|
HC GI INTRALUMINAL IMAGING ESOPHAGUS
|
Facility
|
OP
|
$1,202.46
|
|
|
Service Code
|
CPT 91111
|
| Hospital Charge Code |
75000009
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$440.75 |
| Max. Negotiated Rate |
$2,536.56 |
| Rate for Payer: Aetna American Axle |
$781.60
|
| Rate for Payer: Aetna Commercial |
$1,022.09
|
| Rate for Payer: Aetna Medicare |
$837.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$781.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,007.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,007.19
|
| Rate for Payer: BCBS Complete |
$462.82
|
| Rate for Payer: BCBS MAPPO |
$805.75
|
| Rate for Payer: BCN Medicare Advantage |
$805.75
|
| Rate for Payer: Cash Price |
$961.97
|
| 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: Health Alliance Plan Medicare Advantage |
$805.75
|
| 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: Mclaren Medicaid |
$440.75
|
| Rate for Payer: Mclaren Medicare |
$805.75
|
| Rate for Payer: Meridian Medicaid |
$462.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$846.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$926.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,022.09
|
| Rate for Payer: PACE Medicare |
$765.46
|
| Rate for Payer: PACE SWMI |
$805.75
|
| Rate for Payer: PHP Commercial |
$1,022.09
|
| Rate for Payer: PHP Medicare Advantage |
$805.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$440.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$841.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,536.56
|
| Rate for Payer: Priority Health Medicare |
$805.75
|
| Rate for Payer: Priority Health Narrow Network |
$2,029.25
|
| Rate for Payer: Priority Health SBD |
$757.55
|
| Rate for Payer: Railroad Medicare Medicare |
$805.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$945.13
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$805.75
|
| Rate for Payer: UHC Exchange |
$859.21
|
| Rate for Payer: UHC Medicare Advantage |
$829.92
|
| Rate for Payer: UMR Bronson Commercial |
$444.91
|
| Rate for Payer: VA VA |
$805.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$901.84
|
|
|
HC GI INTRALUMINAL IMAGING ESOPH THROUGH ILEUM
|
Facility
|
OP
|
$1,322.71
|
|
|
Service Code
|
CPT 91110
|
| Hospital Charge Code |
75000008
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$440.75 |
| Max. Negotiated Rate |
$3,190.35 |
| Rate for Payer: Aetna American Axle |
$859.76
|
| Rate for Payer: Aetna Commercial |
$1,124.30
|
| Rate for Payer: Aetna Medicare |
$837.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$859.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,007.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,007.19
|
| Rate for Payer: BCBS Complete |
$462.82
|
| Rate for Payer: BCBS MAPPO |
$805.75
|
| Rate for Payer: BCBS Trust/PPO |
$3,190.35
|
| Rate for Payer: BCN Medicare Advantage |
$805.75
|
| Rate for Payer: Cash Price |
$1,058.17
|
| Rate for Payer: Cash Price |
$1,058.17
|
| Rate for Payer: Cofinity Commercial |
$1,137.53
|
| Rate for Payer: Cofinity Commercial |
$925.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,058.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$805.75
|
| Rate for Payer: Healthscope Commercial |
$1,190.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$925.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$992.03
|
| Rate for Payer: Mclaren Medicaid |
$440.75
|
| Rate for Payer: Mclaren Medicare |
$805.75
|
| Rate for Payer: Meridian Medicaid |
$462.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$846.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$926.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,124.30
|
| Rate for Payer: PACE Medicare |
$765.46
|
| Rate for Payer: PACE SWMI |
$805.75
|
| Rate for Payer: PHP Commercial |
$1,124.30
|
| Rate for Payer: PHP Medicare Advantage |
$805.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$440.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$925.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,536.56
|
| Rate for Payer: Priority Health Medicare |
$805.75
|
| Rate for Payer: Priority Health Narrow Network |
$2,029.25
|
| Rate for Payer: Priority Health SBD |
$833.31
|
| Rate for Payer: Railroad Medicare Medicare |
$805.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$788.81
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$805.75
|
| Rate for Payer: UHC Exchange |
$717.10
|
| Rate for Payer: UHC Medicare Advantage |
$829.92
|
| Rate for Payer: UMR Bronson Commercial |
$489.40
|
| Rate for Payer: VA VA |
$805.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$992.03
|
|
|
HC GI INTRALUMINAL IMAGING ESOPH THROUGH ILEUM
|
Facility
|
IP
|
$1,322.71
|
|
|
Service Code
|
CPT 91110
|
| Hospital Charge Code |
75000008
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$581.99 |
| Max. Negotiated Rate |
$1,190.44 |
| Rate for Payer: Aetna American Axle |
$859.76
|
| Rate for Payer: Aetna Commercial |
