|
HC HELICOBACTER PYLORI IGG
|
Facility
|
IP
|
$107.60
|
|
|
Service Code
|
CPT 86677
|
| Hospital Charge Code |
30200271
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$47.34 |
| Max. Negotiated Rate |
$96.84 |
| Rate for Payer: Aetna American Axle |
$69.94
|
| Rate for Payer: Aetna Commercial |
$91.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.94
|
| Rate for Payer: Cash Price |
$86.08
|
| Rate for Payer: Cofinity Commercial |
$75.32
|
| Rate for Payer: Cofinity Commercial |
$92.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.08
|
| Rate for Payer: Healthscope Commercial |
$96.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$75.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$91.46
|
| Rate for Payer: PHP Commercial |
$91.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.32
|
| Rate for Payer: Priority Health SBD |
$67.79
|
| Rate for Payer: UMR Bronson Commercial |
$47.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.70
|
|
|
HC HELICO PYL BREATH TST NON RADIOACTIVE ISOTOPE
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
CPT 83013
|
| Hospital Charge Code |
30600223
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$67.32 |
| Max. Negotiated Rate |
$137.70 |
| Rate for Payer: Aetna American Axle |
$99.45
|
| Rate for Payer: Aetna Commercial |
$130.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.45
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cofinity Commercial |
$107.10
|
| Rate for Payer: Cofinity Commercial |
$131.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.40
|
| Rate for Payer: Healthscope Commercial |
$137.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$107.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$130.05
|
| Rate for Payer: PHP Commercial |
$130.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.10
|
| Rate for Payer: Priority Health SBD |
$96.39
|
| Rate for Payer: UMR Bronson Commercial |
$67.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.75
|
|
|
HC HELICO PYL BREATH TST NON RADIOACTIVE ISOTOPE
|
Facility
|
OP
|
$153.00
|
|
|
Service Code
|
CPT 83013
|
| Hospital Charge Code |
30600223
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$36.85 |
| Max. Negotiated Rate |
$137.70 |
| Rate for Payer: Aetna American Axle |
$99.45
|
| Rate for Payer: Aetna Commercial |
$130.05
|
| Rate for Payer: Aetna Medicare |
$70.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$84.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$84.20
|
| Rate for Payer: BCBS Complete |
$38.69
|
| Rate for Payer: BCBS MAPPO |
$67.36
|
| Rate for Payer: BCBS Trust/PPO |
$60.58
|
| Rate for Payer: BCN Medicare Advantage |
$67.36
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cofinity Commercial |
$131.58
|
| Rate for Payer: Cofinity Commercial |
$107.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$67.36
|
| Rate for Payer: Healthscope Commercial |
$137.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$107.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.75
|
| Rate for Payer: Mclaren Medicaid |
$36.85
|
| Rate for Payer: Mclaren Medicare |
$67.36
|
| Rate for Payer: Meridian Medicaid |
$38.69
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$70.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$77.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$130.05
|
| Rate for Payer: PACE Medicare |
$63.99
|
| Rate for Payer: PACE SWMI |
$67.36
|
| Rate for Payer: PHP Commercial |
$130.05
|
| Rate for Payer: PHP Medicare Advantage |
$67.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$36.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$92.40
|
| Rate for Payer: Priority Health Medicare |
$67.36
|
| Rate for Payer: Priority Health Narrow Network |
$73.92
|
| Rate for Payer: Priority Health SBD |
$96.39
|
| Rate for Payer: Railroad Medicare Medicare |
$67.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.83
|
| Rate for Payer: UHC Core |
$111.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$67.36
|
| Rate for Payer: UHC Exchange |
$67.36
|
| Rate for Payer: UHC Medicare Advantage |
$69.38
|
| Rate for Payer: UMR Bronson Commercial |
$56.61
|
| Rate for Payer: VA VA |
$67.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.75
|
|
|
HC HELMINTHO SETOMELANO IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200088
|
|
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 |
$17.42
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| 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 HELMINTHO SETOMELANO IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200088
|
|
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 |
