|
HC HAEMOPHILUS INFLUENZAE
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600269
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.87 |
| Max. Negotiated Rate |
$57.89 |
| Rate for Payer: Aetna American Axle |
$33.15
|
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna Medicare |
$36.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: BCBS Complete |
$20.16
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$31.56
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$35.70
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.25
|
| Rate for Payer: Mclaren Medicaid |
$19.19
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Medicaid |
$20.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health SBD |
$32.13
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.11
|
| Rate for Payer: UHC Core |
$57.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.09
|
| Rate for Payer: UHC Exchange |
$35.09
|
| Rate for Payer: UHC Medicare Advantage |
$36.14
|
| Rate for Payer: UMR Bronson Commercial |
$18.87
|
| Rate for Payer: VA VA |
$35.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.25
|
|
|
HC HAEMOPHILUS INFLUENZAE TYPE B VACCINE (HIB) PRP-T CONJUGATE, 4 DOSE IM
|
Facility
|
IP
|
$32.64
|
|
|
Service Code
|
CPT 90648
|
| Hospital Charge Code |
63600069
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.36 |
| Max. Negotiated Rate |
$29.38 |
| Rate for Payer: Aetna American Axle |
$21.22
|
| Rate for Payer: Aetna Commercial |
$27.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.22
|
| Rate for Payer: Cash Price |
$26.11
|
| Rate for Payer: Cofinity Commercial |
$22.85
|
| Rate for Payer: Cofinity Commercial |
$28.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.11
|
| Rate for Payer: Healthscope Commercial |
$29.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$27.74
|
| Rate for Payer: PHP Commercial |
$27.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.85
|
| Rate for Payer: Priority Health SBD |
$20.56
|
| Rate for Payer: UMR Bronson Commercial |
$14.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.48
|
|
|
HC HAEMOPHILUS INFLUENZAE TYPE B VACCINE (HIB) PRP-T CONJUGATE, 4 DOSE IM
|
Facility
|
OP
|
$32.64
|
|
|
Service Code
|
CPT 90648
|
| Hospital Charge Code |
63600069
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.08 |
| Max. Negotiated Rate |
$58.90 |
| Rate for Payer: Aetna American Axle |
$21.22
|
| Rate for Payer: Aetna Commercial |
$27.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.22
|
| Rate for Payer: BCBS Complete |
$13.06
|
| Rate for Payer: BCBS Trust/PPO |
$58.90
|
| Rate for Payer: Cash Price |
$26.11
|
| Rate for Payer: Cash Price |
$26.11
|
| Rate for Payer: Cofinity Commercial |
$22.85
|
| Rate for Payer: Cofinity Commercial |
$28.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.11
|
| Rate for Payer: Healthscope Commercial |
$29.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$27.74
|
| Rate for Payer: PHP Commercial |
$27.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.85
|
| Rate for Payer: Priority Health SBD |
$20.56
|
| Rate for Payer: UMR Bronson Commercial |
$12.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.48
|
|
|
HC HAI ESTABLISHED PATIENT LEVEL I
|
Facility
|
IP
|
$148.19
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000014
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$65.20 |
| Max. Negotiated Rate |
$133.37 |
| Rate for Payer: Aetna American Axle |
$96.32
|
| Rate for Payer: Aetna Commercial |
$125.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.32
|
| Rate for Payer: Cash Price |
$118.55
|
| Rate for Payer: Cofinity Commercial |
$103.73
|
| Rate for Payer: Cofinity Commercial |
$127.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.55
|
| Rate for Payer: Healthscope Commercial |
$133.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$103.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$125.96
|
| Rate for Payer: PHP Commercial |
$125.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.73
|
| Rate for Payer: Priority Health SBD |
$93.36
|
| Rate for Payer: UMR Bronson Commercial |
$65.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.14
|
|
|
HC HAI ESTABLISHED PATIENT LEVEL I
|
Facility
|
OP
|
$148.19
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000014
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$8.51 |
| Max. Negotiated Rate |
$133.37 |
| Rate for Payer: Aetna American Axle |
$96.32
|
