|
HC GASTRIN LEVEL
|
Facility
|
OP
|
$41.82
|
|
|
Service Code
|
CPT 82941
|
| Hospital Charge Code |
30100220
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.64 |
| Max. Negotiated Rate |
$37.64 |
| Rate for Payer: Aetna American Axle |
$27.18
|
| Rate for Payer: Aetna Commercial |
$35.55
|
| Rate for Payer: Aetna Medicare |
$18.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.04
|
| Rate for Payer: BCBS Complete |
$10.13
|
| Rate for Payer: BCBS MAPPO |
$17.63
|
| Rate for Payer: BCBS Trust/PPO |
$15.85
|
| Rate for Payer: BCN Medicare Advantage |
$17.63
|
| Rate for Payer: Cash Price |
$33.46
|
| Rate for Payer: Cash Price |
$33.46
|
| Rate for Payer: Cofinity Commercial |
$35.97
|
| Rate for Payer: Cofinity Commercial |
$29.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.63
|
| Rate for Payer: Healthscope Commercial |
$37.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.36
|
| Rate for Payer: Mclaren Medicaid |
$9.64
|
| Rate for Payer: Mclaren Medicare |
$17.63
|
| Rate for Payer: Meridian Medicaid |
$10.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$35.55
|
| Rate for Payer: PACE Medicare |
$16.75
|
| Rate for Payer: PACE SWMI |
$17.63
|
| Rate for Payer: PHP Commercial |
$35.55
|
| Rate for Payer: PHP Medicare Advantage |
$17.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24.19
|
| Rate for Payer: Priority Health Medicare |
$17.63
|
| Rate for Payer: Priority Health Narrow Network |
$19.35
|
| Rate for Payer: Priority Health SBD |
$26.35
|
| Rate for Payer: Railroad Medicare Medicare |
$17.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.16
|
| Rate for Payer: UHC Core |
$29.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.63
|
| Rate for Payer: UHC Exchange |
$17.63
|
| Rate for Payer: UHC Medicare Advantage |
$18.16
|
| Rate for Payer: UMR Bronson Commercial |
$15.47
|
| Rate for Payer: VA VA |
$17.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.36
|
|
|
HC GASTRIN LEVEL
|
Facility
|
IP
|
$41.82
|
|
|
Service Code
|
CPT 82941
|
| Hospital Charge Code |
30100220
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.40 |
| Max. Negotiated Rate |
$37.64 |
| Rate for Payer: Aetna American Axle |
$27.18
|
| Rate for Payer: Aetna Commercial |
$35.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.18
|
| Rate for Payer: Cash Price |
$33.46
|
| Rate for Payer: Cofinity Commercial |
$29.27
|
| Rate for Payer: Cofinity Commercial |
$35.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.46
|
| Rate for Payer: Healthscope Commercial |
$37.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$35.55
|
| Rate for Payer: PHP Commercial |
$35.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.27
|
| Rate for Payer: Priority Health SBD |
$26.35
|
| Rate for Payer: UMR Bronson Commercial |
$18.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.36
|
|
|
HC GASTROGRAFIN PER ML
|
Facility
|
OP
|
$3.41
|
|
|
Service Code
|
HCPCS Q9963
|
| Hospital Charge Code |
63600010
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$3.07 |
| Rate for Payer: Aetna American Axle |
$2.22
|
| Rate for Payer: Aetna Commercial |
$2.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.22
|
| Rate for Payer: BCBS Complete |
$1.36
|
| Rate for Payer: BCBS Trust/PPO |
$0.25
|
| Rate for Payer: Cash Price |
$2.73
|
| Rate for Payer: Cash Price |
$2.73
|
| Rate for Payer: Cofinity Commercial |
$2.39
|
| Rate for Payer: Cofinity Commercial |
$2.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.73
|
| Rate for Payer: Healthscope Commercial |
$3.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.90
|
| Rate for Payer: PHP Commercial |
$2.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.39
|
| Rate for Payer: Priority Health SBD |
$2.15
|
| Rate for Payer: UMR Bronson Commercial |
$1.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.56
|
|
|
HC GASTROGRAFIN PER ML
|
Facility
|
IP
|
$3.41
|
|
|
Service Code
|
HCPCS Q9963
|
| Hospital Charge Code |
63600010
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$3.07 |
