|
HC ALPHA DEFENSINS-SF
|
Facility
|
IP
|
$173.40
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30200405
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$76.30 |
| Max. Negotiated Rate |
$156.06 |
| Rate for Payer: Aetna American Axle |
$112.71
|
| Rate for Payer: Aetna Commercial |
$147.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.71
|
| Rate for Payer: Cash Price |
$138.72
|
| Rate for Payer: Cofinity Commercial |
$121.38
|
| Rate for Payer: Cofinity Commercial |
$149.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$121.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.72
|
| Rate for Payer: Healthscope Commercial |
$156.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$121.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$130.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.39
|
| Rate for Payer: PHP Commercial |
$147.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.71
|
| Rate for Payer: Priority Health SBD |
$109.24
|
| Rate for Payer: UMR Bronson Commercial |
$76.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$130.05
|
|
|
HC ALPHA FETOPROTEIN AMNIOTIC
|
Facility
|
OP
|
$74.56
|
|
|
Service Code
|
CPT 82106
|
| Hospital Charge Code |
30200001
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.11 |
| Max. Negotiated Rate |
$67.10 |
| Rate for Payer: Aetna American Axle |
$48.46
|
| Rate for Payer: Aetna Commercial |
$63.38
|
| Rate for Payer: Aetna Medicare |
$17.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.25
|
| Rate for Payer: BCBS Complete |
$9.57
|
| Rate for Payer: BCBS MAPPO |
$17.00
|
| Rate for Payer: BCN Medicare Advantage |
$17.00
|
| Rate for Payer: Cash Price |
$59.65
|
| Rate for Payer: Cash Price |
$59.65
|
| Rate for Payer: Cofinity Commercial |
$64.12
|
| Rate for Payer: Cofinity Commercial |
$52.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$52.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.00
|
| Rate for Payer: Healthscope Commercial |
$67.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.92
|
| Rate for Payer: Mclaren Medicaid |
$9.11
|
| Rate for Payer: Mclaren Medicare |
$17.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.85
|
| Rate for Payer: Meridian Medicaid |
$9.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.38
|
| Rate for Payer: PACE Medicare |
$16.15
|
| Rate for Payer: PACE SWMI |
$17.00
|
| Rate for Payer: PHP Commercial |
$63.38
|
| Rate for Payer: PHP Medicare Advantage |
$17.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.46
|
| Rate for Payer: Priority Health Medicare |
$17.00
|
| Rate for Payer: Priority Health SBD |
$46.97
|
| Rate for Payer: Railroad Medicare Medicare |
$17.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.00
|
| Rate for Payer: UHC Exchange |
$32.49
|
| Rate for Payer: UHC Medicare Advantage |
$17.00
|
| Rate for Payer: UHCCP Medicaid |
$9.11
|
| Rate for Payer: UMR Bronson Commercial |
$27.59
|
| Rate for Payer: VA VA |
$17.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.92
|
|
|
HC ALPHA FETOPROTEIN AMNIOTIC
|
Facility
|
IP
|
$74.56
|
|
|
Service Code
|
CPT 82106
|
| Hospital Charge Code |
30200001
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$32.81 |
| Max. Negotiated Rate |
$67.10 |
| Rate for Payer: Aetna American Axle |
$48.46
|
| Rate for Payer: Aetna Commercial |
$63.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.46
|
| Rate for Payer: Cash Price |
$59.65
|
| Rate for Payer: Cofinity Commercial |
$52.19
|
| Rate for Payer: Cofinity Commercial |
$64.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$52.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.65
|
| Rate for Payer: Healthscope Commercial |
$67.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.38
|
| Rate for Payer: PHP Commercial |
$63.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.46
|
| Rate for Payer: Priority Health SBD |
$46.97
|
| Rate for Payer: UMR Bronson Commercial |
$32.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.92
|
|
|
HC ALPHA FETOPROTEIN SERUM
|
Facility
|
IP
|
$36.41
|
|
|
Service Code
|
CPT 82105
|
| Hospital Charge Code |
30100087
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.02 |
| Max. Negotiated Rate |
$32.77 |
| Rate for Payer: Aetna American Axle |
$23.67
|
| Rate for Payer: Aetna Commercial |
$30.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.67
|
| Rate for Payer: Cash Price |
$29.13
|
| Rate for Payer: Cofinity Commercial |
$25.49
|