$21.41
|
| Rate for Payer: Cofinity Commercial |
$17.42
|
| 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 HEMATOCRIT
|
Facility
|
IP
|
$23.40
|
|
|
Service Code
|
CPT 85014
|
| Hospital Charge Code |
30500005
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$10.30 |
| Max. Negotiated Rate |
$21.06 |
| Rate for Payer: Aetna American Axle |
$15.21
|
| Rate for Payer: Aetna Commercial |
$19.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.21
|
| Rate for Payer: Cash Price |
$18.72
|
| Rate for Payer: Cofinity Commercial |
$20.12
|
| Rate for Payer: Cofinity Commercial |
$16.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.72
|
| Rate for Payer: Healthscope Commercial |
$21.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.89
|
| Rate for Payer: PHP Commercial |
$19.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.38
|
| Rate for Payer: Priority Health SBD |
$14.74
|
| Rate for Payer: UMR Bronson Commercial |
$10.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.55
|
|
|
HC HEMATOCRIT
|
Facility
|
OP
|
$23.40
|
|
|
Service Code
|
CPT 85014
|
| Hospital Charge Code |
30500005
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$21.06 |
| Rate for Payer: Aetna American Axle |
$15.21
|
| Rate for Payer: Aetna Commercial |
$19.89
|
| Rate for Payer: Aetna Medicare |
$2.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.96
|
| Rate for Payer: BCBS Complete |
$1.36
|
| Rate for Payer: BCBS MAPPO |
$2.37
|
| Rate for Payer: BCBS Trust/PPO |
$2.13
|
| Rate for Payer: BCN Medicare Advantage |
$2.37
|
| Rate for Payer: Cash Price |
$18.72
|
| Rate for Payer: Cash Price |
$18.72
|
| Rate for Payer: Cofinity Commercial |
$16.38
|
| Rate for Payer: Cofinity Commercial |
$20.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.37
|
| Rate for Payer: Healthscope Commercial |
$21.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.55
|
| Rate for Payer: Mclaren Medicaid |
$1.30
|
| Rate for Payer: Mclaren Medicare |
$2.37
|
| Rate for Payer: Meridian Medicaid |
$1.36
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.89
|
| Rate for Payer: PACE Medicare |
$2.25
|
| Rate for Payer: PACE SWMI |
$2.37
|
| Rate for Payer: PHP Commercial |
$19.89
|
| Rate for Payer: PHP Medicare Advantage |
$2.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.25
|
| Rate for Payer: Priority Health Medicare |
$2.37
|
| Rate for Payer: Priority Health Narrow Network |
$2.60
|
| Rate for Payer: Priority Health SBD |
$14.74
|
| Rate for Payer: Railroad Medicare Medicare |
$2.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.84
|
| Rate for Payer: UHC Core |
$3.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.37
|
| Rate for Payer: UHC Exchange |
$2.37
|
| Rate for Payer: UHC Medicare Advantage |
$2.44
|
| Rate for Payer: UMR Bronson Commercial |
$8.66
|
| Rate for Payer: VA VA |
$2.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.55
|
|
|
HC HEMOCHROMATOSIS GENE ANALYSIS
|
Facility
|
IP
|
$260.10
|
|
|
Service Code
|
CPT 81256
|
| Hospital Charge Code |
31000100
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$114.44 |
| Max. Negotiated Rate |
$234.09 |
| Rate for Payer: Aetna American Axle |
$169.06
|
| Rate for Payer: Aetna Commercial |
$221.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.06
|
| Rate for Payer: Cash Price |
$208.08
|
| Rate for Payer: Cofinity Commercial |
$223.69
|
| Rate for Payer: Cofinity Commercial |
$182.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.08
|
| Rate for Payer: Healthscope Commercial |
$234.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$182.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$195.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$221.08
|
| Rate for Payer: PHP Commercial |
$221.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.07
|
| Rate for Payer: Priority Health SBD |
$163.86
|
| Rate for Payer: UMR Bronson Commercial |
$114.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$195.08
|
|
|
HC HEMOCHROMATOSIS GENE ANALYSIS
|
Facility
|
OP
|
$260.10
|
|
|
Service Code
|
CPT 81256
|
| Hospital Charge Code |
31000100
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$35.75 |
| Max. Negotiated Rate |
$234.09 |
| Rate for Payer: Aetna American Axle |
$169.06
|
| Rate for Payer: Aetna Commercial |
$221.08
|
| Rate for Payer: Aetna Medicare |
$67.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$81.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$81.70
|
| Rate for Payer: BCBS Complete |
$37.54
|
| Rate for Payer: BCBS MAPPO |
$65.36
|
| Rate for Payer: BCBS Trust/PPO |
$58.78
|
| Rate for Payer: BCN Medicare Advantage |
$65.36
|
