|
HC ARBOVIRUS E EQUINE CMPT
|
Facility
|
IP
|
$26.01
|
|
|
Service Code
|
CPT 86652
|
| Hospital Charge Code |
30200389
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.44 |
| Max. Negotiated Rate |
$23.41 |
| Rate for Payer: Aetna American Axle |
$16.91
|
| Rate for Payer: Aetna Commercial |
$22.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.91
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$18.21
|
| Rate for Payer: Cofinity Commercial |
$22.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Healthscope Commercial |
$23.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: PHP Commercial |
$22.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: Priority Health SBD |
$16.39
|
| Rate for Payer: UMR Bronson Commercial |
$11.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.51
|
|
|
HC ARBOVIRUS E EQUINE CMPT
|
Facility
|
OP
|
$26.01
|
|
|
Service Code
|
CPT 86652
|
| Hospital Charge Code |
30200389
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.07 |
| Max. Negotiated Rate |
$23.41 |
| Rate for Payer: Aetna American Axle |
$16.91
|
| Rate for Payer: Aetna Commercial |
$22.11
|
| Rate for Payer: Aetna Medicare |
$13.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.49
|
| Rate for Payer: BCBS Complete |
$7.42
|
| Rate for Payer: BCBS MAPPO |
$13.19
|
| Rate for Payer: BCBS Trust/PPO |
$12.70
|
| Rate for Payer: BCN Commercial |
$12.70
|
| Rate for Payer: BCN Medicare Advantage |
$13.19
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$22.37
|
| Rate for Payer: Cofinity Commercial |
$18.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.19
|
| Rate for Payer: Healthscope Commercial |
$23.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.51
|
| Rate for Payer: Mclaren Medicaid |
$7.07
|
| Rate for Payer: Mclaren Medicare |
$13.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.85
|
| Rate for Payer: Meridian Medicaid |
$7.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: Nomi Health Commercial |
$19.78
|
| Rate for Payer: PACE Medicare |
$12.53
|
| Rate for Payer: PACE SWMI |
$13.19
|
| Rate for Payer: PHP Commercial |
$22.11
|
| Rate for Payer: PHP Medicare Advantage |
$13.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.57
|
| Rate for Payer: Priority Health Medicare |
$13.19
|
| Rate for Payer: Priority Health Narrow Network |
$10.86
|
| Rate for Payer: Priority Health SBD |
$16.39
|
| Rate for Payer: Railroad Medicare Medicare |
$13.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.19
|
| Rate for Payer: UHC Exchange |
$13.19
|
| Rate for Payer: UHC Medicare Advantage |
$13.19
|
| Rate for Payer: UHCCP Medicaid |
$7.07
|
| Rate for Payer: UMR Bronson Commercial |
$9.62
|
| Rate for Payer: VA VA |
$13.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.51
|
|
|
HC ARBOVIRUS IGG/IGM PNL, CSF
|
Facility
|
IP
|
$26.01
|
|
|
Service Code
|
CPT 86651
|
| Hospital Charge Code |
30200387
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.44 |
| Max. Negotiated Rate |
$23.41 |
| Rate for Payer: Aetna American Axle |
$16.91
|
| Rate for Payer: Aetna Commercial |
$22.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.91
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$18.21
|
| Rate for Payer: Cofinity Commercial |
$22.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Healthscope Commercial |
$23.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: PHP Commercial |
$22.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: Priority Health SBD |
$16.39
|
| Rate for Payer: UMR Bronson Commercial |
$11.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.51
|
|
|
HC ARBOVIRUS IGG/IGM PNL, CSF
|
Facility
|
OP
|
$26.01
|
|
|
Service Code
|
CPT 86651
|
| Hospital Charge Code |
30200387
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.07 |
| Max. Negotiated Rate |
$23.41 |
| Rate for Payer: Aetna American Axle |
$16.91
|
| Rate for Payer: Aetna Commercial |
$22.11
|
| Rate for Payer: Aetna Medicare |
$13.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.49
|
| Rate for Payer: BCBS Complete |
$7.42
|
| Rate for Payer: BCBS MAPPO |
$13.19
|
| Rate for Payer: BCBS Trust/PPO |
$12.70
|
| Rate for Payer: BCN Commercial |
$12.70
|
| Rate for Payer: BCN Medicare Advantage |
$13.19
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$22.37
|
| Rate for Payer: Cofinity Commercial |
$18.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.19
|
| Rate for Payer: Healthscope Commercial |
$23.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.51
|
| Rate for Payer: Mclaren Medicaid |
$7.07
|
| Rate for Payer: Mclaren Medicare |
$13.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.85
|
| Rate for Payer: Meridian Medicaid |
$7.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: Nomi Health Commercial |
$19.78
|
| Rate for Payer: PACE Medicare |
$12.53
|
| Rate for Payer: PACE SWMI |
$13.19
|