| Rate for Payer: Cofinity Commercial |
$31.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$25.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.13
|
| Rate for Payer: Healthscope Commercial |
$32.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.95
|
| Rate for Payer: PHP Commercial |
$30.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.67
|
| Rate for Payer: Priority Health SBD |
$22.94
|
| Rate for Payer: UMR Bronson Commercial |
$16.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.31
|
|
|
HC ALPHA FETOPROTEIN SERUM
|
Facility
|
OP
|
$36.41
|
|
|
Service Code
|
CPT 82105
|
| Hospital Charge Code |
30100087
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.99 |
| Max. Negotiated Rate |
$47.21 |
| Rate for Payer: Aetna American Axle |
$23.67
|
| Rate for Payer: Aetna Commercial |
$30.95
|
| Rate for Payer: Aetna Medicare |
$17.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.96
|
| Rate for Payer: BCBS Complete |
$9.44
|
| Rate for Payer: BCBS MAPPO |
$16.77
|
| Rate for Payer: BCN Medicare Advantage |
$16.77
|
| Rate for Payer: Cash Price |
$29.13
|
| Rate for Payer: Cash Price |
$29.13
|
| Rate for Payer: Cofinity Commercial |
$31.31
|
| Rate for Payer: Cofinity Commercial |
$25.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$25.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.77
|
| Rate for Payer: Healthscope Commercial |
$32.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.31
|
| Rate for Payer: Mclaren Medicaid |
$8.99
|
| Rate for Payer: Mclaren Medicare |
$16.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.61
|
| Rate for Payer: Meridian Medicaid |
$9.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.95
|
| Rate for Payer: PACE Medicare |
$15.93
|
| Rate for Payer: PACE SWMI |
$16.77
|
| Rate for Payer: PHP Commercial |
$30.95
|
| Rate for Payer: PHP Medicare Advantage |
$16.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.67
|
| Rate for Payer: Priority Health Medicare |
$16.77
|
| Rate for Payer: Priority Health SBD |
$22.94
|
| Rate for Payer: Railroad Medicare Medicare |
$16.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.77
|
| Rate for Payer: UHC Exchange |
$32.05
|
| Rate for Payer: UHC Medicare Advantage |
$16.77
|
| Rate for Payer: UHCCP Medicaid |
$8.99
|
| Rate for Payer: UMR Bronson Commercial |
$13.47
|
| Rate for Payer: VA VA |
$16.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.31
|
|
|
HC ALPHA FETOPROTEIN TUMOR MARKER
|
Facility
|
OP
|
$64.50
|
|
|
Service Code
|
CPT 82105
|
| Hospital Charge Code |
30100086
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.99 |
| Max. Negotiated Rate |
$58.05 |
| Rate for Payer: Aetna American Axle |
$41.92
|
| Rate for Payer: Aetna Commercial |
$54.83
|
| Rate for Payer: Aetna Medicare |
$17.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.96
|
| Rate for Payer: BCBS Complete |
$9.44
|
| Rate for Payer: BCBS MAPPO |
$16.77
|
| Rate for Payer: BCN Medicare Advantage |
$16.77
|
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cofinity Commercial |
$55.47
|
| Rate for Payer: Cofinity Commercial |
$45.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$45.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.77
|
| Rate for Payer: Healthscope Commercial |
$58.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.38
|
| Rate for Payer: Mclaren Medicaid |
$8.99
|
| Rate for Payer: Mclaren Medicare |
$16.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.61
|
| Rate for Payer: Meridian Medicaid |
$9.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.83
|
| Rate for Payer: PACE Medicare |
$15.93
|
| Rate for Payer: PACE SWMI |
$16.77
|
| Rate for Payer: PHP Commercial |
$54.83
|
| Rate for Payer: PHP Medicare Advantage |
$16.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.92
|
| Rate for Payer: Priority Health Medicare |
$16.77
|
| Rate for Payer: Priority Health SBD |
$40.63
|
| Rate for Payer: Railroad Medicare Medicare |
$16.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.77
|
| Rate for Payer: UHC Exchange |
$32.05
|
| Rate for Payer: UHC Medicare Advantage |
$16.77
|
| Rate for Payer: UHCCP Medicaid |
$8.99
|
| Rate for Payer: UMR Bronson Commercial |
$23.86
|
| Rate for Payer: VA VA |
$16.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.38
|
|
|
HC ALPHA FETOPROTEIN TUMOR MARKER
|
Facility
|
IP
|
$64.50
|
|
|
Service Code
|
CPT 82105
|
| Hospital Charge Code |
30100086
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.38 |