$1,124.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$859.76
|
| Rate for Payer: Cash Price |
$1,058.17
|
| Rate for Payer: Cofinity Commercial |
$1,137.53
|
| Rate for Payer: Cofinity Commercial |
$925.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,058.17
|
| Rate for Payer: Healthscope Commercial |
$1,190.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$925.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$992.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,124.30
|
| Rate for Payer: PHP Commercial |
$1,124.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$925.90
|
| Rate for Payer: Priority Health SBD |
$833.31
|
| Rate for Payer: UMR Bronson Commercial |
$581.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$992.03
|
|
|
HC GI LONG TUBE PLACEMENT
|
Facility
|
IP
|
$1,251.48
|
|
|
Service Code
|
CPT 44500
|
| Hospital Charge Code |
36100193
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$550.65 |
| Max. Negotiated Rate |
$1,126.33 |
| Rate for Payer: Aetna American Axle |
$813.46
|
| Rate for Payer: Aetna Commercial |
$1,063.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$813.46
|
| Rate for Payer: Cash Price |
$1,001.18
|
| Rate for Payer: Cofinity Commercial |
$1,076.27
|
| Rate for Payer: Cofinity Commercial |
$876.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,001.18
|
| Rate for Payer: Healthscope Commercial |
$1,126.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$876.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$938.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,063.76
|
| Rate for Payer: PHP Commercial |
$1,063.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$876.04
|
| Rate for Payer: Priority Health SBD |
$788.43
|
| Rate for Payer: UMR Bronson Commercial |
$550.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$938.61
|
|
|
HC GI LONG TUBE PLACEMENT
|
Facility
|
OP
|
$1,251.48
|
|
|
Service Code
|
CPT 44500
|
| Hospital Charge Code |
36100193
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$18.34 |
| Max. Negotiated Rate |
$2,536.56 |
| Rate for Payer: Aetna American Axle |
$813.46
|
| Rate for Payer: Aetna Commercial |
$1,063.76
|
| Rate for Payer: Aetna Medicare |
$837.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$813.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,007.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,007.19
|
| Rate for Payer: BCBS Complete |
$462.82
|
| Rate for Payer: BCBS MAPPO |
$805.75
|
| Rate for Payer: BCBS Trust/PPO |
$1,232.50
|
| Rate for Payer: BCN Medicare Advantage |
$805.75
|
| Rate for Payer: Cash Price |
$1,001.18
|
| Rate for Payer: Cash Price |
$1,001.18
|
| Rate for Payer: Cofinity Commercial |
$876.04
|
| Rate for Payer: Cofinity Commercial |
$1,076.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,001.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$805.75
|
| Rate for Payer: Healthscope Commercial |
$1,126.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$876.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$938.61
|
| Rate for Payer: Mclaren Medicaid |
$440.75
|
| Rate for Payer: Mclaren Medicare |
$805.75
|
| Rate for Payer: Meridian Medicaid |
$462.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$846.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$926.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,063.76
|
| Rate for Payer: PACE Medicare |
$765.46
|
| Rate for Payer: PACE SWMI |
$805.75
|
| Rate for Payer: PHP Commercial |
$1,063.76
|
| Rate for Payer: PHP Medicare Advantage |
$805.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$440.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$876.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,536.56
|
| Rate for Payer: Priority Health Medicare |
$805.75
|
| Rate for Payer: Priority Health Narrow Network |
$2,029.25
|
| Rate for Payer: Priority Health SBD |
$788.43
|
| Rate for Payer: Railroad Medicare Medicare |
$805.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.17
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$805.75
|
| Rate for Payer: UHC Exchange |
$18.34
|
| Rate for Payer: UHC Medicare Advantage |
$829.92
|
| Rate for Payer: UMR Bronson Commercial |
$463.05
|
| Rate for Payer: VA VA |
$805.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$938.61
|
|
|
HC GI OSTOMY OBSTRUCT REMOVL
|
Facility
|
OP
|
$869.96
|
|
|
Service Code
|
CPT 49460
|
| Hospital Charge Code |
36100232
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$48.79 |
| Max. Negotiated Rate |
$2,536.56 |
| Rate for Payer: Aetna American Axle |
$565.47
|
| Rate for Payer: Aetna Commercial |
$739.47
|
| Rate for Payer: Aetna Medicare |
$837.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$565.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,007.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,007.19
|
| Rate for Payer: BCBS Complete |
$462.82
|
| Rate for Payer: BCBS MAPPO |
$805.75
|
| Rate for Payer: BCBS Trust/PPO |
$561.56
|