| Rate for Payer: Cash Price |
$208.08
|
| Rate for Payer: Cash Price |
$208.08
|
| Rate for Payer: Cofinity Commercial |
$223.69
|
| Rate for Payer: Cofinity Commercial |
$182.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$65.36
|
| Rate for Payer: Healthscope Commercial |
$234.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$182.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$195.08
|
| Rate for Payer: Mclaren Medicaid |
$35.75
|
| Rate for Payer: Mclaren Medicare |
$65.36
|
| Rate for Payer: Meridian Medicaid |
$37.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$68.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$75.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$221.08
|
| Rate for Payer: PACE Medicare |
$62.09
|
| Rate for Payer: PACE SWMI |
$65.36
|
| Rate for Payer: PHP Commercial |
$221.08
|
| Rate for Payer: PHP Medicare Advantage |
$65.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$35.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$89.66
|
| Rate for Payer: Priority Health Medicare |
$65.36
|
| Rate for Payer: Priority Health Narrow Network |
$71.73
|
| Rate for Payer: Priority Health SBD |
$163.86
|
| Rate for Payer: Railroad Medicare Medicare |
$65.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.43
|
| Rate for Payer: UHC Core |
$107.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$65.36
|
| Rate for Payer: UHC Exchange |
$65.36
|
| Rate for Payer: UHC Medicare Advantage |
$67.32
|
| Rate for Payer: UMR Bronson Commercial |
$96.24
|
| Rate for Payer: VA VA |
$65.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$195.08
|
|
|
HC HEMO CMS COMP
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
51500002
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$111.00 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Aetna American Axle |
$195.00
|
| Rate for Payer: Aetna Commercial |
$255.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$195.00
|
| Rate for Payer: BCBS Complete |
$120.00
|
| Rate for Payer: BCBS Trust/PPO |
$238.48
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cofinity Commercial |
$258.00
|
| Rate for Payer: Cofinity Commercial |
$210.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.00
|
| Rate for Payer: Healthscope Commercial |
$270.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$210.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$225.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$255.00
|
| Rate for Payer: PHP Commercial |
$255.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.00
|
| Rate for Payer: Priority Health SBD |
$189.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$154.52
|
| Rate for Payer: UHC Exchange |
$140.47
|
| Rate for Payer: UMR Bronson Commercial |
$111.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.00
|
|
|
HC HEMO CMS COMP
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
51500002
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$132.00 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Aetna American Axle |
$195.00
|
| Rate for Payer: Aetna Commercial |
$255.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$195.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cofinity Commercial |
$258.00
|
| Rate for Payer: Cofinity Commercial |
$210.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.00
|
| Rate for Payer: Healthscope Commercial |
$270.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$210.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$225.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$255.00
|
| Rate for Payer: PHP Commercial |
$255.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.00
|
| Rate for Payer: Priority Health SBD |
$189.00
|
| Rate for Payer: UMR Bronson Commercial |
$132.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.00
|
|
|
HC HEMO CMS F/U
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
51500003
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$55.00 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Aetna American Axle |
$81.25
|
| Rate for Payer: Aetna Commercial |
$106.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.25
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cofinity Commercial |
$107.50
|
| Rate for Payer: Cofinity Commercial |
$87.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.00
|
| Rate for Payer: Healthscope Commercial |
$112.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$87.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$106.25
|
| Rate for Payer: PHP Commercial |
$106.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.50
|
| Rate for Payer: Priority Health SBD |