| Max. Negotiated Rate |
$58.05 |
| Rate for Payer: Aetna American Axle |
$41.92
|
| Rate for Payer: Aetna Commercial |
$54.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.92
|
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cofinity Commercial |
$45.15
|
| Rate for Payer: Cofinity Commercial |
$55.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$45.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.60
|
| Rate for Payer: Healthscope Commercial |
$58.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.83
|
| Rate for Payer: PHP Commercial |
$54.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.92
|
| Rate for Payer: Priority Health SBD |
$40.63
|
| Rate for Payer: UMR Bronson Commercial |
$28.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.38
|
|
|
HC ALPHA-GLOBIN GENE ANALYSIS
|
Facility
|
IP
|
$421.61
|
|
|
Service Code
|
CPT 81269
|
| Hospital Charge Code |
31000088
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$185.51 |
| Max. Negotiated Rate |
$379.45 |
| Rate for Payer: Aetna American Axle |
$274.05
|
| Rate for Payer: Aetna Commercial |
$358.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$274.05
|
| Rate for Payer: Cash Price |
$337.29
|
| Rate for Payer: Cofinity Commercial |
$295.13
|
| Rate for Payer: Cofinity Commercial |
$362.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$295.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$337.29
|
| Rate for Payer: Healthscope Commercial |
$379.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$295.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$316.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$358.37
|
| Rate for Payer: PHP Commercial |
$358.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$274.05
|
| Rate for Payer: Priority Health SBD |
$265.61
|
| Rate for Payer: UMR Bronson Commercial |
$185.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$316.21
|
|
|
HC ALPHA-GLOBIN GENE ANALYSIS
|
Facility
|
OP
|
$421.61
|
|
|
Service Code
|
CPT 81269
|
| Hospital Charge Code |
31000088
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$108.49 |
| Max. Negotiated Rate |
$569.74 |
| Rate for Payer: Aetna American Axle |
$274.05
|
| Rate for Payer: Aetna Commercial |
$358.37
|
| Rate for Payer: Aetna Medicare |
$210.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$274.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$253.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$253.00
|
| Rate for Payer: BCBS Complete |
$113.91
|
| Rate for Payer: BCBS MAPPO |
$202.40
|
| Rate for Payer: BCN Medicare Advantage |
$202.40
|
| Rate for Payer: Cash Price |
$337.29
|
| Rate for Payer: Cash Price |
$337.29
|
| Rate for Payer: Cofinity Commercial |
$362.58
|
| Rate for Payer: Cofinity Commercial |
$295.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$295.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$337.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$202.40
|
| Rate for Payer: Healthscope Commercial |
$379.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$295.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$316.21
|
| Rate for Payer: Mclaren Medicaid |
$108.49
|
| Rate for Payer: Mclaren Medicare |
$202.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$212.52
|
| Rate for Payer: Meridian Medicaid |
$113.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$232.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$358.37
|
| Rate for Payer: PACE Medicare |
$192.28
|
| Rate for Payer: PACE SWMI |
$202.40
|
| Rate for Payer: PHP Commercial |
$358.37
|
| Rate for Payer: PHP Medicare Advantage |
$202.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$108.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$274.05
|
| Rate for Payer: Priority Health Medicare |
$202.40
|
| Rate for Payer: Priority Health SBD |
$265.61
|
| Rate for Payer: Railroad Medicare Medicare |
$202.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$569.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$202.40
|
| Rate for Payer: UHC Exchange |
$386.81
|
| Rate for Payer: UHC Medicare Advantage |
$202.40
|
| Rate for Payer: UHCCP Medicaid |
$108.49
|
| Rate for Payer: UMR Bronson Commercial |
$156.00
|
| Rate for Payer: VA VA |
$202.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$316.21
|
|
|
HC ALTEPLASE RECOMBINANT, PER 1 MG
|
Facility
|
OP
|
$88.43
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
63600144