| Rate for Payer: BCN Medicare Advantage |
$805.75
|
| Rate for Payer: Cash Price |
$695.97
|
| Rate for Payer: Cash Price |
$695.97
|
| Rate for Payer: Cofinity Commercial |
$748.17
|
| Rate for Payer: Cofinity Commercial |
$608.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$695.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$805.75
|
| Rate for Payer: Healthscope Commercial |
$782.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$608.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$652.47
|
| Rate for Payer: Mclaren Medicaid |
$440.75
|
| Rate for Payer: Mclaren Medicare |
$805.75
|
| Rate for Payer: Meridian Medicaid |
$462.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$846.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$926.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$739.47
|
| Rate for Payer: PACE Medicare |
$765.46
|
| Rate for Payer: PACE SWMI |
$805.75
|
| Rate for Payer: PHP Commercial |
$739.47
|
| Rate for Payer: PHP Medicare Advantage |
$805.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$440.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$608.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,536.56
|
| Rate for Payer: Priority Health Medicare |
$805.75
|
| Rate for Payer: Priority Health Narrow Network |
$2,029.25
|
| Rate for Payer: Priority Health SBD |
$548.07
|
| Rate for Payer: Railroad Medicare Medicare |
$805.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.67
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$805.75
|
| Rate for Payer: UHC Exchange |
$48.79
|
| Rate for Payer: UHC Medicare Advantage |
$829.92
|
| Rate for Payer: UMR Bronson Commercial |
$321.89
|
| Rate for Payer: VA VA |
$805.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$652.47
|
|
|
HC GI OSTOMY OBSTRUCT REMOVL
|
Facility
|
IP
|
$869.96
|
|
|
Service Code
|
CPT 49460
|
| Hospital Charge Code |
36100232
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$382.78 |
| Max. Negotiated Rate |
$782.96 |
| Rate for Payer: Aetna American Axle |
$565.47
|
| Rate for Payer: Aetna Commercial |
$739.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$565.47
|
| Rate for Payer: Cash Price |
$695.97
|
| Rate for Payer: Cofinity Commercial |
$608.97
|
| Rate for Payer: Cofinity Commercial |
$748.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$695.97
|
| Rate for Payer: Healthscope Commercial |
$782.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$608.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$652.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$739.47
|
| Rate for Payer: PHP Commercial |
$739.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$608.97
|
| Rate for Payer: Priority Health SBD |
$548.07
|
| Rate for Payer: UMR Bronson Commercial |
$382.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$652.47
|
|
|
HC GI PATHOGEN PANEL, PCR, F
|
Facility
|
IP
|
$704.62
|
|
|
Service Code
|
HCPCS 87507
|
| Hospital Charge Code |
30600322
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$310.03 |
| Max. Negotiated Rate |
$634.16 |
| Rate for Payer: Aetna American Axle |
$458.00
|
| Rate for Payer: Aetna Commercial |
$598.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$458.00
|
| Rate for Payer: Cash Price |
$563.70
|
| Rate for Payer: Cofinity Commercial |
$493.23
|
| Rate for Payer: Cofinity Commercial |
$605.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$563.70
|
| Rate for Payer: Healthscope Commercial |
$634.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$493.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$528.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$598.93
|
| Rate for Payer: PHP Commercial |
$598.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$493.23
|
| Rate for Payer: Priority Health SBD |
$443.91
|
| Rate for Payer: UMR Bronson Commercial |
$310.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$528.46
|
|
|
HC GI PATHOGEN PANEL, PCR, F
|
Facility
|
OP
|
$704.62
|
|
|
Service Code
|
HCPCS 87507
|
| Hospital Charge Code |
30600322
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$227.98 |
| Max. Negotiated Rate |
$680.62 |
| Rate for Payer: Aetna American Axle |
$458.00
|
| Rate for Payer: Aetna Commercial |
$598.93
|
| Rate for Payer: Aetna Medicare |
$433.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$458.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$520.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$520.98
|
| Rate for Payer: BCBS Complete |
$239.40
|
| Rate for Payer: BCBS MAPPO |
$416.78
|
| Rate for Payer: BCBS Trust/PPO |
$374.83
|
| Rate for Payer: BCN Medicare Advantage |
$416.78
|
| Rate for Payer: Cash Price |
$563.70
|
| Rate for Payer: Cash Price |
$563.70
|
| Rate for Payer: Cofinity Commercial |
$605.97
|
| Rate for Payer: Cofinity Commercial |
$493.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$563.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$416.78
|
| Rate for Payer: Healthscope Commercial |