| Rate for Payer: Aetna American Axle |
$2.22
|
| Rate for Payer: Aetna Commercial |
$2.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.22
|
| Rate for Payer: Cash Price |
$2.73
|
| Rate for Payer: Cofinity Commercial |
$2.39
|
| Rate for Payer: Cofinity Commercial |
$2.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.73
|
| Rate for Payer: Healthscope Commercial |
$3.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.90
|
| Rate for Payer: PHP Commercial |
$2.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.39
|
| Rate for Payer: Priority Health SBD |
$2.15
|
| Rate for Payer: UMR Bronson Commercial |
$1.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.56
|
|
|
HC GASTROSCOPY
|
Facility
|
IP
|
$1,923.68
|
|
| Hospital Charge Code |
36000047
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$846.42 |
| Max. Negotiated Rate |
$1,731.31 |
| Rate for Payer: Aetna American Axle |
$1,250.39
|
| Rate for Payer: Aetna Commercial |
$1,635.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,250.39
|
| Rate for Payer: Cash Price |
$1,538.94
|
| Rate for Payer: Cofinity Commercial |
$1,346.58
|
| Rate for Payer: Cofinity Commercial |
$1,654.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,538.94
|
| Rate for Payer: Healthscope Commercial |
$1,731.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,346.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,442.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,635.13
|
| Rate for Payer: PHP Commercial |
$1,635.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,346.58
|
| Rate for Payer: Priority Health SBD |
$1,211.92
|
| Rate for Payer: UMR Bronson Commercial |
$846.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,442.76
|
|
|
HC GASTROSCOPY
|
Facility
|
OP
|
$1,923.68
|
|
| Hospital Charge Code |
36000047
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$711.76 |
| Max. Negotiated Rate |
$1,731.31 |
| Rate for Payer: Aetna American Axle |
$1,250.39
|
| Rate for Payer: Aetna Commercial |
$1,635.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,250.39
|
| Rate for Payer: BCBS Complete |
$769.47
|
| Rate for Payer: Cash Price |
$1,538.94
|
| Rate for Payer: Cofinity Commercial |
$1,346.58
|
| Rate for Payer: Cofinity Commercial |
$1,654.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,538.94
|
| Rate for Payer: Healthscope Commercial |
$1,731.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,346.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,442.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,635.13
|
| Rate for Payer: PHP Commercial |
$1,635.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,346.58
|
| Rate for Payer: Priority Health SBD |
$1,211.92
|
| Rate for Payer: UMR Bronson Commercial |
$711.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,442.76
|
|
|
HC GEN ANES ADDL 15 MIN
|
Facility
|
IP
|
$146.98
|
|
| Hospital Charge Code |
37000001
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$64.67 |
| Max. Negotiated Rate |
$132.28 |
| Rate for Payer: Aetna American Axle |
$95.54
|
| Rate for Payer: Aetna Commercial |
$124.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.54
|
| Rate for Payer: Cash Price |
$117.58
|
| Rate for Payer: Cofinity Commercial |
$102.89
|
| Rate for Payer: Cofinity Commercial |
$126.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.58
|
| Rate for Payer: Healthscope Commercial |
$132.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$102.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$124.93
|
| Rate for Payer: PHP Commercial |
$124.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.89
|
| Rate for Payer: Priority Health SBD |
$92.60
|
| Rate for Payer: UMR Bronson Commercial |
$64.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.24
|
|
|
HC GEN ANES ADDL 15 MIN
|
Facility
|
OP
|
$146.98
|
|
| Hospital Charge Code |
37000001
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$54.38 |
| Max. Negotiated Rate |
$132.28 |
| Rate for Payer: Aetna American Axle |
$95.54