$78.75
|
| Rate for Payer: UMR Bronson Commercial |
$55.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.75
|
|
|
HC HEMO CMS F/U
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
51500003
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$46.25 |
| Max. Negotiated Rate |
$136.73 |
| Rate for Payer: Aetna American Axle |
$81.25
|
| Rate for Payer: Aetna Commercial |
$106.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.25
|
| Rate for Payer: BCBS Complete |
$50.00
|
| Rate for Payer: BCBS Trust/PPO |
$136.73
|
| Rate for Payer: BCCCP Commercial |
$72.85
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cofinity Commercial |
$107.50
|
| Rate for Payer: Cofinity Commercial |
$87.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.00
|
| Rate for Payer: Healthscope Commercial |
$112.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$87.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$106.25
|
| Rate for Payer: PHP Commercial |
$106.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.50
|
| Rate for Payer: Priority Health SBD |
$78.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.60
|
| Rate for Payer: UHC Exchange |
$64.18
|
| Rate for Payer: UMR Bronson Commercial |
$46.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.75
|
|
|
HC HEMO CMS INITIAL COMP
|
Facility
|
OP
|
$450.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
51500001
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$140.47 |
| Max. Negotiated Rate |
$405.00 |
| Rate for Payer: Aetna American Axle |
$292.50
|
| Rate for Payer: Aetna Commercial |
$382.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$292.50
|
| Rate for Payer: BCBS Complete |
$180.00
|
| Rate for Payer: BCBS Trust/PPO |
$238.48
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cofinity Commercial |
$387.00
|
| Rate for Payer: Cofinity Commercial |
$315.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.00
|
| Rate for Payer: Healthscope Commercial |
$405.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$315.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$337.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$382.50
|
| Rate for Payer: PHP Commercial |
$382.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.00
|
| Rate for Payer: Priority Health SBD |
$283.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$154.52
|
| Rate for Payer: UHC Exchange |
$140.47
|
| Rate for Payer: UMR Bronson Commercial |
$166.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$337.50
|
|
|
HC HEMO CMS INITIAL COMP
|
Facility
|
IP
|
$450.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
51500001
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$198.00 |
| Max. Negotiated Rate |
$405.00 |
| Rate for Payer: Aetna American Axle |
$292.50
|
| Rate for Payer: Aetna Commercial |
$382.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$292.50
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cofinity Commercial |
$387.00
|
| Rate for Payer: Cofinity Commercial |
$315.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.00
|
| Rate for Payer: Healthscope Commercial |
$405.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$315.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$337.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$382.50
|
| Rate for Payer: PHP Commercial |
$382.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.00
|
| Rate for Payer: Priority Health SBD |
$283.50
|
| Rate for Payer: UMR Bronson Commercial |
$198.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$337.50
|
|
|
HC HEMO CMS SUPP/SERV
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51500004
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$8.51 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Aetna American Axle |
$48.75
|
| Rate for Payer: Aetna Commercial |
$63.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.75
|
| Rate for Payer: BCBS Complete |
$30.00
|
| Rate for Payer: BCBS Trust/PPO |
$56.49
|
| Rate for Payer: BCCCP Commercial |
$22.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cofinity Commercial |
$64.50
|
| Rate for Payer: Cofinity Commercial |
$52.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.00
|
| Rate for Payer: Healthscope Commercial |
$67.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.75
|
| Rate for Payer: PHP Commercial |
$63.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.50
|
| Rate for Payer: Priority Health SBD |
$47.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.36
|
| Rate for Payer: UHC Exchange |
$8.51
|
| Rate for Payer: UMR Bronson Commercial |
$27.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.25