$634.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$493.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$528.46
|
| Rate for Payer: Mclaren Medicaid |
$227.98
|
| Rate for Payer: Mclaren Medicare |
$416.78
|
| Rate for Payer: Meridian Medicaid |
$239.40
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$437.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$479.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$598.93
|
| Rate for Payer: PACE Medicare |
$395.94
|
| Rate for Payer: PACE SWMI |
$416.78
|
| Rate for Payer: PHP Commercial |
$598.93
|
| Rate for Payer: PHP Medicare Advantage |
$416.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$227.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$493.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$571.72
|
| Rate for Payer: Priority Health Medicare |
$416.78
|
| Rate for Payer: Priority Health Narrow Network |
$457.38
|
| Rate for Payer: Priority Health SBD |
$443.91
|
| Rate for Payer: Railroad Medicare Medicare |
$416.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$500.14
|
| Rate for Payer: UHC Core |
$680.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$416.78
|
| Rate for Payer: UHC Exchange |
$416.78
|
| Rate for Payer: UHC Medicare Advantage |
$429.28
|
| Rate for Payer: UMR Bronson Commercial |
$260.71
|
| Rate for Payer: VA VA |
$416.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$528.46
|
|
|
HC GI REPLAC D OR J TUBE W F
|
Facility
|
OP
|
$869.96
|
|
|
Service Code
|
CPT 49451
|
| Hospital Charge Code |
36100230
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$84.48 |
| Max. Negotiated Rate |
$2,536.56 |
| Rate for Payer: Aetna American Axle |
$565.47
|
| Rate for Payer: Aetna Commercial |
$739.47
|
| Rate for Payer: Aetna Medicare |
$837.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$565.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,007.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,007.19
|
| Rate for Payer: BCBS Complete |
$462.82
|
| Rate for Payer: BCBS MAPPO |
$805.75
|
| Rate for Payer: BCBS Trust/PPO |
$1,149.77
|
| Rate for Payer: BCN Medicare Advantage |
$805.75
|
| Rate for Payer: Cash Price |
$695.97
|
| Rate for Payer: Cash Price |
$695.97
|
| Rate for Payer: Cofinity Commercial |
$748.17
|
| Rate for Payer: Cofinity Commercial |
$608.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$695.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$805.75
|
| Rate for Payer: Healthscope Commercial |
$782.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$608.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$652.47
|
| Rate for Payer: Mclaren Medicaid |
$440.75
|
| Rate for Payer: Mclaren Medicare |
$805.75
|
| Rate for Payer: Meridian Medicaid |
$462.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$846.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$926.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$739.47
|
| Rate for Payer: PACE Medicare |
$765.46
|
| Rate for Payer: PACE SWMI |
$805.75
|
| Rate for Payer: PHP Commercial |
$739.47
|
| Rate for Payer: PHP Medicare Advantage |
$805.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$440.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$608.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,536.56
|
| Rate for Payer: Priority Health Medicare |
$805.75
|
| Rate for Payer: Priority Health Narrow Network |
$2,029.25
|
| Rate for Payer: Priority Health SBD |
$548.07
|
| Rate for Payer: Railroad Medicare Medicare |
$805.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$92.93
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$805.75
|
| Rate for Payer: UHC Exchange |
$84.48
|
| Rate for Payer: UHC Medicare Advantage |
$829.92
|
| Rate for Payer: UMR Bronson Commercial |
$321.89
|
| Rate for Payer: VA VA |
$805.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$652.47
|
|
|
HC GI REPLAC D OR J TUBE W F
|
Facility
|
IP
|
$869.96
|
|
|
Service Code
|
CPT 49451
|
| Hospital Charge Code |
36100230
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$382.78 |
| Max. Negotiated Rate |
$782.96 |
| Rate for Payer: Aetna American Axle |
$565.47
|
| Rate for Payer: Aetna Commercial |
$739.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$565.47
|
| Rate for Payer: Cash Price |
$695.97
|
| Rate for Payer: Cofinity Commercial |
$748.17
|
| Rate for Payer: Cofinity Commercial |
$608.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$695.97
|
| Rate for Payer: Healthscope Commercial |
$782.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$608.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$652.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$739.47
|
| Rate for Payer: PHP Commercial |
$739.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$608.97
|
| Rate for Payer: Priority Health SBD |
$548.07
|
| Rate for Payer: UMR Bronson Commercial |
$382.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$652.47
|
|
|
HC GI REPLAC GJ TUBE W FLUOR