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.72 |
| Max. Negotiated Rate |
$265.87 |
| Rate for Payer: Aetna American Axle |
$57.48
|
| Rate for Payer: Aetna Commercial |
$75.17
|
| Rate for Payer: Aetna Medicare |
$98.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$118.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$118.06
|
| Rate for Payer: BCBS Complete |
$53.16
|
| Rate for Payer: BCBS MAPPO |
$94.45
|
| Rate for Payer: BCN Medicare Advantage |
$94.45
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Cofinity Commercial |
$76.05
|
| Rate for Payer: Cofinity Commercial |
$61.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$61.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$94.45
|
| Rate for Payer: Healthscope Commercial |
$79.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$61.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.32
|
| Rate for Payer: Mclaren Medicaid |
$50.63
|
| Rate for Payer: Mclaren Medicare |
$94.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$99.17
|
| Rate for Payer: Meridian Medicaid |
$53.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$108.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.17
|
| Rate for Payer: PACE Medicare |
$89.73
|
| Rate for Payer: PACE SWMI |
$94.45
|
| Rate for Payer: PHP Commercial |
$75.17
|
| Rate for Payer: PHP Medicare Advantage |
$94.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$50.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.48
|
| Rate for Payer: Priority Health Medicare |
$94.45
|
| Rate for Payer: Priority Health SBD |
$55.71
|
| Rate for Payer: Railroad Medicare Medicare |
$94.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$265.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$94.45
|
| Rate for Payer: UHC Exchange |
$180.50
|
| Rate for Payer: UHC Medicare Advantage |
$94.45
|
| Rate for Payer: UHCCP Medicaid |
$50.63
|
| Rate for Payer: UMR Bronson Commercial |
$32.72
|
| Rate for Payer: VA VA |
$94.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.32
|
|
|
HC ALTEPLASE RECOMBINANT, PER 1 MG
|
Facility
|
IP
|
$88.43
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
63600144
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.91 |
| Max. Negotiated Rate |
$79.59 |
| Rate for Payer: Aetna American Axle |
$57.48
|
| Rate for Payer: Aetna Commercial |
$75.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.48
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Cofinity Commercial |
$61.90
|
| Rate for Payer: Cofinity Commercial |
$76.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$61.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.74
|
| Rate for Payer: Healthscope Commercial |
$79.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$61.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.17
|
| Rate for Payer: PHP Commercial |
$75.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.48
|
| Rate for Payer: Priority Health SBD |
$55.71
|
| Rate for Payer: UMR Bronson Commercial |
$38.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.32
|
|
|
HC ALTERNARIA IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200027
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna American Axle |
$16.50
|
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.04
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$16.00
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$9.98
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.80
|
| Rate for Payer: UMR Bronson Commercial |
$9.39
|
| Rate for Payer: VA VA |
$5.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.04
|
|
|
HC ALTERNARIA IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200027
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.17 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna American Axle |
$16.50
|
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health SBD |
$16.00
|
| Rate for Payer: UMR Bronson Commercial |
$11.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.04
|
|
|
HC ALUMINUM
|
Facility
|
IP
|
$56.18
|
|
|
Service Code
|
CPT 82108
|
| Hospital Charge Code |
30100088
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.72 |
| Max. Negotiated Rate |
$50.56 |
| Rate for Payer: Aetna American Axle |
$36.52
|
| Rate for Payer: Aetna Commercial |
$47.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.52
|
| Rate for Payer: Cash Price |
$44.94
|
| Rate for Payer: Cofinity Commercial |
$39.33
|