|
| Rate for Payer: Aetna Commercial |
$124.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.54
|
| Rate for Payer: BCBS Complete |
$58.79
|
| Rate for Payer: Cash Price |
$117.58
|
| Rate for Payer: Cofinity Commercial |
$102.89
|
| Rate for Payer: Cofinity Commercial |
$126.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.58
|
| Rate for Payer: Healthscope Commercial |
$132.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$102.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$124.93
|
| Rate for Payer: PHP Commercial |
$124.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.89
|
| Rate for Payer: Priority Health SBD |
$92.60
|
| Rate for Payer: UMR Bronson Commercial |
$54.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.24
|
|
|
HC GEN ANES INIT 30 MIN
|
Facility
|
OP
|
$578.16
|
|
| Hospital Charge Code |
37000002
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$213.92 |
| Max. Negotiated Rate |
$520.34 |
| Rate for Payer: Aetna American Axle |
$375.80
|
| Rate for Payer: Aetna Commercial |
$491.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$375.80
|
| Rate for Payer: BCBS Complete |
$231.26
|
| Rate for Payer: Cash Price |
$462.53
|
| Rate for Payer: Cofinity Commercial |
$404.71
|
| Rate for Payer: Cofinity Commercial |
$497.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$462.53
|
| Rate for Payer: Healthscope Commercial |
$520.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$404.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$433.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$491.44
|
| Rate for Payer: PHP Commercial |
$491.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$404.71
|
| Rate for Payer: Priority Health SBD |
$364.24
|
| Rate for Payer: UMR Bronson Commercial |
$213.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$433.62
|
|
|
HC GEN ANES INIT 30 MIN
|
Facility
|
IP
|
$578.16
|
|
| Hospital Charge Code |
37000002
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$254.39 |
| Max. Negotiated Rate |
$520.34 |
| Rate for Payer: Aetna American Axle |
$375.80
|
| Rate for Payer: Aetna Commercial |
$491.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$375.80
|
| Rate for Payer: Cash Price |
$462.53
|
| Rate for Payer: Cofinity Commercial |
$404.71
|
| Rate for Payer: Cofinity Commercial |
$497.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$462.53
|
| Rate for Payer: Healthscope Commercial |
$520.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$404.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$433.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$491.44
|
| Rate for Payer: PHP Commercial |
$491.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$404.71
|
| Rate for Payer: Priority Health SBD |
$364.24
|
| Rate for Payer: UMR Bronson Commercial |
$254.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$433.62
|
|
|
HC GENERAL HEALTH PANEL
|
Facility
|
OP
|
$226.20
|
|
|
Service Code
|
CPT 80050
|
| Hospital Charge Code |
30100011
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.61 |
| Max. Negotiated Rate |
$203.58 |
| Rate for Payer: Aetna American Axle |
$147.03
|
| Rate for Payer: Aetna Commercial |
$192.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$147.03
|
| Rate for Payer: BCBS Complete |
$90.48
|
| Rate for Payer: BCBS Trust/PPO |
$42.89
|
| Rate for Payer: Cash Price |
$180.96
|
| Rate for Payer: Cash Price |
$180.96
|
| Rate for Payer: Cofinity Commercial |
$158.34
|
| Rate for Payer: Cofinity Commercial |
$194.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.96
|
| Rate for Payer: Healthscope Commercial |
$203.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$158.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$169.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$192.27
|
| Rate for Payer: PHP Commercial |
$192.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$47.01
|
| Rate for Payer: Priority Health Narrow Network |
$37.61
|
| Rate for Payer: Priority Health SBD |
$142.51
|