|
Facility
|
OP
|
$869.96
|
|
|
Service Code
|
CPT 49452
|
| Hospital Charge Code |
36100231
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$129.99 |
| Max. Negotiated Rate |
$2,536.56 |
| Rate for Payer: Aetna American Axle |
$565.47
|
| Rate for Payer: Aetna Commercial |
$739.47
|
| Rate for Payer: Aetna Medicare |
$837.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$565.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,007.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,007.19
|
| Rate for Payer: BCBS Complete |
$462.82
|
| Rate for Payer: BCBS MAPPO |
$805.75
|
| Rate for Payer: BCBS Trust/PPO |
$882.80
|
| Rate for Payer: BCN Medicare Advantage |
$805.75
|
| Rate for Payer: Cash Price |
$695.97
|
| Rate for Payer: Cash Price |
$695.97
|
| Rate for Payer: Cofinity Commercial |
$748.17
|
| Rate for Payer: Cofinity Commercial |
$608.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$695.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$805.75
|
| Rate for Payer: Healthscope Commercial |
$782.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$608.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$652.47
|
| Rate for Payer: Mclaren Medicaid |
$440.75
|
| Rate for Payer: Mclaren Medicare |
$805.75
|
| Rate for Payer: Meridian Medicaid |
$462.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$846.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$926.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$739.47
|
| Rate for Payer: PACE Medicare |
$765.46
|
| Rate for Payer: PACE SWMI |
$805.75
|
| Rate for Payer: PHP Commercial |
$739.47
|
| Rate for Payer: PHP Medicare Advantage |
$805.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$440.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$608.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,536.56
|
| Rate for Payer: Priority Health Medicare |
$805.75
|
| Rate for Payer: Priority Health Narrow Network |
$2,029.25
|
| Rate for Payer: Priority Health SBD |
$548.07
|
| Rate for Payer: Railroad Medicare Medicare |
$805.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$142.99
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$805.75
|
| Rate for Payer: UHC Exchange |
$129.99
|
| Rate for Payer: UHC Medicare Advantage |
$829.92
|
| Rate for Payer: UMR Bronson Commercial |
$321.89
|
| Rate for Payer: VA VA |
$805.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$652.47
|
|
|
HC GI REPLAC GJ TUBE W FLUOR
|
Facility
|
IP
|
$869.96
|
|
|
Service Code
|
CPT 49452
|
| Hospital Charge Code |
36100231
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$382.78 |
| Max. Negotiated Rate |
$782.96 |
| Rate for Payer: Aetna American Axle |
$565.47
|
| Rate for Payer: Aetna Commercial |
$739.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$565.47
|
| Rate for Payer: Cash Price |
$695.97
|
| Rate for Payer: Cofinity Commercial |
$608.97
|
| Rate for Payer: Cofinity Commercial |
$748.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$695.97
|
| Rate for Payer: Healthscope Commercial |
$782.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$608.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$652.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$739.47
|
| Rate for Payer: PHP Commercial |
$739.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$608.97
|
| Rate for Payer: Priority Health SBD |
$548.07
|
| Rate for Payer: UMR Bronson Commercial |
$382.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$652.47
|
|
|
HC GI REPLAC G OR EC TUBE W
|
Facility
|
OP
|
$869.96
|
|
|
Service Code
|
CPT 49450
|
| Hospital Charge Code |
36100229
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$62.54 |
| Max. Negotiated Rate |
$2,536.56 |
| Rate for Payer: Aetna American Axle |
$565.47
|
| Rate for Payer: Aetna Commercial |
$739.47
|
| Rate for Payer: Aetna Medicare |
$837.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$565.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,007.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,007.19
|
| Rate for Payer: BCBS Complete |
$462.82
|
| Rate for Payer: BCBS MAPPO |
$805.75
|
| Rate for Payer: BCBS Trust/PPO |
$966.36
|
| Rate for Payer: BCN Medicare Advantage |
$805.75
|
| Rate for Payer: Cash Price |
$695.97
|
| Rate for Payer: Cash Price |
$695.97
|
| Rate for Payer: Cofinity Commercial |
$608.97
|
| Rate for Payer: Cofinity Commercial |
$748.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$695.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$805.75
|
| Rate for Payer: Healthscope Commercial |
$782.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$608.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$652.47
|
| Rate for Payer: Mclaren Medicaid |
$440.75
|
| Rate for Payer: Mclaren Medicare |
$805.75
|
| Rate for Payer: Meridian Medicaid |
$462.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$846.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$926.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$739.47