| Rate for Payer: Cofinity Commercial |
$48.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$39.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.94
|
| Rate for Payer: Healthscope Commercial |
$50.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.75
|
| Rate for Payer: PHP Commercial |
$47.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.52
|
| Rate for Payer: Priority Health SBD |
$35.39
|
| Rate for Payer: UMR Bronson Commercial |
$24.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.13
|
|
|
HC ALUMINUM
|
Facility
|
OP
|
$56.18
|
|
|
Service Code
|
CPT 82108
|
| Hospital Charge Code |
30100088
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.66 |
| Max. Negotiated Rate |
$71.72 |
| Rate for Payer: Aetna American Axle |
$36.52
|
| Rate for Payer: Aetna Commercial |
$47.75
|
| Rate for Payer: Aetna Medicare |
$26.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.85
|
| Rate for Payer: BCBS Complete |
$14.34
|
| Rate for Payer: BCBS MAPPO |
$25.48
|
| Rate for Payer: BCN Medicare Advantage |
$25.48
|
| Rate for Payer: Cash Price |
$44.94
|
| Rate for Payer: Cash Price |
$44.94
|
| Rate for Payer: Cofinity Commercial |
$48.31
|
| Rate for Payer: Cofinity Commercial |
$39.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$39.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.48
|
| Rate for Payer: Healthscope Commercial |
$50.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.13
|
| Rate for Payer: Mclaren Medicaid |
$13.66
|
| Rate for Payer: Mclaren Medicare |
$25.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.75
|
| Rate for Payer: Meridian Medicaid |
$14.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.75
|
| Rate for Payer: PACE Medicare |
$24.21
|
| Rate for Payer: PACE SWMI |
$25.48
|
| Rate for Payer: PHP Commercial |
$47.75
|
| Rate for Payer: PHP Medicare Advantage |
$25.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.52
|
| Rate for Payer: Priority Health Medicare |
$25.48
|
| Rate for Payer: Priority Health SBD |
$35.39
|
| Rate for Payer: Railroad Medicare Medicare |
$25.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.48
|
| Rate for Payer: UHC Exchange |
$48.69
|
| Rate for Payer: UHC Medicare Advantage |
$25.48
|
| Rate for Payer: UHCCP Medicaid |
$13.66
|
| Rate for Payer: UMR Bronson Commercial |
$20.79
|
| Rate for Payer: VA VA |
$25.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.13
|
|
|
HC AMIKACIN LEVEL
|
Facility
|
OP
|
$78.45
|
|
|
Service Code
|
CPT 80150
|
| Hospital Charge Code |
30100006
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.08 |
| Max. Negotiated Rate |
$70.61 |
| Rate for Payer: Aetna American Axle |
$50.99
|
| Rate for Payer: Aetna Commercial |
$66.68
|
| Rate for Payer: Aetna Medicare |
$15.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.85
|
| Rate for Payer: BCBS Complete |
$8.49
|
| Rate for Payer: BCBS MAPPO |
$15.08
|
| Rate for Payer: BCN Medicare Advantage |
$15.08
|
| Rate for Payer: Cash Price |
$62.76
|
| Rate for Payer: Cash Price |
$62.76
|
| Rate for Payer: Cofinity Commercial |
$67.47
|
| Rate for Payer: Cofinity Commercial |
$54.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$54.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.08
|
| Rate for Payer: Healthscope Commercial |
$70.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$54.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.84
|
| Rate for Payer: Mclaren Medicaid |
$8.08
|
| Rate for Payer: Mclaren Medicare |
$15.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.83
|
| Rate for Payer: Meridian Medicaid |
$8.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.68
|
| Rate for Payer: PACE Medicare |
$14.33
|
| Rate for Payer: PACE SWMI |
$15.08
|
| Rate for Payer: PHP Commercial |
$66.68
|
| Rate for Payer: PHP Medicare Advantage |
$15.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.99
|
| Rate for Payer: Priority Health Medicare |
$15.08
|
| Rate for Payer: Priority Health SBD |
$49.42
|
| Rate for Payer: Railroad Medicare Medicare |
$15.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.08
|
| Rate for Payer: UHC Exchange |
$28.82
|
| Rate for Payer: UHC Medicare Advantage |
$15.08
|
| Rate for Payer: UHCCP Medicaid |
$8.08
|
| Rate for Payer: UMR Bronson Commercial |
$29.03
|
| Rate for Payer: VA VA |
$15.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.84
|
|
|
HC AMIKACIN LEVEL
|
Facility
|
IP
|
$78.45
|
|
|
Service Code
|
CPT 80150
|
| Hospital Charge Code |