| Rate for Payer: UHC Core |
$49.00
|
| Rate for Payer: UMR Bronson Commercial |
$83.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$169.65
|
|
|
HC GENERAL HEALTH PANEL
|
Facility
|
IP
|
$226.20
|
|
|
Service Code
|
CPT 80050
|
| Hospital Charge Code |
30100011
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$99.53 |
| Max. Negotiated Rate |
$203.58 |
| Rate for Payer: Aetna American Axle |
$147.03
|
| Rate for Payer: Aetna Commercial |
$192.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$147.03
|
| Rate for Payer: Cash Price |
$180.96
|
| Rate for Payer: Cofinity Commercial |
$158.34
|
| Rate for Payer: Cofinity Commercial |
$194.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.96
|
| Rate for Payer: Healthscope Commercial |
$203.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$158.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$169.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$192.27
|
| Rate for Payer: PHP Commercial |
$192.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.34
|
| Rate for Payer: Priority Health SBD |
$142.51
|
| Rate for Payer: UMR Bronson Commercial |
$99.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$169.65
|
|
|
HC GENTAMICIN LEVEL
|
Facility
|
IP
|
$120.60
|
|
|
Service Code
|
CPT 80170
|
| Hospital Charge Code |
30100030
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$53.06 |
| Max. Negotiated Rate |
$108.54 |
| Rate for Payer: Aetna American Axle |
$78.39
|
| Rate for Payer: Aetna Commercial |
$102.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.39
|
| Rate for Payer: Cash Price |
$96.48
|
| Rate for Payer: Cofinity Commercial |
$84.42
|
| Rate for Payer: Cofinity Commercial |
$103.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.48
|
| Rate for Payer: Healthscope Commercial |
$108.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$84.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$102.51
|
| Rate for Payer: PHP Commercial |
$102.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.42
|
| Rate for Payer: Priority Health SBD |
$75.98
|
| Rate for Payer: UMR Bronson Commercial |
$53.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.45
|
|
|
HC GENTAMICIN LEVEL
|
Facility
|
OP
|
$120.60
|
|
|
Service Code
|
CPT 80170
|
| Hospital Charge Code |
30100030
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.96 |
| Max. Negotiated Rate |
$108.54 |
| Rate for Payer: Aetna American Axle |
$78.39
|
| Rate for Payer: Aetna Commercial |
$102.51
|
| Rate for Payer: Aetna Medicare |
$17.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.48
|
| Rate for Payer: BCBS Complete |
$9.41
|
| Rate for Payer: BCBS MAPPO |
$16.38
|
| Rate for Payer: BCBS Trust/PPO |
$14.74
|
| Rate for Payer: BCN Medicare Advantage |
$16.38
|
| Rate for Payer: Cash Price |
$96.48
|
| Rate for Payer: Cash Price |
$96.48
|
| Rate for Payer: Cofinity Commercial |
$84.42
|
| Rate for Payer: Cofinity Commercial |
$103.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.38
|
| Rate for Payer: Healthscope Commercial |
$108.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$84.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.45
|
| Rate for Payer: Mclaren Medicaid |
$8.96
|
| Rate for Payer: Mclaren Medicare |
$16.38
|
| Rate for Payer: Meridian Medicaid |
$9.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$102.51
|
| Rate for Payer: PACE Medicare |
$15.56
|
| Rate for Payer: PACE SWMI |
$16.38
|
| Rate for Payer: PHP Commercial |
$102.51
|
| Rate for Payer: PHP Medicare Advantage |
$16.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.01
|
| Rate for Payer: Priority Health Medicare |
$16.38
|
| Rate for Payer: Priority Health Narrow Network |
$10.41
|
| Rate for Payer: Priority Health SBD |
$75.98
|
| Rate for Payer: Railroad Medicare Medicare |
$16.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.66
|
| Rate for Payer: UHC Core |
$27.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.38
|
| Rate for Payer: UHC Exchange |
$16.38
|
| Rate for Payer: UHC Medicare Advantage |