| Rate for Payer: Aetna Commercial |
$125.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.32
|
| Rate for Payer: BCBS Complete |
$59.28
|
| Rate for Payer: BCBS Trust/PPO |
$56.49
|
| Rate for Payer: BCCCP Commercial |
$22.00
|
| Rate for Payer: Cash Price |
$118.55
|
| Rate for Payer: Cash Price |
$118.55
|
| Rate for Payer: Cofinity Commercial |
$127.44
|
| Rate for Payer: Cofinity Commercial |
$103.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.55
|
| Rate for Payer: Healthscope Commercial |
$133.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$103.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$125.96
|
| Rate for Payer: PHP Commercial |
$125.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.73
|
| Rate for Payer: Priority Health SBD |
$93.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.36
|
| Rate for Payer: UHC Exchange |
$8.51
|
| Rate for Payer: UMR Bronson Commercial |
$54.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.14
|
|
|
HC HAI PICC FLUSH
|
Facility
|
IP
|
$134.71
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000060
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$59.27 |
| Max. Negotiated Rate |
$121.24 |
| Rate for Payer: Aetna American Axle |
$87.56
|
| Rate for Payer: Aetna Commercial |
$114.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.56
|
| Rate for Payer: Cash Price |
$107.77
|
| Rate for Payer: Cofinity Commercial |
$115.85
|
| Rate for Payer: Cofinity Commercial |
$94.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.77
|
| Rate for Payer: Healthscope Commercial |
$121.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$94.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$101.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$114.50
|
| Rate for Payer: PHP Commercial |
$114.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.30
|
| Rate for Payer: Priority Health SBD |
$84.87
|
| Rate for Payer: UMR Bronson Commercial |
$59.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$101.03
|
|
|
HC HAI PICC FLUSH
|
Facility
|
OP
|
$134.71
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000060
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$8.51 |
| Max. Negotiated Rate |
$121.24 |
| Rate for Payer: Aetna American Axle |
$87.56
|
| Rate for Payer: Aetna Commercial |
$114.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.56
|
| Rate for Payer: BCBS Complete |
$53.88
|
| Rate for Payer: BCBS Trust/PPO |
$56.49
|
| Rate for Payer: BCCCP Commercial |
$22.00
|
| Rate for Payer: Cash Price |
$107.77
|
| Rate for Payer: Cash Price |
$107.77
|
| Rate for Payer: Cofinity Commercial |
$94.30
|
| Rate for Payer: Cofinity Commercial |
$115.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.77
|
| Rate for Payer: Healthscope Commercial |
$121.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$94.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$101.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$114.50
|
| Rate for Payer: PHP Commercial |
$114.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.30
|
| Rate for Payer: Priority Health SBD |
$84.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.36
|
| Rate for Payer: UHC Exchange |
$8.51
|
| Rate for Payer: UMR Bronson Commercial |
$49.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$101.03
|
|
|
HC HAI PORTA CATH ACCESS
|
Facility
|
OP
|
$134.71
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000058
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$8.51 |
| Max. Negotiated Rate |
$121.24 |
| Rate for Payer: Aetna American Axle |
$87.56
|
| Rate for Payer: Aetna Commercial |
$114.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.56
|
| Rate for Payer: BCBS Complete |
$53.88
|
| Rate for Payer: BCBS Trust/PPO |
$56.49
|
| Rate for Payer: BCCCP Commercial |
$22.00
|
| Rate for Payer: Cash Price |
$107.77
|
| Rate for Payer: Cash Price |
$107.77
|
| Rate for Payer: Cofinity Commercial |
$94.30
|
| Rate for Payer: Cofinity Commercial |
$115.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.77
|
| Rate for Payer: Healthscope Commercial |
$121.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$94.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$101.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$114.50
|
| Rate for Payer: PHP Commercial |
$114.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.30
|
| Rate for Payer: Priority Health SBD |
$84.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.36