30100006
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.52 |
| Max. Negotiated Rate |
$70.61 |
| Rate for Payer: Aetna American Axle |
$50.99
|
| Rate for Payer: Aetna Commercial |
$66.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.99
|
| Rate for Payer: Cash Price |
$62.76
|
| Rate for Payer: Cofinity Commercial |
$54.91
|
| Rate for Payer: Cofinity Commercial |
$67.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$54.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.76
|
| Rate for Payer: Healthscope Commercial |
$70.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$54.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.68
|
| Rate for Payer: PHP Commercial |
$66.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.99
|
| Rate for Payer: Priority Health SBD |
$49.42
|
| Rate for Payer: UMR Bronson Commercial |
$34.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.84
|
|
|
HC AMINO ACID FRACTIONATION
|
Facility
|
OP
|
$158.14
|
|
|
Service Code
|
CPT 82139
|
| Hospital Charge Code |
30100091
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.04 |
| Max. Negotiated Rate |
$142.33 |
| Rate for Payer: Aetna American Axle |
$102.79
|
| Rate for Payer: Aetna Commercial |
$134.42
|
| Rate for Payer: Aetna Medicare |
$17.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.09
|
| Rate for Payer: BCBS Complete |
$9.49
|
| Rate for Payer: BCBS MAPPO |
$16.87
|
| Rate for Payer: BCN Medicare Advantage |
$16.87
|
| Rate for Payer: Cash Price |
$126.51
|
| Rate for Payer: Cash Price |
$126.51
|
| Rate for Payer: Cofinity Commercial |
$136.00
|
| Rate for Payer: Cofinity Commercial |
$110.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$110.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.87
|
| Rate for Payer: Healthscope Commercial |
$142.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$110.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$118.61
|
| Rate for Payer: Mclaren Medicaid |
$9.04
|
| Rate for Payer: Mclaren Medicare |
$16.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.71
|
| Rate for Payer: Meridian Medicaid |
$9.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.42
|
| Rate for Payer: PACE Medicare |
$16.03
|
| Rate for Payer: PACE SWMI |
$16.87
|
| Rate for Payer: PHP Commercial |
$134.42
|
| Rate for Payer: PHP Medicare Advantage |
$16.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.79
|
| Rate for Payer: Priority Health Medicare |
$16.87
|
| Rate for Payer: Priority Health SBD |
$99.63
|
| Rate for Payer: Railroad Medicare Medicare |
$16.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.87
|
| Rate for Payer: UHC Exchange |
$32.24
|
| Rate for Payer: UHC Medicare Advantage |
$16.87
|
| Rate for Payer: UHCCP Medicaid |
$9.04
|
| Rate for Payer: UMR Bronson Commercial |
$58.51
|
| Rate for Payer: VA VA |
$16.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$118.61
|
|
|
HC AMINO ACID FRACTIONATION
|
Facility
|
IP
|
$158.14
|
|
|
Service Code
|
CPT 82139
|
| Hospital Charge Code |
30100091
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$69.58 |
| Max. Negotiated Rate |
$142.33 |
| Rate for Payer: Aetna American Axle |
$102.79
|
| Rate for Payer: Aetna Commercial |
$134.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.79
|
| Rate for Payer: Cash Price |
$126.51
|
| Rate for Payer: Cofinity Commercial |
$110.70
|
| Rate for Payer: Cofinity Commercial |
$136.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$110.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.51
|
| Rate for Payer: Healthscope Commercial |
$142.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$110.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$118.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.42
|
| Rate for Payer: PHP Commercial |
$134.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.79
|
| Rate for Payer: Priority Health SBD |
$99.63
|
| Rate for Payer: UMR Bronson Commercial |
$69.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$118.61
|
|
|
HC AMINO ACID QUANT CSF
|
Facility
|
OP
|
$234.09
|
|
|
Service Code
|
CPT 82139
|
| Hospital Charge Code |
30100093
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.04 |
| Max. Negotiated Rate |
$210.68 |
| Rate for Payer: Aetna American Axle |
$152.16
|
| Rate for Payer: Aetna Commercial |
$198.98
|
| Rate for Payer: Aetna Medicare |
$17.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.09
|
| Rate for Payer: BCBS Complete |