| Rate for Payer: PHP Commercial |
$22.11
|
| Rate for Payer: PHP Medicare Advantage |
$13.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.57
|
| Rate for Payer: Priority Health Medicare |
$13.19
|
| Rate for Payer: Priority Health Narrow Network |
$10.86
|
| Rate for Payer: Priority Health SBD |
$16.39
|
| Rate for Payer: Railroad Medicare Medicare |
$13.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.19
|
| Rate for Payer: UHC Exchange |
$13.19
|
| Rate for Payer: UHC Medicare Advantage |
$13.19
|
| Rate for Payer: UHCCP Medicaid |
$7.07
|
| Rate for Payer: UMR Bronson Commercial |
$9.62
|
| Rate for Payer: VA VA |
$13.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.51
|
|
|
HC ARBOVIRUS T LOUIS CMPT
|
Facility
|
OP
|
$26.01
|
|
|
Service Code
|
CPT 86653
|
| Hospital Charge Code |
30200390
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.07 |
| Max. Negotiated Rate |
$23.41 |
| Rate for Payer: Aetna American Axle |
$16.91
|
| Rate for Payer: Aetna Commercial |
$22.11
|
| Rate for Payer: Aetna Medicare |
$13.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.49
|
| Rate for Payer: BCBS Complete |
$7.42
|
| Rate for Payer: BCBS MAPPO |
$13.19
|
| Rate for Payer: BCBS Trust/PPO |
$12.70
|
| Rate for Payer: BCN Commercial |
$12.70
|
| Rate for Payer: BCN Medicare Advantage |
$13.19
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$22.37
|
| Rate for Payer: Cofinity Commercial |
$18.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.19
|
| Rate for Payer: Healthscope Commercial |
$23.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.51
|
| Rate for Payer: Mclaren Medicaid |
$7.07
|
| Rate for Payer: Mclaren Medicare |
$13.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.85
|
| Rate for Payer: Meridian Medicaid |
$7.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: Nomi Health Commercial |
$19.78
|
| Rate for Payer: PACE Medicare |
$12.53
|
| Rate for Payer: PACE SWMI |
$13.19
|
| Rate for Payer: PHP Commercial |
$22.11
|
| Rate for Payer: PHP Medicare Advantage |
$13.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.57
|
| Rate for Payer: Priority Health Medicare |
$13.19
|
| Rate for Payer: Priority Health Narrow Network |
$10.86
|
| Rate for Payer: Priority Health SBD |
$16.39
|
| Rate for Payer: Railroad Medicare Medicare |
$13.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.19
|
| Rate for Payer: UHC Exchange |
$13.19
|
| Rate for Payer: UHC Medicare Advantage |
$13.19
|
| Rate for Payer: UHCCP Medicaid |
$7.07
|
| Rate for Payer: UMR Bronson Commercial |
$9.62
|
| Rate for Payer: VA VA |
$13.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.51
|
|
|
HC ARBOVIRUS T LOUIS CMPT
|
Facility
|
IP
|
$26.01
|
|
|
Service Code
|
CPT 86653
|
| Hospital Charge Code |
30200390
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.44 |
| Max. Negotiated Rate |
$23.41 |
| Rate for Payer: Aetna American Axle |
$16.91
|
| Rate for Payer: Aetna Commercial |
$22.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.91
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$18.21
|
| Rate for Payer: Cofinity Commercial |
$22.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Healthscope Commercial |
$23.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: PHP Commercial |
$22.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: Priority Health SBD |
$16.39
|
| Rate for Payer: UMR Bronson Commercial |
$11.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.51
|
|
|
HC ARBOVIRUS W EQUINE CMPT
|
Facility
|
IP
|
$26.01
|
|
|
Service Code
|
CPT 86654
|
| Hospital Charge Code |
30200391
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.44 |
| Max. Negotiated Rate |
$23.41 |
| Rate for Payer: Aetna American Axle |
$16.91
|
| Rate for Payer: Aetna Commercial |
$22.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.91
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$18.21
|
| Rate for Payer: Cofinity Commercial |
$22.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Healthscope Commercial |
$23.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: PHP Commercial |
$22.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: Priority Health SBD |
$16.39
|
| Rate for Payer: UMR Bronson Commercial |
$11.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.51
|
|
|
HC ARBOVIRUS W EQUINE CMPT
|
Facility
|
OP
|
$26.01
|
|
|
Service Code
|
CPT 86654
|
| Hospital Charge Code |
30200391
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.07 |
| Max. Negotiated Rate |
$23.41 |
| Rate for Payer: Aetna American Axle |
$16.91
|
| Rate for Payer: Aetna Commercial |
$22.11
|
| Rate for Payer: Aetna Medicare |
$13.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.49
|
| Rate for Payer: BCBS Complete |
$7.42
|
| Rate for Payer: BCBS MAPPO |
$13.19
|
| Rate for Payer: BCBS Trust/PPO |
$12.70
|
| Rate for Payer: BCN Commercial |
$12.70
|