|
| Rate for Payer: UHC Exchange |
$8.51
|
| Rate for Payer: UMR Bronson Commercial |
$49.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$101.03
|
|
|
HC HAI PORTA CATH ACCESS
|
Facility
|
IP
|
$134.71
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000058
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$59.27 |
| Max. Negotiated Rate |
$121.24 |
| Rate for Payer: Aetna American Axle |
$87.56
|
| Rate for Payer: Aetna Commercial |
$114.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.56
|
| Rate for Payer: Cash Price |
$107.77
|
| Rate for Payer: Cofinity Commercial |
$115.85
|
| Rate for Payer: Cofinity Commercial |
$94.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.77
|
| Rate for Payer: Healthscope Commercial |
$121.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$94.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$101.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$114.50
|
| Rate for Payer: PHP Commercial |
$114.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.30
|
| Rate for Payer: Priority Health SBD |
$84.87
|
| Rate for Payer: UMR Bronson Commercial |
$59.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$101.03
|
|
|
HC HALOPERIDOL LEVEL
|
Facility
|
OP
|
$104.00
|
|
|
Service Code
|
CPT 80173
|
| Hospital Charge Code |
30100031
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.63 |
| Max. Negotiated Rate |
$93.60 |
| Rate for Payer: Aetna American Axle |
$67.60
|
| Rate for Payer: Aetna Commercial |
$88.40
|
| Rate for Payer: Aetna Medicare |
$16.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.72
|
| Rate for Payer: BCBS Complete |
$9.06
|
| Rate for Payer: BCBS MAPPO |
$15.78
|
| Rate for Payer: BCBS Trust/PPO |
$14.20
|
| Rate for Payer: BCN Medicare Advantage |
$15.78
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Cofinity Commercial |
$72.80
|
| Rate for Payer: Cofinity Commercial |
$89.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.78
|
| Rate for Payer: Healthscope Commercial |
$93.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$72.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.00
|
| Rate for Payer: Mclaren Medicaid |
$8.63
|
| Rate for Payer: Mclaren Medicare |
$15.78
|
| Rate for Payer: Meridian Medicaid |
$9.06
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$88.40
|
| Rate for Payer: PACE Medicare |
$14.99
|
| Rate for Payer: PACE SWMI |
$15.78
|
| Rate for Payer: PHP Commercial |
$88.40
|
| Rate for Payer: PHP Medicare Advantage |
$15.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.98
|
| Rate for Payer: Priority Health Medicare |
$15.78
|
| Rate for Payer: Priority Health Narrow Network |
$15.98
|
| Rate for Payer: Priority Health SBD |
$65.52
|
| Rate for Payer: Railroad Medicare Medicare |
$15.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.94
|
| Rate for Payer: UHC Core |
$24.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.78
|
| Rate for Payer: UHC Exchange |
$15.78
|
| Rate for Payer: UHC Medicare Advantage |
$16.25
|
| Rate for Payer: UMR Bronson Commercial |
$38.48
|
| Rate for Payer: VA VA |
$15.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.00
|
|
|
HC HALOPERIDOL LEVEL
|
Facility
|
IP
|
$104.00
|
|
|
Service Code
|
CPT 80173
|
| Hospital Charge Code |
30100031
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.76 |
| Max. Negotiated Rate |
$93.60 |
| Rate for Payer: Aetna American Axle |
$67.60
|
| Rate for Payer: Aetna Commercial |
$88.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.60
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Cofinity Commercial |
$72.80
|
| Rate for Payer: Cofinity Commercial |
$89.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.20
|
| Rate for Payer: Healthscope Commercial |
$93.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$72.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$88.40
|
| Rate for Payer: PHP Commercial |
$88.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.80
|
| Rate for Payer: Priority Health SBD |
$65.52
|
| Rate for Payer: UMR Bronson Commercial |
$45.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.00
|
|
|
HC HALO RING APPLICATION
|
Facility
|
OP
|
$2,460.76
|
|
| Hospital Charge Code |
27000085
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$910.48 |
| Max. Negotiated Rate |
$2,214.68 |
| Rate for Payer: Aetna American Axle |
$1,599.49
|
| Rate for Payer: Aetna Commercial |
$2,091.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,599.49