$16.87
|
| Rate for Payer: UMR Bronson Commercial |
$44.62
|
| Rate for Payer: VA VA |
$16.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.45
|
|
|
HC GGTP
|
Facility
|
IP
|
$68.00
|
|
|
Service Code
|
CPT 82977
|
| Hospital Charge Code |
30100229
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.92 |
| Max. Negotiated Rate |
$61.20 |
| Rate for Payer: Aetna American Axle |
$44.20
|
| Rate for Payer: Aetna Commercial |
$57.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.20
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Cofinity Commercial |
$47.60
|
| Rate for Payer: Cofinity Commercial |
$58.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.40
|
| Rate for Payer: Healthscope Commercial |
$61.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$57.80
|
| Rate for Payer: PHP Commercial |
$57.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.60
|
| Rate for Payer: Priority Health SBD |
$42.84
|
| Rate for Payer: UMR Bronson Commercial |
$29.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.00
|
|
|
HC GGTP
|
Facility
|
OP
|
$68.00
|
|
|
Service Code
|
CPT 82977
|
| Hospital Charge Code |
30100229
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.94 |
| Max. Negotiated Rate |
$61.20 |
| Rate for Payer: Aetna American Axle |
$44.20
|
| Rate for Payer: Aetna Commercial |
$57.80
|
| Rate for Payer: Aetna Medicare |
$7.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.00
|
| Rate for Payer: BCBS Complete |
$4.14
|
| Rate for Payer: BCBS MAPPO |
$7.20
|
| Rate for Payer: BCN Medicare Advantage |
$7.20
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Cofinity Commercial |
$47.60
|
| Rate for Payer: Cofinity Commercial |
$58.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.20
|
| Rate for Payer: Healthscope Commercial |
$61.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.00
|
| Rate for Payer: Mclaren Medicaid |
$3.94
|
| Rate for Payer: Mclaren Medicare |
$7.20
|
| Rate for Payer: Meridian Medicaid |
$4.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$57.80
|
| Rate for Payer: PACE Medicare |
$6.84
|
| Rate for Payer: PACE SWMI |
$7.20
|
| Rate for Payer: PHP Commercial |
$57.80
|
| Rate for Payer: PHP Medicare Advantage |
$7.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.88
|
| Rate for Payer: Priority Health Medicare |
$7.20
|
| Rate for Payer: Priority Health Narrow Network |
$7.90
|
| Rate for Payer: Priority Health SBD |
$42.84
|
| Rate for Payer: Railroad Medicare Medicare |
$7.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.64
|
| Rate for Payer: UHC Core |
$11.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.20
|
| Rate for Payer: UHC Exchange |
$7.20
|
| Rate for Payer: UHC Medicare Advantage |
$7.42
|
| Rate for Payer: UMR Bronson Commercial |
$25.16
|
| Rate for Payer: VA VA |
$7.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.00
|
|
|
HC GIARDIA SCREEN
|
Facility
|
IP
|
$44.88
|
|
|
Service Code
|
CPT 87329
|
| Hospital Charge Code |
30600119
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$19.75 |
| Max. Negotiated Rate |
$40.39 |
| Rate for Payer: Aetna American Axle |
$29.17
|
| Rate for Payer: Aetna Commercial |
$38.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.17
|
| Rate for Payer: Cash Price |
$35.90
|
| Rate for Payer: Cofinity Commercial |
$31.42
|
| Rate for Payer: Cofinity Commercial |
$38.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.90
|
| Rate for Payer: Healthscope Commercial |
$40.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.15
|
| Rate for Payer: PHP Commercial |
$38.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.42
|
| Rate for Payer: Priority Health SBD |
$28.27
|
| Rate for Payer: UMR Bronson Commercial |
$19.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.66
|
|
|
HC GIARDIA SCREEN
|
Facility
|
OP
|
$44.88
|
|
|
Service Code
|
CPT 87329
|
| Hospital Charge Code |
30600119
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.55 |
| Max. Negotiated Rate |
$40.39 |
| Rate for Payer: Aetna American Axle |
