.76
|
| Rate for Payer: BCBS MAPPO |
$5.02
|
| Rate for Payer: BCN Medicare Advantage |
$5.02
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cofinity Advantage |
$14.86
|
| Rate for Payer: Cofinity Commercial |
$18.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.02
|
| Rate for Payer: Healthscope Commercial |
$19.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.92
|
| Rate for Payer: Mclaren Medicaid |
$5.02
|
| Rate for Payer: Mclaren Medicare |
$5.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.27
|
| Rate for Payer: Meridian Medicaid |
$5.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.05
|
| Rate for Payer: Nomi Health Commercial |
$7.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.92
|
| Rate for Payer: PACE Medicare |
$4.77
|
| Rate for Payer: PACE SWMI |
$5.02
|
| Rate for Payer: PHP Commercial |
$18.05
|
| Rate for Payer: PHP Medicare Advantage |
$5.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.02
|
| Rate for Payer: Priority Health Medicare |
$5.02
|
| Rate for Payer: Priority Health SBD |
$13.37
|
| Rate for Payer: Priority Health Tiered Network |
$4.02
|
| Rate for Payer: Railroad Medicare Medicare |
$5.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.53
|
| Rate for Payer: UHC Core |
$7.53
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.02
|
| Rate for Payer: UHC Exchange |
$7.53
|
| Rate for Payer: UHC Medicaid |
$2.63
|
| Rate for Payer: UHCCP Medicaid |
$2.63
|
| Rate for Payer: UMR Bronson Commercial |
$7.86
|
| Rate for Payer: VA VA |
$5.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.92
|
|
|
HC BILIRUBIN TOTAL
|
Facility
|
IP
|
$21.23
|
|
|
Service Code
|
CPT 82247
|
| Hospital Charge Code |
30100117
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.34 |
| Max. Negotiated Rate |
$19.11 |
| Rate for Payer: Aetna American Axle |
$13.80
|
| Rate for Payer: Aetna Commercial |
$18.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.80
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cofinity Advantage |
$14.86
|
| Rate for Payer: Cofinity Commercial |
$18.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.98
|
| Rate for Payer: Healthscope Commercial |
$19.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.92
|
| Rate for Payer: PHP Commercial |
$18.05
|
| Rate for Payer: Priority Health SBD |
$13.37
|
| Rate for Payer: UMR Bronson Commercial |
$9.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.92
|
|
|
HC BILIRUBIN TOTAL
|
Facility
|
OP
|
$21.23
|
|
|
Service Code
|
CPT 82247
|
| Hospital Charge Code |
30100117
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.63 |
| Max. Negotiated Rate |
$19.11 |
| Rate for Payer: Aetna American Axle |
$13.80
|
| Rate for Payer: Aetna Commercial |
$18.05
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.28
|
| Rate for Payer: BCBS Complete |
$2.76
|
| Rate for Payer: BCBS MAPPO |
$5.02
|
| Rate for Payer: BCN Medicare Advantage |
$5.02
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cofinity Advantage |
$14.86
|
| Rate for Payer: Cofinity Commercial |
$18.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.02
|
| Rate for Payer: Healthscope Commercial |
$19.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.92
|
| Rate for Payer: Mclaren Medicaid |
$5.02
|
| Rate for Payer: Mclaren Medicare |
$5.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.27
|
| Rate for Payer: Meridian Medicaid |
$5.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.05
|
| Rate for Payer: Nomi Health Commercial |
$7.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.92
|
| Rate for Payer: PACE Medicare |
$4.77
|
| Rate for Payer: PACE SWMI |
$5.02
|
| Rate for Payer: PHP Commercial |
$18.05
|
| Rate for Payer: PHP Medicare Advantage |
$5.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.02
|
| Rate for Payer: Priority Health Medicare |
$5.02
|
| Rate for Payer: Priority Health SBD |
$13.37
|
| Rate for Payer: Priority Health Tiered Network |
$4.02
|
| Rate for Payer: Railroad Medicare Medicare |
$5.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.53
|
| Rate for Payer: UHC Core |
$7.53
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.02
|
| Rate for Payer: UHC Exchange |
$7.53
|
| Rate for Payer: UHC Medicaid |
$2.63
|
| Rate for Payer: UHCCP Medicaid |
$2.63
|
| Rate for Payer: UMR Bronson Commercial |
$7.86
|
| Rate for Payer: VA VA |
$5.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.92
|
|
|
HC BILIRUBIN TOTAL TRANSCUTANEOUS
|
Facility
|
OP
|
$48.43
|
|
|
Service Code
|
CPT 88720
|
| Hospital Charge Code |
30100694
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.63 |
| Max. Negotiated Rate |
$43.59 |
| Rate for Payer: Aetna American Axle |
$31.48
|
| Rate for Payer: Aetna Commercial |
$41.17
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.28
|
| Rate for Payer: BCBS Complete |
$2.76
|
| Rate for Payer: BCBS MAPPO |
$5.02
|
| Rate for Payer: BCBS Trust/PPO |
$5.81
|
| Rate for Payer: BCN Commercial |
$5.81
|
| Rate for Payer: BCN Medicare Advantage |
$5.02
|
| Rate for Payer: Cash Price |
$38.74
|
| Rate for Payer: Cash Price |
$38.74
|
| Rate for Payer: Cofinity Advantage |
$33.90
|
| Rate for Payer: Cofinity Commercial |
$41.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.02
|
| Rate for Payer: Healthscope Commercial |
$43.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.32
|
| Rate for Payer: Mclaren Medicaid |
$5.02
|
| Rate for Payer: Mclaren Medicare |
$5.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.27
|
| Rate for Payer: Meridian Medicaid |
$5.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.17
|
| Rate for Payer: Nomi Health Commercial |
$7.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.32
|
| Rate for Payer: PACE Medicare |
$4.77
|
| Rate for Payer: PACE SWMI |
$5.02
|
| Rate for Payer: PHP Commercial |
$41.17
|
| Rate for Payer: PHP Medicare Advantage |
$5.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.02
|
| Rate for Payer: Priority Health Medicare |
$5.02
|
| Rate for Payer: Priority Health SBD |
$30.51
|
| Rate for Payer: Priority Health Tiered Network |
$4.02
|
| Rate for Payer: Railroad Medicare Medicare |
$5.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.53
|
| Rate for Payer: UHC Core |
$7.53
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.02
|
| Rate for Payer: UHC Exchange |
$7.53
|
| Rate for Payer: UHC Medicaid |
$2.63
|
| Rate for Payer: UHCCP Medicaid |
$2.63
|
| Rate for Payer: UMR Bronson Commercial |
$17.92
|
| Rate for Payer: VA VA |
$5.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.32
|
|
|
HC BILIRUBIN TOTAL TRANSCUTANEOUS
|
Facility
|
IP
|
$48.43
|
|
|
Service Code
|
CPT 88720
|
| Hospital Charge Code |
30100694
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.31 |
| Max. Negotiated Rate |
$43.59 |
| Rate for Payer: Aetna American Axle |
$31.48
|
| Rate for Payer: Aetna Commercial |
$41.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.48
|
| Rate for Payer: Cash Price |
$38.74
|
| Rate for Payer: Cofinity Advantage |
$33.90
|
| Rate for Payer: Cofinity Commercial |
$41.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.74
|
| Rate for Payer: Healthscope Commercial |
$43.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.32
|
| Rate for Payer: PHP Commercial |
$41.17
|
| Rate for Payer: Priority Health SBD |
$30.51
|
| Rate for Payer: UMR Bronson Commercial |
$21.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.32
|
|