|
| Rate for Payer: BCBS Complete |
$984.30
|
| Rate for Payer: Cash Price |
$1,968.61
|
| Rate for Payer: Cofinity Commercial |
$1,722.53
|
| Rate for Payer: Cofinity Commercial |
$2,116.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,968.61
|
| Rate for Payer: Healthscope Commercial |
$2,214.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,722.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,845.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,091.65
|
| Rate for Payer: PHP Commercial |
$2,091.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,722.53
|
| Rate for Payer: Priority Health SBD |
$1,550.28
|
| Rate for Payer: UMR Bronson Commercial |
$910.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,845.57
|
|
|
HC HALO RING APPLICATION
|
Facility
|
IP
|
$2,460.76
|
|
| Hospital Charge Code |
27000085
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,082.73 |
| Max. Negotiated Rate |
$2,214.68 |
| Rate for Payer: Aetna American Axle |
$1,599.49
|
| Rate for Payer: Aetna Commercial |
$2,091.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,599.49
|
| Rate for Payer: Cash Price |
$1,968.61
|
| Rate for Payer: Cofinity Commercial |
$1,722.53
|
| Rate for Payer: Cofinity Commercial |
$2,116.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,968.61
|
| Rate for Payer: Healthscope Commercial |
$2,214.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,722.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,845.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,091.65
|
| Rate for Payer: PHP Commercial |
$2,091.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,722.53
|
| Rate for Payer: Priority Health SBD |
$1,550.28
|
| Rate for Payer: UMR Bronson Commercial |
$1,082.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,845.57
|
|
|
HC HALO RING & VEST
|
Facility
|
IP
|
$6,162.09
|
|
| Hospital Charge Code |
27000084
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2,711.32 |
| Max. Negotiated Rate |
$5,545.88 |
| Rate for Payer: Aetna American Axle |
$4,005.36
|
| Rate for Payer: Aetna Commercial |
$5,237.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,005.36
|
| Rate for Payer: Cash Price |
$4,929.67
|
| Rate for Payer: Cofinity Commercial |
$4,313.46
|
| Rate for Payer: Cofinity Commercial |
$5,299.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,929.67
|
| Rate for Payer: Healthscope Commercial |
$5,545.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,313.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,621.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,237.78
|
| Rate for Payer: PHP Commercial |
$5,237.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,313.46
|
| Rate for Payer: Priority Health SBD |
$3,882.12
|
| Rate for Payer: UMR Bronson Commercial |
$2,711.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,621.57
|
|
|
HC HALO RING & VEST
|
Facility
|
OP
|
$6,162.09
|
|
| Hospital Charge Code |
27000084
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2,279.97 |
| Max. Negotiated Rate |
$5,545.88 |
| Rate for Payer: Aetna American Axle |
$4,005.36
|
| Rate for Payer: Aetna Commercial |
$5,237.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,005.36
|
| Rate for Payer: BCBS Complete |
$2,464.84
|
| Rate for Payer: Cash Price |
$4,929.67
|
| Rate for Payer: Cofinity Commercial |
$4,313.46
|
| Rate for Payer: Cofinity Commercial |
$5,299.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,929.67
|
| Rate for Payer: Healthscope Commercial |
$5,545.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,313.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,621.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,237.78
|
| Rate for Payer: PHP Commercial |
$5,237.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,313.46
|
| Rate for Payer: Priority Health SBD |
$3,882.12
|
| Rate for Payer: UMR Bronson Commercial |
$2,279.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,621.57
|
|
|
HC HALO VEST APPLICATION
|
Facility
|
OP
|
$5,653.12
|
|
| Hospital Charge Code |
27000086
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2,091.65 |
| Max. Negotiated Rate |
$5,087.81 |
| Rate for Payer: Aetna American Axle |
$3,674.53
|
| Rate for Payer: Aetna Commercial |
$4,805.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,674.53
|
| Rate for Payer: BCBS Complete |
$2,261.25
|
| Rate for Payer: Cash Price |
$4,522.50
|
| Rate for Payer: Cofinity Commercial |