$29.17
|
| Rate for Payer: Aetna Commercial |
$38.15
|
| Rate for Payer: Aetna Medicare |
$12.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.98
|
| Rate for Payer: BCBS Complete |
$6.88
|
| Rate for Payer: BCBS MAPPO |
$11.98
|
| Rate for Payer: BCBS Trust/PPO |
$10.78
|
| Rate for Payer: BCN Medicare Advantage |
$11.98
|
| Rate for Payer: Cash Price |
$35.90
|
| Rate for Payer: Cash Price |
$35.90
|
| Rate for Payer: Cofinity Commercial |
$31.42
|
| Rate for Payer: Cofinity Commercial |
$38.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.98
|
| Rate for Payer: Healthscope Commercial |
$40.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.66
|
| Rate for Payer: Mclaren Medicaid |
$6.55
|
| Rate for Payer: Mclaren Medicare |
$11.98
|
| Rate for Payer: Meridian Medicaid |
$6.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.15
|
| Rate for Payer: PACE Medicare |
$11.38
|
| Rate for Payer: PACE SWMI |
$11.98
|
| Rate for Payer: PHP Commercial |
$38.15
|
| Rate for Payer: PHP Medicare Advantage |
$11.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.44
|
| Rate for Payer: Priority Health Medicare |
$11.98
|
| Rate for Payer: Priority Health Narrow Network |
$13.15
|
| Rate for Payer: Priority Health SBD |
$28.27
|
| Rate for Payer: Railroad Medicare Medicare |
$11.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.38
|
| Rate for Payer: UHC Core |
$19.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.98
|
| Rate for Payer: UHC Exchange |
$11.98
|
| Rate for Payer: UHC Medicare Advantage |
$12.34
|
| Rate for Payer: UMR Bronson Commercial |
$16.61
|
| Rate for Payer: VA VA |
$11.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.66
|
|
|
HC GI CONVERT G TO GJ TUBE W
|
Facility
|
OP
|
$1,761.21
|
|
|
Service Code
|
CPT 49446
|
| Hospital Charge Code |
36100228
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$139.49 |
| Max. Negotiated Rate |
$5,324.53 |
| Rate for Payer: Aetna American Axle |
$1,144.79
|
| Rate for Payer: Aetna Commercial |
$1,497.03
|
| Rate for Payer: Aetna Medicare |
$1,759.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,144.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,114.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,114.21
|
| Rate for Payer: BCBS Complete |
$971.52
|
| Rate for Payer: BCBS MAPPO |
$1,691.37
|
| Rate for Payer: BCBS Trust/PPO |
$2,156.55
|
| Rate for Payer: BCN Medicare Advantage |
$1,691.37
|
| Rate for Payer: Cash Price |
$1,408.97
|
| Rate for Payer: Cash Price |
$1,408.97
|
| Rate for Payer: Cofinity Commercial |
$1,232.85
|
| Rate for Payer: Cofinity Commercial |
$1,514.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,408.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,691.37
|
| Rate for Payer: Healthscope Commercial |
$1,585.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,232.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,320.91
|
| Rate for Payer: Mclaren Medicaid |
$925.18
|
| Rate for Payer: Mclaren Medicare |
$1,691.37
|
| Rate for Payer: Meridian Medicaid |
$971.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,775.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,945.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,497.03
|
| Rate for Payer: PACE Medicare |
$1,606.80
|
| Rate for Payer: PACE SWMI |
$1,691.37
|
| Rate for Payer: PHP Commercial |
$1,497.03
|
| Rate for Payer: PHP Medicare Advantage |
$1,691.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$925.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,232.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,324.53
|
| Rate for Payer: Priority Health Medicare |
$1,691.37
|
| Rate for Payer: Priority Health Narrow Network |
$4,259.62
|
| Rate for Payer: Priority Health SBD |
$1,109.56
|
| Rate for Payer: Railroad Medicare Medicare |
$1,691.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$153.44
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,691.37
|
| Rate for Payer: UHC Exchange |
$139.49
|
| Rate for Payer: UHC Medicare Advantage |