|
| Rate for Payer: PACE Medicare |
$765.46
|
| Rate for Payer: PACE SWMI |
$805.75
|
| Rate for Payer: PHP Commercial |
$739.47
|
| Rate for Payer: PHP Medicare Advantage |
$805.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$440.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$608.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,536.56
|
| Rate for Payer: Priority Health Medicare |
$805.75
|
| Rate for Payer: Priority Health Narrow Network |
$2,029.25
|
| Rate for Payer: Priority Health SBD |
$548.07
|
| Rate for Payer: Railroad Medicare Medicare |
$805.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.79
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$805.75
|
| Rate for Payer: UHC Exchange |
$62.54
|
| Rate for Payer: UHC Medicare Advantage |
$829.92
|
| Rate for Payer: UMR Bronson Commercial |
$321.89
|
| Rate for Payer: VA VA |
$805.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$652.47
|
|
|
HC GI REPLAC G OR EC TUBE W
|
Facility
|
IP
|
$869.96
|
|
|
Service Code
|
CPT 49450
|
| Hospital Charge Code |
36100229
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$382.78 |
| Max. Negotiated Rate |
$782.96 |
| Rate for Payer: Aetna American Axle |
$565.47
|
| Rate for Payer: Aetna Commercial |
$739.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$565.47
|
| Rate for Payer: Cash Price |
$695.97
|
| Rate for Payer: Cofinity Commercial |
$608.97
|
| Rate for Payer: Cofinity Commercial |
$748.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$695.97
|
| Rate for Payer: Healthscope Commercial |
$782.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$608.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$652.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$739.47
|
| Rate for Payer: PHP Commercial |
$739.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$608.97
|
| Rate for Payer: Priority Health SBD |
$548.07
|
| Rate for Payer: UMR Bronson Commercial |
$382.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$652.47
|
|
|
HC GI TRANSIT WIRELESS CAPSULE STOMACH TO COLON
|
Facility
|
OP
|
$1,202.46
|
|
|
Service Code
|
CPT 91112
|
| Hospital Charge Code |
75000010
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$440.75 |
| Max. Negotiated Rate |
$2,536.56 |
| Rate for Payer: Aetna American Axle |
$781.60
|
| Rate for Payer: Aetna Commercial |
$1,022.09
|
| Rate for Payer: Aetna Medicare |
$837.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$781.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,007.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,007.19
|
| Rate for Payer: BCBS Complete |
$462.82
|
| Rate for Payer: BCBS MAPPO |
$805.75
|
| Rate for Payer: BCN Medicare Advantage |
$805.75
|
| Rate for Payer: Cash Price |
$961.97
|
| Rate for Payer: Cash Price |
$961.97
|
| Rate for Payer: Cofinity Commercial |
$841.72
|
| Rate for Payer: Cofinity Commercial |
$1,034.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$961.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$805.75
|
| 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: Mclaren Medicaid |
$440.75
|
| Rate for Payer: Mclaren Medicare |
$805.75
|
| Rate for Payer: Meridian Medicaid |
$462.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$846.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$926.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,022.09
|
| Rate for Payer: PACE Medicare |
$765.46
|
| Rate for Payer: PACE SWMI |
$805.75
|
| Rate for Payer: PHP Commercial |
$1,022.09
|
| Rate for Payer: PHP Medicare Advantage |
$805.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$440.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$841.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,536.56
|
| Rate for Payer: Priority Health Medicare |
$805.75
|
| Rate for Payer: Priority Health Narrow Network |
$2,029.25
|
| Rate for Payer: Priority Health SBD |
$757.55
|
| Rate for Payer: Railroad Medicare Medicare |
$805.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,738.62
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$805.75
|
| Rate for Payer: UHC Exchange |
$1,580.56
|
| Rate for Payer: UHC Medicare Advantage |
$829.92
|
| Rate for Payer: UMR Bronson Commercial |
$444.91
|
| Rate for Payer: VA VA |
$805.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$901.84
|
|
|
HC GI TRANSIT WIRELESS CAPSULE STOMACH TO COLON
|
Facility
|
IP
|
$1,202.46
|
|
|
Service Code
|
CPT 91112
|
| Hospital Charge Code |
75000010
|
|
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
|
|
|
HC GLIADIN AB DEAMINATED IGA
|
Facility
|
OP
|
$35.70
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30200007
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.31 |
| Max. Negotiated Rate |
$32.13 |
| Rate for Payer: Aetna American Axle |
$23.20
|
| Rate for Payer: Aetna Commercial |
$30.34
|
| Rate for Payer: Aetna Medicare |
$11.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.41
|