$3,957.18
|
| Rate for Payer: Cofinity Commercial |
$4,861.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,522.50
|
| Rate for Payer: Healthscope Commercial |
$5,087.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,957.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,239.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,805.15
|
| Rate for Payer: PHP Commercial |
$4,805.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,957.18
|
| Rate for Payer: Priority Health SBD |
$3,561.47
|
| Rate for Payer: UMR Bronson Commercial |
$2,091.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,239.84
|
|
|
HC HALO VEST APPLICATION
|
Facility
|
IP
|
$5,653.12
|
|
| Hospital Charge Code |
27000086
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2,487.37 |
| Max. Negotiated Rate |
$5,087.81 |
| Rate for Payer: Aetna American Axle |
$3,674.53
|
| Rate for Payer: Aetna Commercial |
$4,805.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,674.53
|
| Rate for Payer: Cash Price |
$4,522.50
|
| Rate for Payer: Cofinity Commercial |
$3,957.18
|
| Rate for Payer: Cofinity Commercial |
$4,861.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,522.50
|
| Rate for Payer: Healthscope Commercial |
$5,087.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,957.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,239.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,805.15
|
| Rate for Payer: PHP Commercial |
$4,805.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,957.18
|
| Rate for Payer: Priority Health SBD |
$3,561.47
|
| Rate for Payer: UMR Bronson Commercial |
$2,487.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,239.84
|
|
|
HC HAPTOGLOGIN
|
Facility
|
IP
|
$83.00
|
|
|
Service Code
|
CPT 83010
|
| Hospital Charge Code |
30100234
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$36.52 |
| Max. Negotiated Rate |
$74.70 |
| Rate for Payer: Aetna American Axle |
$53.95
|
| Rate for Payer: Aetna Commercial |
$70.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.95
|
| Rate for Payer: Cash Price |
$66.40
|
| Rate for Payer: Cofinity Commercial |
$71.38
|
| Rate for Payer: Cofinity Commercial |
$58.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.40
|
| Rate for Payer: Healthscope Commercial |
$74.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$58.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$70.55
|
| Rate for Payer: PHP Commercial |
$70.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.10
|
| Rate for Payer: Priority Health SBD |
$52.29
|
| Rate for Payer: UMR Bronson Commercial |
$36.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.25
|
|
|
HC HAPTOGLOGIN
|
Facility
|
OP
|
$83.00
|
|
|
Service Code
|
CPT 83010
|
| Hospital Charge Code |
30100234
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.88 |
| Max. Negotiated Rate |
$74.70 |
| Rate for Payer: Aetna American Axle |
$53.95
|
| Rate for Payer: Aetna Commercial |
$70.55
|
| Rate for Payer: Aetna Medicare |
$13.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.72
|
| Rate for Payer: BCBS Complete |
$7.23
|
| Rate for Payer: BCBS MAPPO |
$12.58
|
| Rate for Payer: BCBS Trust/PPO |
$11.32
|
| Rate for Payer: BCN Medicare Advantage |
$12.58
|
| Rate for Payer: Cash Price |
$66.40
|
| Rate for Payer: Cash Price |
$66.40
|
| Rate for Payer: Cofinity Commercial |
$71.38
|
| Rate for Payer: Cofinity Commercial |
$58.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.58
|
| Rate for Payer: Healthscope Commercial |
$74.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$58.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.25
|
| Rate for Payer: Mclaren Medicaid |
$6.88
|
| Rate for Payer: Mclaren Medicare |
$12.58
|
| Rate for Payer: Meridian Medicaid |
$7.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$70.55
|
| Rate for Payer: PACE Medicare |
$11.95
|
| Rate for Payer: PACE SWMI |
$12.58
|
| Rate for Payer: PHP Commercial |
$70.55
|
| Rate for Payer: PHP Medicare Advantage |
$12.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.25
|
| Rate for Payer: Priority Health Medicare |
$12.58
|
| Rate for Payer: Priority Health Narrow Network |
$13.80
|
| Rate for Payer: Priority Health SBD |
$52.29
|
| Rate for Payer: Railroad Medicare Medicare |
$12.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.10
|
| Rate for Payer: UHC Core |
$20.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.58
|
| Rate for Payer: UHC Exchange |
$12.58
|