|
|
|
HC HEMO CMS SUPP/SERV
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51500004
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$33.00 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Aetna American Axle |
$48.75
|
| Rate for Payer: Aetna Commercial |
$63.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.75
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cofinity Commercial |
$52.50
|
| Rate for Payer: Cofinity Commercial |
$64.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.00
|
| Rate for Payer: Healthscope Commercial |
$67.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.75
|
| Rate for Payer: PHP Commercial |
$63.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.50
|
| Rate for Payer: Priority Health SBD |
$47.25
|
| Rate for Payer: UMR Bronson Commercial |
$33.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.25
|
|
|
HC HEMOCONCENTRATOR
|
Facility
|
OP
|
$228.66
|
|
| Hospital Charge Code |
27006703
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$84.60 |
| Max. Negotiated Rate |
$205.79 |
| Rate for Payer: Aetna American Axle |
$148.63
|
| Rate for Payer: Aetna Commercial |
$194.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.63
|
| Rate for Payer: BCBS Complete |
$91.46
|
| Rate for Payer: Cash Price |
$182.93
|
| Rate for Payer: Cofinity Commercial |
$160.06
|
| Rate for Payer: Cofinity Commercial |
$196.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.93
|
| Rate for Payer: Healthscope Commercial |
$205.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$160.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$171.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$194.36
|
| Rate for Payer: PHP Commercial |
$194.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.06
|
| Rate for Payer: Priority Health SBD |
$144.06
|
| Rate for Payer: UMR Bronson Commercial |
$84.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$171.50
|
|
|
HC HEMOCONCENTRATOR
|
Facility
|
IP
|
$228.66
|
|
| Hospital Charge Code |
27006703
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$100.61 |
| Max. Negotiated Rate |
$205.79 |
| Rate for Payer: Aetna American Axle |
$148.63
|
| Rate for Payer: Aetna Commercial |
$194.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.63
|
| Rate for Payer: Cash Price |
$182.93
|
| Rate for Payer: Cofinity Commercial |
$160.06
|
| Rate for Payer: Cofinity Commercial |
$196.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.93
|
| Rate for Payer: Healthscope Commercial |
$205.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$160.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$171.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$194.36
|
| Rate for Payer: PHP Commercial |
$194.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.06
|
| Rate for Payer: Priority Health SBD |
$144.06
|
| Rate for Payer: UMR Bronson Commercial |
$100.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$171.50
|
|
|
HC HEMOCONCENTRATOR DHF
|
Facility
|
OP
|
$252.00
|
|
| Hospital Charge Code |
27000658
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$93.24 |
| Max. Negotiated Rate |
$226.80 |
| Rate for Payer: Aetna American Axle |
$163.80
|
| Rate for Payer: Aetna Commercial |
$214.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$163.80
|
| Rate for Payer: BCBS Complete |
$100.80
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cofinity Commercial |
$176.40
|
| Rate for Payer: Cofinity Commercial |
$216.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.60
|
| Rate for Payer: Healthscope Commercial |
$226.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$176.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$189.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$214.20
|
| Rate for Payer: PHP Commercial |
$214.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.40
|
| Rate for Payer: Priority Health SBD |
$158.76
|
| Rate for Payer: UMR Bronson Commercial |
$93.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$189.00
|
|
|
HC HEMOCONCENTRATOR DHF
|
Facility
|
IP
|
$252.00
|
|
| Hospital Charge Code |
27000658
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$110.88 |
| Max. Negotiated Rate |
$226.80 |
| Rate for Payer: Aetna American Axle |
$163.80
|
| Rate for Payer: Aetna Commercial |
$214.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$163.80
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cofinity Commercial |
$176.40
|
| Rate for Payer: Cofinity Commercial |
$216.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.60
|
| Rate for Payer: Healthscope Commercial |