$1,742.11
|
| Rate for Payer: UMR Bronson Commercial |
$651.65
|
| Rate for Payer: VA VA |
$1,691.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,320.91
|
|
|
HC GI CONVERT G TO GJ TUBE W
|
Facility
|
IP
|
$1,761.21
|
|
|
Service Code
|
CPT 49446
|
| Hospital Charge Code |
36100228
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$774.93 |
| Max. Negotiated Rate |
$1,585.09 |
| Rate for Payer: Aetna American Axle |
$1,144.79
|
| Rate for Payer: Aetna Commercial |
$1,497.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,144.79
|
| Rate for Payer: Cash Price |
$1,408.97
|
| Rate for Payer: Cofinity Commercial |
$1,232.85
|
| Rate for Payer: Cofinity Commercial |
$1,514.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,408.97
|
| Rate for Payer: Healthscope Commercial |
$1,585.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,232.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,320.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,497.03
|
| Rate for Payer: PHP Commercial |
$1,497.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,232.85
|
| Rate for Payer: Priority Health SBD |
$1,109.56
|
| Rate for Payer: UMR Bronson Commercial |
$774.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,320.91
|
|
|
HC GI FOREIGN BODY REMOVAL
|
Facility
|
OP
|
$1,775.59
|
|
| Hospital Charge Code |
36000049
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$656.97 |
| Max. Negotiated Rate |
$1,598.03 |
| Rate for Payer: Aetna American Axle |
$1,154.13
|
| Rate for Payer: Aetna Commercial |
$1,509.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,154.13
|
| Rate for Payer: BCBS Complete |
$710.24
|
| Rate for Payer: Cash Price |
$1,420.47
|
| Rate for Payer: Cofinity Commercial |
$1,242.91
|
| Rate for Payer: Cofinity Commercial |
$1,527.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,420.47
|
| Rate for Payer: Healthscope Commercial |
$1,598.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,242.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,331.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,509.25
|
| Rate for Payer: PHP Commercial |
$1,509.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,242.91
|
| Rate for Payer: Priority Health SBD |
$1,118.62
|
| Rate for Payer: UMR Bronson Commercial |
$656.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,331.69
|
|
|
HC GI FOREIGN BODY REMOVAL
|
Facility
|
IP
|
$1,775.59
|
|
| Hospital Charge Code |
36000049
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$781.26 |
| Max. Negotiated Rate |
$1,598.03 |
| Rate for Payer: Aetna American Axle |
$1,154.13
|
| Rate for Payer: Aetna Commercial |
$1,509.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,154.13
|
| Rate for Payer: Cash Price |
$1,420.47
|
| Rate for Payer: Cofinity Commercial |
$1,242.91
|
| Rate for Payer: Cofinity Commercial |
$1,527.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,420.47
|
| Rate for Payer: Healthscope Commercial |
$1,598.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,242.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,331.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,509.25
|
| Rate for Payer: PHP Commercial |
$1,509.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,242.91
|
| Rate for Payer: Priority Health SBD |
$1,118.62
|
| Rate for Payer: UMR Bronson Commercial |
$781.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,331.69
|
|
|
HC GI GASTRIC TUBE REPOSITION
|
Facility
|
IP
|
$1,243.08
|
|
|
Service Code
|
CPT 43761
|
| Hospital Charge Code |
36100192
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$546.96 |
| Max. Negotiated Rate |
$1,118.77 |
| Rate for Payer: Aetna American Axle |
$808.00
|
| Rate for Payer: Aetna Commercial |
$1,056.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$808.00
|
| Rate for Payer: Cash Price |
$994.46
|
| Rate for Payer: Cofinity Commercial |
$1,069.05
|
| Rate for Payer: Cofinity Commercial |
$870.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$994.46
|
| Rate for Payer: Healthscope Commercial |