| Rate for Payer: UHC Medicare Advantage |
$12.96
|
| Rate for Payer: UMR Bronson Commercial |
$30.71
|
| Rate for Payer: VA VA |
$12.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.25
|
|
|
HC HAZELNUT FILBERT IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200043
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna American Axle |
$16.18
|
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: BCBS Complete |
$3.00
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$4.70
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Cofinity Commercial |
$17.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.67
|
| Rate for Payer: Mclaren Medicaid |
$2.86
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Medicaid |
$3.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7.16
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$5.73
|
| Rate for Payer: Priority Health SBD |
$15.68
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.26
|
| Rate for Payer: UHC Core |
$8.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$5.22
|
| Rate for Payer: UHC Medicare Advantage |
$5.38
|
| Rate for Payer: UMR Bronson Commercial |
$9.21
|
| Rate for Payer: VA VA |
$5.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.67
|
|
|
HC HAZELNUT FILBERT IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200043
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.95 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna American Axle |
$16.18
|
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.18
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$17.42
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health SBD |
$15.68
|
| Rate for Payer: UMR Bronson Commercial |
$10.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.67
|
|
|
HC HBO PER 30 MINUTES
|
Facility
|
IP
|
$641.40
|
|
|
Service Code
|
HCPCS G0277
|
| Hospital Charge Code |
41300001
|
|
Hospital Revenue Code
|
413
|
| Min. Negotiated Rate |
$282.22 |
| Max. Negotiated Rate |
$577.26 |
| Rate for Payer: Aetna Commercial |
$545.19
|
| Rate for Payer: Aetna American Axle |
$416.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$416.91
|
| Rate for Payer: Cash Price |
$513.12
|
| Rate for Payer: Cofinity Commercial |
$448.98
|
| Rate for Payer: Cofinity Commercial |
$551.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$513.12
|
| Rate for Payer: Healthscope Commercial |
$577.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$448.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$481.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$545.19
|
| Rate for Payer: PHP Commercial |
$545.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$448.98
|
| Rate for Payer: Priority Health SBD |
$404.08
|
| Rate for Payer: UMR Bronson Commercial |
$282.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$481.05
|
|
|
HC HBO PER 30 MINUTES
|
Facility
|
OP
|
$641.40
|
|
|
Service Code
|
HCPCS G0277
|
| Hospital Charge Code |
41300001
|
|
Hospital Revenue Code
|
413
|
| Min. Negotiated Rate |
$67.47 |
| Max. Negotiated Rate |
$3,917.00 |
| Rate for Payer: Aetna American Axle |
$416.91
|
| Rate for Payer: Aetna Commercial |
$545.19
|
| Rate for Payer: Aetna Medicare |
$128.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$416.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$154.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$154.18
|
| Rate for Payer: BCBS Complete |
$70.85
|
| Rate for Payer: BCBS MAPPO |
$123.34
|
| Rate for Payer: BCBS Trust/PPO |
$351.84
|
| Rate for Payer: BCN Medicare Advantage |
$123.34
|
| Rate for Payer: Cash Price |
$513.12
|
| Rate for Payer: Cash Price |
$513.12
|
| Rate for Payer: Cash Price |
$513.12
|
| Rate for Payer: Cofinity Commercial |
$448.98
|
| Rate for Payer: Cofinity Commercial |
$551.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$513.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$123.34
|
| Rate for Payer: Healthscope Commercial |
$577.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$448.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$481.05
|
| Rate for Payer: Mclaren Medicaid |
$67.47
|
| Rate for Payer: Mclaren Medicare |
$123.34
|
| Rate for Payer: Meridian Medicaid |
$70.85
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$129.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$141.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$545.19
|
| Rate for Payer: PACE Medicare |
$117.17
|
| Rate for Payer: PACE SWMI |