| Rate for Payer: BCBS Complete |
$6.62
|
| Rate for Payer: BCBS MAPPO |
$11.53
|
| Rate for Payer: BCBS Trust/PPO |
$10.37
|
| Rate for Payer: BCN Medicare Advantage |
$11.53
|
| Rate for Payer: Cash Price |
$28.56
|
| Rate for Payer: Cash Price |
$28.56
|
| Rate for Payer: Cofinity Commercial |
$24.99
|
| Rate for Payer: Cofinity Commercial |
$30.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.53
|
| Rate for Payer: Healthscope Commercial |
$32.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.78
|
| Rate for Payer: Mclaren Medicaid |
$6.31
|
| Rate for Payer: Mclaren Medicare |
$11.53
|
| Rate for Payer: Meridian Medicaid |
$6.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.34
|
| Rate for Payer: PACE Medicare |
$10.95
|
| Rate for Payer: PACE SWMI |
$11.53
|
| Rate for Payer: PHP Commercial |
$30.34
|
| Rate for Payer: PHP Medicare Advantage |
$11.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.82
|
| Rate for Payer: Priority Health Medicare |
$11.53
|
| Rate for Payer: Priority Health Narrow Network |
$12.66
|
| Rate for Payer: Priority Health SBD |
$22.49
|
| Rate for Payer: Railroad Medicare Medicare |
$11.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.84
|
| Rate for Payer: UHC Core |
$19.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.53
|
| Rate for Payer: UHC Exchange |
$11.53
|
| Rate for Payer: UHC Medicare Advantage |
$11.88
|
| Rate for Payer: UMR Bronson Commercial |
$13.21
|
| Rate for Payer: VA VA |
$11.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.78
|
|
|
HC GLIADIN AB DEAMINATED IGA
|
Facility
|
IP
|
$35.70
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30200007
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.71 |
| Max. Negotiated Rate |
$32.13 |
| Rate for Payer: Aetna American Axle |
$23.20
|
| Rate for Payer: Aetna Commercial |
$30.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.20
|
| Rate for Payer: Cash Price |
$28.56
|
| Rate for Payer: Cofinity Commercial |
$24.99
|
| Rate for Payer: Cofinity Commercial |
$30.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.56
|
| Rate for Payer: Healthscope Commercial |
$32.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.34
|
| Rate for Payer: PHP Commercial |
$30.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.99
|
| Rate for Payer: Priority Health SBD |
$22.49
|
| Rate for Payer: UMR Bronson Commercial |
$15.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.78
|
|
|
HC GLIADIN AB DEAMINATED IGG
|
Facility
|
OP
|
$27.85
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30200009
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.31 |
| Max. Negotiated Rate |
$25.06 |
| Rate for Payer: Aetna American Axle |
$18.10
|
| Rate for Payer: Aetna Commercial |
$23.67
|
| Rate for Payer: Aetna Medicare |
$11.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.41
|
| Rate for Payer: BCBS Complete |
$6.62
|
| Rate for Payer: BCBS MAPPO |
$11.53
|
| Rate for Payer: BCBS Trust/PPO |
$10.37
|
| Rate for Payer: BCN Medicare Advantage |
$11.53
|
| Rate for Payer: Cash Price |
$22.28
|
| Rate for Payer: Cash Price |
$22.28
|
| Rate for Payer: Cofinity Commercial |
$19.50
|
| Rate for Payer: Cofinity Commercial |
$23.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.53
|
| Rate for Payer: Healthscope Commercial |
$25.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.89
|
| Rate for Payer: Mclaren Medicaid |
$6.31
|
| Rate for Payer: Mclaren Medicare |
$11.53
|
| Rate for Payer: Meridian Medicaid |
$6.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.67
|
| Rate for Payer: PACE Medicare |
$10.95
|
| Rate for Payer: PACE SWMI |
$11.53
|
| Rate for Payer: PHP Commercial |
$23.67
|
| Rate for Payer: PHP Medicare Advantage |
$11.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.82
|
| Rate for Payer: Priority Health Medicare |
$11.53
|
| Rate for Payer: Priority Health Narrow Network |
$12.66
|
| Rate for Payer: Priority Health SBD |
$17.55
|
| Rate for Payer: Railroad Medicare Medicare |
$11.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.84
|
| Rate for Payer: UHC Core |
$19.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.53
|
| Rate for Payer: UHC Exchange |
$11.53
|
| Rate for Payer: UHC Medicare Advantage |
$11.88
|
| Rate for Payer: UMR Bronson Commercial |
$10.30
|
| Rate for Payer: VA VA |
$11.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.89
|
|
|
HC GLIADIN AB DEAMINATED IGG
|
Facility
|
IP
|
$27.85
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30200009
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.25 |
| Max. Negotiated Rate |
$25.06 |
| Rate for Payer: Aetna American Axle |
$18.10
|
| Rate for Payer: Aetna Commercial |
$23.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.10
|
| Rate for Payer: Cash Price |
$22.28
|
| Rate for Payer: Cofinity Commercial |
$19.50
|
| Rate for Payer: Cofinity Commercial |
$23.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.28
|
| Rate for Payer: Healthscope Commercial |