| Rate for Payer: BCN Medicare Advantage |
$13.19
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$22.37
|
| Rate for Payer: Cofinity Commercial |
$18.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.19
|
| Rate for Payer: Healthscope Commercial |
$23.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.51
|
| Rate for Payer: Mclaren Medicaid |
$7.07
|
| Rate for Payer: Mclaren Medicare |
$13.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.85
|
| Rate for Payer: Meridian Medicaid |
$7.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: Nomi Health Commercial |
$19.78
|
| Rate for Payer: PACE Medicare |
$12.53
|
| Rate for Payer: PACE SWMI |
$13.19
|
| Rate for Payer: PHP Commercial |
$22.11
|
| Rate for Payer: PHP Medicare Advantage |
$13.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.57
|
| Rate for Payer: Priority Health Medicare |
$13.19
|
| Rate for Payer: Priority Health Narrow Network |
$10.86
|
| Rate for Payer: Priority Health SBD |
$16.39
|
| Rate for Payer: Railroad Medicare Medicare |
$13.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.19
|
| Rate for Payer: UHC Exchange |
$13.19
|
| Rate for Payer: UHC Medicare Advantage |
$13.19
|
| Rate for Payer: UHCCP Medicaid |
$7.07
|
| Rate for Payer: UMR Bronson Commercial |
$9.62
|
| Rate for Payer: VA VA |
$13.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.51
|
|
|
HC ARCTIC SUN TORSO/LEG PADS
|
Facility
|
IP
|
$2,580.84
|
|
| Hospital Charge Code |
27000610
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,135.57 |
| Max. Negotiated Rate |
$2,322.76 |
| Rate for Payer: Aetna American Axle |
$1,677.55
|
| Rate for Payer: Aetna Commercial |
$2,193.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,677.55
|
| Rate for Payer: Cash Price |
$2,064.67
|
| Rate for Payer: Cofinity Commercial |
$1,806.59
|
| Rate for Payer: Cofinity Commercial |
$2,219.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,806.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,064.67
|
| Rate for Payer: Healthscope Commercial |
$2,322.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,806.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,935.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,193.71
|
| Rate for Payer: PHP Commercial |
$2,193.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,677.55
|
| Rate for Payer: Priority Health SBD |
$1,625.93
|
| Rate for Payer: UMR Bronson Commercial |
$1,135.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,935.63
|
|
|
HC ARCTIC SUN TORSO/LEG PADS
|
Facility
|
OP
|
$2,580.84
|
|
| Hospital Charge Code |
27000610
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$954.91 |
| Max. Negotiated Rate |
$2,322.76 |
| Rate for Payer: Aetna American Axle |
$1,677.55
|
| Rate for Payer: Aetna Commercial |
$2,193.71
|
| Rate for Payer: Aetna Medicare |
$1,290.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,677.55
|
| Rate for Payer: BCBS Complete |
$1,032.34
|
| Rate for Payer: Cash Price |
$2,064.67
|
| Rate for Payer: Cofinity Commercial |
$1,806.59
|
| Rate for Payer: Cofinity Commercial |
$2,219.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,806.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,064.67
|
| Rate for Payer: Healthscope Commercial |
$2,322.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,806.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,935.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,193.71
|
| Rate for Payer: PHP Commercial |
$2,193.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,677.55
|
| Rate for Payer: Priority Health SBD |
$1,625.93
|
| Rate for Payer: UMR Bronson Commercial |
$954.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,935.63
|
|
|
HC ARCTIC SUN UNIVERSAL PAD
|
Facility
|
OP
|
$1,118.37
|
|
| Hospital Charge Code |
27000617
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$413.80 |
| Max. Negotiated Rate |
$1,006.53 |
| Rate for Payer: Aetna American Axle |
$726.94
|
| Rate for Payer: Aetna Commercial |
$950.61
|
| Rate for Payer: Aetna Medicare |
$559.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$726.94
|
| Rate for Payer: BCBS Complete |
$447.35
|
| Rate for Payer: Cash Price |
$894.70
|
| Rate for Payer: Cofinity Commercial |
$782.86
|
| Rate for Payer: Cofinity Commercial |
$961.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$782.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$894.70
|
| Rate for Payer: Healthscope Commercial |
$1,006.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$782.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$838.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$950.61
|
| Rate for Payer: PHP Commercial |
$950.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$726.94
|
| Rate for Payer: Priority Health SBD |
$704.57
|
| Rate for Payer: UMR Bronson Commercial |
$413.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$838.78