$123.34
|
| Rate for Payer: PHP Commercial |
$545.19
|
| Rate for Payer: PHP Medicare Advantage |
$123.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$448.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$388.28
|
| Rate for Payer: Priority Health Medicare |
$123.34
|
| Rate for Payer: Priority Health Narrow Network |
$310.62
|
| Rate for Payer: Priority Health SBD |
$404.08
|
| Rate for Payer: Railroad Medicare Medicare |
$123.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$197.02
|
| Rate for Payer: UHC Core |
$3,917.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$123.34
|
| Rate for Payer: UHC Exchange |
$179.11
|
| Rate for Payer: UHC Medicare Advantage |
$127.04
|
| Rate for Payer: UMR Bronson Commercial |
$237.32
|
| Rate for Payer: VA VA |
$123.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$481.05
|
|
|
HC HBO TCPO2 ARTERIAL STUDY COMPLETE
|
Facility
|
OP
|
$819.04
|
|
|
Service Code
|
CPT 93923
|
| Hospital Charge Code |
92100005
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$75.95 |
| Max. Negotiated Rate |
$737.14 |
| Rate for Payer: Aetna American Axle |
$532.38
|
| Rate for Payer: Aetna Commercial |
$696.18
|
| Rate for Payer: Aetna Medicare |
$144.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$532.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$173.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$173.56
|
| Rate for Payer: BCBS Complete |
$79.76
|
| Rate for Payer: BCBS MAPPO |
$138.85
|
| Rate for Payer: BCBS Trust/PPO |
$536.21
|
| Rate for Payer: BCN Medicare Advantage |
$138.85
|
| Rate for Payer: Cash Price |
$655.23
|
| Rate for Payer: Cash Price |
$655.23
|
| Rate for Payer: Cash Price |
$655.23
|
| Rate for Payer: Cofinity Commercial |
$573.33
|
| Rate for Payer: Cofinity Commercial |
$704.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$655.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.85
|
| Rate for Payer: Healthscope Commercial |
$737.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$573.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$614.28
|
| Rate for Payer: Mclaren Medicaid |
$75.95
|
| Rate for Payer: Mclaren Medicare |
$138.85
|
| Rate for Payer: Meridian Medicaid |
$79.76
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$145.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$159.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$696.18
|
| Rate for Payer: PACE Medicare |
$131.91
|
| Rate for Payer: PACE SWMI |
$138.85
|
| Rate for Payer: PHP Commercial |
$696.18
|
| Rate for Payer: PHP Medicare Advantage |
$138.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$75.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$573.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$437.09
|
| Rate for Payer: Priority Health Medicare |
$138.85
|
| Rate for Payer: Priority Health Narrow Network |
$349.67
|
| Rate for Payer: Priority Health SBD |
$516.00
|
| Rate for Payer: Railroad Medicare Medicare |
$138.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$140.83
|
| Rate for Payer: UHC Core |
$587.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$138.85
|
| Rate for Payer: UHC Exchange |
$128.03
|
| Rate for Payer: UHC Medicare Advantage |
$143.02
|
| Rate for Payer: UMR Bronson Commercial |
$303.04
|
| Rate for Payer: VA VA |
$138.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$614.28
|
|
|
HC HBO TCPO2 ARTERIAL STUDY COMPLETE
|
Facility
|
IP
|
$819.04
|
|
|
Service Code
|
CPT 93923
|
| Hospital Charge Code |
92100005
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$360.38 |
| Max. Negotiated Rate |
$737.14 |
| Rate for Payer: Aetna American Axle |
$532.38
|
| Rate for Payer: Aetna Commercial |
$696.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$532.38
|
| Rate for Payer: Cash Price |
$655.23
|
| Rate for Payer: Cofinity Commercial |
$573.33
|
| Rate for Payer: Cofinity Commercial |
$704.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$655.23
|
| Rate for Payer: Healthscope Commercial |
$737.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$573.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$614.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$696.18
|
| Rate for Payer: PHP Commercial |
$696.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$573.33
|
| Rate for Payer: Priority Health SBD |
$516.00
|
| Rate for Payer: UMR Bronson Commercial |
$360.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$614.28
|
|