$1,118.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$870.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$932.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,056.62
|
| Rate for Payer: PHP Commercial |
$1,056.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$870.16
|
| Rate for Payer: Priority Health SBD |
$783.14
|
| Rate for Payer: UMR Bronson Commercial |
$546.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$932.31
|
|
|
HC GI GASTRIC TUBE REPOSITION
|
Facility
|
OP
|
$1,243.08
|
|
|
Service Code
|
CPT 43761
|
| Hospital Charge Code |
36100192
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$101.18 |
| Max. Negotiated Rate |
$1,118.77 |
| Rate for Payer: Aetna American Axle |
$808.00
|
| Rate for Payer: Aetna Commercial |
$1,056.62
|
| Rate for Payer: Aetna Medicare |
$228.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$808.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$274.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$274.60
|
| Rate for Payer: BCBS Complete |
$126.18
|
| Rate for Payer: BCBS MAPPO |
$219.68
|
| Rate for Payer: BCBS Trust/PPO |
$510.36
|
| Rate for Payer: BCN Medicare Advantage |
$219.68
|
| Rate for Payer: Cash Price |
$994.46
|
| Rate for Payer: Cash Price |
$994.46
|
| Rate for Payer: Cofinity Commercial |
$1,069.05
|
| Rate for Payer: Cofinity Commercial |
$870.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$994.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$219.68
|
| Rate for Payer: Healthscope Commercial |
$1,118.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$870.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$932.31
|
| Rate for Payer: Mclaren Medicaid |
$120.16
|
| Rate for Payer: Mclaren Medicare |
$219.68
|
| Rate for Payer: Meridian Medicaid |
$126.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$230.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$252.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,056.62
|
| Rate for Payer: PACE Medicare |
$208.70
|
| Rate for Payer: PACE SWMI |
$219.68
|
| Rate for Payer: PHP Commercial |
$1,056.62
|
| Rate for Payer: PHP Medicare Advantage |
$219.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$120.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$870.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$691.57
|
| Rate for Payer: Priority Health Medicare |
$219.68
|
| Rate for Payer: Priority Health Narrow Network |
$553.26
|
| Rate for Payer: Priority Health SBD |
$783.14
|
| Rate for Payer: Railroad Medicare Medicare |
$219.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$111.30
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$219.68
|
| Rate for Payer: UHC Exchange |
$101.18
|
| Rate for Payer: UHC Medicare Advantage |
$226.27
|
| Rate for Payer: UMR Bronson Commercial |
$459.94
|
| Rate for Payer: VA VA |
$219.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$932.31
|
|
|
HC GI INTRALUMINAL IMAGING ESOPHAGUS
|
Facility
|
IP
|
$1,202.46
|
|
|
Service Code
|
CPT 91111
|
| Hospital Charge Code |
75000009
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$529.08 |
| Max. Negotiated Rate |
$1,082.21 |
| Rate for Payer: Aetna American Axle |
$781.60
|
| Rate for Payer: Aetna Commercial |
$1,022.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$781.60
|
| Rate for Payer: Cash Price |
$961.97
|
| Rate for Payer: Cofinity Commercial |
$1,034.12
|
| Rate for Payer: Cofinity Commercial |
$841.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$961.97
|
| Rate for Payer: Healthscope Commercial |
$1,082.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$841.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$901.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,022.09
|
| Rate for Payer: PHP Commercial |
$1,022.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$841.72
|
| Rate for Payer: Priority Health SBD |
$757.55
|
| Rate for Payer: UMR Bronson Commercial |
$529.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$901.84
|
|