$9.49
|
| Rate for Payer: BCBS MAPPO |
$16.87
|
| Rate for Payer: BCN Medicare Advantage |
$16.87
|
| Rate for Payer: Cash Price |
$187.27
|
| Rate for Payer: Cash Price |
$187.27
|
| Rate for Payer: Cofinity Commercial |
$201.32
|
| Rate for Payer: Cofinity Commercial |
$163.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$163.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.87
|
| Rate for Payer: Healthscope Commercial |
$210.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$163.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$175.57
|
| Rate for Payer: Mclaren Medicaid |
$9.04
|
| Rate for Payer: Mclaren Medicare |
$16.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.71
|
| Rate for Payer: Meridian Medicaid |
$9.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$198.98
|
| Rate for Payer: PACE Medicare |
$16.03
|
| Rate for Payer: PACE SWMI |
$16.87
|
| Rate for Payer: PHP Commercial |
$198.98
|
| Rate for Payer: PHP Medicare Advantage |
$16.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.16
|
| Rate for Payer: Priority Health Medicare |
$16.87
|
| Rate for Payer: Priority Health SBD |
$147.48
|
| Rate for Payer: Railroad Medicare Medicare |
$16.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.87
|
| Rate for Payer: UHC Exchange |
$32.24
|
| Rate for Payer: UHC Medicare Advantage |
$16.87
|
| Rate for Payer: UHCCP Medicaid |
$9.04
|
| Rate for Payer: UMR Bronson Commercial |
$86.61
|
| Rate for Payer: VA VA |
$16.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$175.57
|
|
|
HC AMINO ACID QUANT CSF
|
Facility
|
IP
|
$234.09
|
|
|
Service Code
|
CPT 82139
|
| Hospital Charge Code |
30100093
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$103.00 |
| Max. Negotiated Rate |
$210.68 |
| Rate for Payer: Aetna American Axle |
$152.16
|
| Rate for Payer: Aetna Commercial |
$198.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.16
|
| Rate for Payer: Cash Price |
$187.27
|
| Rate for Payer: Cofinity Commercial |
$163.86
|
| Rate for Payer: Cofinity Commercial |
$201.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$163.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.27
|
| Rate for Payer: Healthscope Commercial |
$210.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$163.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$175.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$198.98
|
| Rate for Payer: PHP Commercial |
$198.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.16
|
| Rate for Payer: Priority Health SBD |
$147.48
|
| Rate for Payer: UMR Bronson Commercial |
$103.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$175.57
|
|
|
HC AMINO ACID QUANT RANDOM URINE
|
Facility
|
OP
|
$213.28
|
|
|
Service Code
|
CPT 82139
|
| Hospital Charge Code |
30100092
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.04 |
| Max. Negotiated Rate |
$191.95 |
| Rate for Payer: Aetna American Axle |
$138.63
|
| Rate for Payer: Aetna Commercial |
$181.29
|
| Rate for Payer: Aetna Medicare |
$17.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$138.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.09
|
| Rate for Payer: BCBS Complete |
$9.49
|
| Rate for Payer: BCBS MAPPO |
$16.87
|
| Rate for Payer: BCN Medicare Advantage |
$16.87
|
| Rate for Payer: Cash Price |
$170.62
|
| Rate for Payer: Cash Price |
$170.62
|
| Rate for Payer: Cofinity Commercial |
$183.42
|
| Rate for Payer: Cofinity Commercial |
$149.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$149.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$170.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.87
|
| Rate for Payer: Healthscope Commercial |
$191.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$149.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$159.96
|
| Rate for Payer: Mclaren Medicaid |
$9.04
|
| Rate for Payer: Mclaren Medicare |
$16.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.71
|
| Rate for Payer: Meridian Medicaid |
$9.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$181.29
|
| Rate for Payer: PACE Medicare |
$16.03
|
| Rate for Payer: PACE SWMI |
$16.87
|
| Rate for Payer: PHP Commercial |
$181.29
|
| Rate for Payer: PHP Medicare Advantage |
$16.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.63
|
| Rate for Payer: Priority Health Medicare |
$16.87
|
| Rate for Payer: Priority Health SBD |
$134.37
|
| Rate for Payer: Railroad Medicare Medicare |