$226.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$176.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$189.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$214.20
|
| Rate for Payer: PHP Commercial |
$214.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.40
|
| Rate for Payer: Priority Health SBD |
$158.76
|
| Rate for Payer: UMR Bronson Commercial |
$110.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$189.00
|
|
|
HC HEMOCONCENTRATOR LONG
|
Facility
|
OP
|
$210.00
|
|
| Hospital Charge Code |
27000103
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$77.70 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Aetna American Axle |
$136.50
|
| Rate for Payer: Aetna Commercial |
$178.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.50
|
| Rate for Payer: BCBS Complete |
$84.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cofinity Commercial |
$147.00
|
| Rate for Payer: Cofinity Commercial |
$180.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.00
|
| Rate for Payer: Healthscope Commercial |
$189.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$147.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$157.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$178.50
|
| Rate for Payer: PHP Commercial |
$178.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$147.00
|
| Rate for Payer: Priority Health SBD |
$132.30
|
| Rate for Payer: UMR Bronson Commercial |
$77.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$157.50
|
|
|
HC HEMOCONCENTRATOR LONG
|
Facility
|
IP
|
$210.00
|
|
| Hospital Charge Code |
27000103
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$92.40 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Aetna American Axle |
$136.50
|
| Rate for Payer: Aetna Commercial |
$178.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.50
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cofinity Commercial |
$147.00
|
| Rate for Payer: Cofinity Commercial |
$180.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.00
|
| Rate for Payer: Healthscope Commercial |
$189.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$147.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$157.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$178.50
|
| Rate for Payer: PHP Commercial |
$178.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$147.00
|
| Rate for Payer: Priority Health SBD |
$132.30
|
| Rate for Payer: UMR Bronson Commercial |
$92.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$157.50
|
|
|
HC HEMODIALYSIS NON-URGENT
|
Facility
|
OP
|
$950.00
|
|
| Hospital Charge Code |
88100003
|
|
Hospital Revenue Code
|
881
|
| Min. Negotiated Rate |
$351.50 |
| Max. Negotiated Rate |
$855.00 |
| Rate for Payer: Aetna American Axle |
$617.50
|
| Rate for Payer: Aetna Commercial |
$807.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$617.50
|
| Rate for Payer: BCBS Complete |
$380.00
|
| Rate for Payer: Cash Price |
$760.00
|
| Rate for Payer: Cofinity Commercial |
$665.00
|
| Rate for Payer: Cofinity Commercial |
$817.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$760.00
|
| Rate for Payer: Healthscope Commercial |
$855.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$665.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$712.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$807.50
|
| Rate for Payer: PHP Commercial |
$807.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$665.00
|
| Rate for Payer: Priority Health SBD |
$598.50
|
| Rate for Payer: UMR Bronson Commercial |
$351.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$712.50
|
|
|
HC HEMODIALYSIS NON-URGENT
|
Facility
|
IP
|
$950.00
|
|
| Hospital Charge Code |
88100003
|
|
Hospital Revenue Code
|
881
|
| Min. Negotiated Rate |
$418.00 |
| Max. Negotiated Rate |
$855.00 |
| Rate for Payer: Aetna American Axle |
$617.50
|
| Rate for Payer: Aetna Commercial |
$807.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$617.50
|
| Rate for Payer: Cash Price |
$760.00
|
| Rate for Payer: Cofinity Commercial |
$665.00
|
| Rate for Payer: Cofinity Commercial |
$817.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$760.00
|
| Rate for Payer: Healthscope Commercial |
$855.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$665.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$712.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$807.50
|
| Rate for Payer: PHP Commercial |
$807.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$665.00
|
| Rate for Payer: Priority Health SBD |
$598.50
|
| Rate for Payer: UMR Bronson Commercial |
$418.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$712.50
|
|