$25.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.67
|
| Rate for Payer: PHP Commercial |
$23.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.50
|
| Rate for Payer: Priority Health SBD |
$17.55
|
| Rate for Payer: UMR Bronson Commercial |
$12.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.89
|
|
|
HC GLIADIN (DEAMIDATED) AB, IGA OR IGG, S
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
CPT 86258
|
| Hospital Charge Code |
30200509
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$21.56 |
| Max. Negotiated Rate |
$44.10 |
| Rate for Payer: Aetna American Axle |
$31.85
|
| Rate for Payer: Aetna Commercial |
$41.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.85
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Cofinity Commercial |
$34.30
|
| Rate for Payer: Cofinity Commercial |
$42.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.20
|
| Rate for Payer: Healthscope Commercial |
$44.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$41.65
|
| Rate for Payer: PHP Commercial |
$41.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.30
|
| Rate for Payer: Priority Health SBD |
$30.87
|
| Rate for Payer: UMR Bronson Commercial |
$21.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.75
|
|
|
HC GLIADIN (DEAMIDATED) AB, IGA OR IGG, S
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
CPT 86258
|
| Hospital Charge Code |
30200509
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.59 |
| Max. Negotiated Rate |
$44.10 |
| Rate for Payer: Aetna American Axle |
$31.85
|
| Rate for Payer: Aetna Commercial |
$41.65
|
| Rate for Payer: Aetna Medicare |
$12.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: BCBS Complete |
$6.92
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$10.84
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Cofinity Commercial |
$42.14
|
| Rate for Payer: Cofinity Commercial |
$34.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$44.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.75
|
| Rate for Payer: Mclaren Medicaid |
$6.59
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Medicaid |
$6.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$41.65
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$41.65
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.53
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health Narrow Network |
$9.22
|
| Rate for Payer: Priority Health SBD |
$30.87
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.46
|
| Rate for Payer: UHC Core |
$13.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.05
|
| Rate for Payer: UHC Exchange |
$12.05
|
| Rate for Payer: UHC Medicare Advantage |
$12.41
|
| Rate for Payer: UMR Bronson Commercial |
$18.13
|
| Rate for Payer: VA VA |
$12.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.75
|
|
|
HC GLIDEWIRE EXCHANGE
|
Facility
|
OP
|
$303.18
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200043
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$112.18 |
| Max. Negotiated Rate |
$272.86 |
| Rate for Payer: Aetna American Axle |
$197.07
|
| Rate for Payer: Aetna Commercial |
$257.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$197.07
|
| Rate for Payer: BCBS Complete |
$121.27
|
| Rate for Payer: Cash Price |
$242.54
|
| Rate for Payer: Cofinity Commercial |
$212.23
|
| Rate for Payer: Cofinity Commercial |
$260.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.54
|
| Rate for Payer: Healthscope Commercial |
$272.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$212.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$227.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$257.70
|
| Rate for Payer: PHP Commercial |
$257.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.23
|
| Rate for Payer: Priority Health SBD |
$191.00
|
| Rate for Payer: UMR Bronson Commercial |
$112.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$227.38
|
|
|
HC GLIDEWIRE EXCHANGE
|
Facility
|
IP
|
$303.18
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200043
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$133.40 |
| Max. Negotiated Rate |
$272.86 |
| Rate for Payer: Aetna American Axle |
$197.07
|
| Rate for Payer: Aetna Commercial |
$257.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$197.07
|
| Rate for Payer: Cash Price |
$242.54
|
| Rate for Payer: Cofinity Commercial |
$212.23
|
| Rate for Payer: Cofinity Commercial |
$260.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.54
|
| Rate for Payer: Healthscope Commercial |
$272.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$212.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$227.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$257.70
|
| Rate for Payer: PHP Commercial |
$257.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.23
|
| Rate for Payer: Priority Health SBD |
$191.00
|
| Rate for Payer: UMR Bronson Commercial |
$133.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$227.38
|
|