$16.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.87
|
| Rate for Payer: UHC Exchange |
$32.24
|
| Rate for Payer: UHC Medicare Advantage |
$16.87
|
| Rate for Payer: UHCCP Medicaid |
$9.04
|
| Rate for Payer: UMR Bronson Commercial |
$78.91
|
| Rate for Payer: VA VA |
$16.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$159.96
|
|
|
HC AMINO ACID QUANT RANDOM URINE
|
Facility
|
IP
|
$213.28
|
|
|
Service Code
|
CPT 82139
|
| Hospital Charge Code |
30100092
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$93.84 |
| Max. Negotiated Rate |
$191.95 |
| Rate for Payer: Aetna American Axle |
$138.63
|
| Rate for Payer: Aetna Commercial |
$181.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$138.63
|
| Rate for Payer: Cash Price |
$170.62
|
| Rate for Payer: Cofinity Commercial |
$149.30
|
| Rate for Payer: Cofinity Commercial |
$183.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$149.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$170.62
|
| Rate for Payer: Healthscope Commercial |
$191.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$149.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$159.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$181.29
|
| Rate for Payer: PHP Commercial |
$181.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.63
|
| Rate for Payer: Priority Health SBD |
$134.37
|
| Rate for Payer: UMR Bronson Commercial |
$93.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$159.96
|
|
|
HC AMINOLEVULINIC ACID URINE
|
Facility
|
OP
|
$87.72
|
|
|
Service Code
|
CPT 82135
|
| Hospital Charge Code |
30100089
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.82 |
| Max. Negotiated Rate |
$78.95 |
| Rate for Payer: Aetna American Axle |
$57.02
|
| Rate for Payer: Aetna Commercial |
$74.56
|
| Rate for Payer: Aetna Medicare |
$17.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.56
|
| Rate for Payer: BCBS Complete |
$9.26
|
| Rate for Payer: BCBS MAPPO |
$16.45
|
| Rate for Payer: BCN Medicare Advantage |
$16.45
|
| Rate for Payer: Cash Price |
$70.18
|
| Rate for Payer: Cash Price |
$70.18
|
| Rate for Payer: Cofinity Commercial |
$75.44
|
| Rate for Payer: Cofinity Commercial |
$61.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$61.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.45
|
| Rate for Payer: Healthscope Commercial |
$78.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$61.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.79
|
| Rate for Payer: Mclaren Medicaid |
$8.82
|
| Rate for Payer: Mclaren Medicare |
$16.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.27
|
| Rate for Payer: Meridian Medicaid |
$9.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.56
|
| Rate for Payer: PACE Medicare |
$15.63
|
| Rate for Payer: PACE SWMI |
$16.45
|
| Rate for Payer: PHP Commercial |
$74.56
|
| Rate for Payer: PHP Medicare Advantage |
$16.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.02
|
| Rate for Payer: Priority Health Medicare |
$16.45
|
| Rate for Payer: Priority Health SBD |
$55.26
|
| Rate for Payer: Railroad Medicare Medicare |
$16.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.45
|
| Rate for Payer: UHC Exchange |
$31.44
|
| Rate for Payer: UHC Medicare Advantage |
$16.45
|
| Rate for Payer: UHCCP Medicaid |
$8.82
|
| Rate for Payer: UMR Bronson Commercial |
$32.46
|
| Rate for Payer: VA VA |
$16.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.79
|
|
|
HC AMINOLEVULINIC ACID URINE
|
Facility
|
IP
|
$87.72
|
|
|
Service Code
|
CPT 82135
|
| Hospital Charge Code |
30100089
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.60 |
| Max. Negotiated Rate |
$78.95 |
| Rate for Payer: Aetna American Axle |
$57.02
|
| Rate for Payer: Aetna Commercial |
$74.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.02
|
| Rate for Payer: Cash Price |
$70.18
|
| Rate for Payer: Cofinity Commercial |
$61.40
|
| Rate for Payer: Cofinity Commercial |
$75.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$61.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.18
|
| Rate for Payer: Healthscope Commercial |
$78.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$61.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.56
|
| Rate for Payer: PHP Commercial |
$74.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.02
|
| Rate for Payer: Priority Health SBD |
$55.26
|
| Rate for Payer: UMR Bronson Commercial |
$38.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.79
|
|