|
|
|
HC ARCTIC SUN UNIVERSAL PAD
|
Facility
|
IP
|
$1,118.37
|
|
| Hospital Charge Code |
27000617
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$492.08 |
| Max. Negotiated Rate |
$1,006.53 |
| Rate for Payer: Aetna American Axle |
$726.94
|
| Rate for Payer: Aetna Commercial |
$950.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$726.94
|
| Rate for Payer: Cash Price |
$894.70
|
| Rate for Payer: Cofinity Commercial |
$782.86
|
| Rate for Payer: Cofinity Commercial |
$961.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$782.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$894.70
|
| Rate for Payer: Healthscope Commercial |
$1,006.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$782.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$838.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$950.61
|
| Rate for Payer: PHP Commercial |
$950.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$726.94
|
| Rate for Payer: Priority Health SBD |
$704.57
|
| Rate for Payer: UMR Bronson Commercial |
$492.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$838.78
|
|
|
HC ARGON PLASMA COAGULATION
|
Facility
|
OP
|
$1,860.09
|
|
| Hospital Charge Code |
36000007
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$688.23 |
| Max. Negotiated Rate |
$1,674.08 |
| Rate for Payer: Aetna American Axle |
$1,209.06
|
| Rate for Payer: Aetna Commercial |
$1,581.08
|
| Rate for Payer: Aetna Medicare |
$930.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,209.06
|
| Rate for Payer: BCBS Complete |
$744.04
|
| Rate for Payer: Cash Price |
$1,488.07
|
| Rate for Payer: Cofinity Commercial |
$1,302.06
|
| Rate for Payer: Cofinity Commercial |
$1,599.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,302.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,488.07
|
| Rate for Payer: Healthscope Commercial |
$1,674.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,302.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,395.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,581.08
|
| Rate for Payer: PHP Commercial |
$1,581.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,209.06
|
| Rate for Payer: Priority Health SBD |
$1,171.86
|
| Rate for Payer: UMR Bronson Commercial |
$688.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,395.07
|
|
|
HC ARGON PLASMA COAGULATION
|
Facility
|
IP
|
$1,860.09
|
|
| Hospital Charge Code |
36000007
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$818.44 |
| Max. Negotiated Rate |
$1,674.08 |
| Rate for Payer: Aetna American Axle |
$1,209.06
|
| Rate for Payer: Aetna Commercial |
$1,581.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,209.06
|
| Rate for Payer: Cash Price |
$1,488.07
|
| Rate for Payer: Cofinity Commercial |
$1,302.06
|
| Rate for Payer: Cofinity Commercial |
$1,599.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,302.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,488.07
|
| Rate for Payer: Healthscope Commercial |
$1,674.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,302.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,395.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,581.08
|
| Rate for Payer: PHP Commercial |
$1,581.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,209.06
|
| Rate for Payer: Priority Health SBD |
$1,171.86
|
| Rate for Payer: UMR Bronson Commercial |
$818.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,395.07
|
|
|
HC ARISTA HEMOSTAT
|
Facility
|
IP
|
$1,141.67
|
|
| Hospital Charge Code |
27200111
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$502.33 |
| Max. Negotiated Rate |
$1,027.50 |
| Rate for Payer: Aetna American Axle |
$742.09
|
| Rate for Payer: Aetna Commercial |
$970.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$742.09
|
| Rate for Payer: Cash Price |
$913.34
|
| Rate for Payer: Cofinity Commercial |
$799.17
|
| Rate for Payer: Cofinity Commercial |
$981.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$799.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$913.34
|
| Rate for Payer: Healthscope Commercial |
$1,027.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$799.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$856.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$970.42
|
| Rate for Payer: PHP Commercial |
$970.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$742.09
|
| Rate for Payer: Priority Health SBD |
$719.25
|
| Rate for Payer: UMR Bronson Commercial |
$502.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$856.25
|
|
|
HC ARISTA HEMOSTAT
|
Facility
|
OP
|
$1,141.67
|
|
| Hospital Charge Code |
27200111
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$422.42 |
| Max. Negotiated Rate |
$1,027.50 |
| Rate for Payer: Aetna American Axle |
$742.09
|
| Rate for Payer: Aetna Commercial |
$970.42
|
| Rate for Payer: Aetna Medicare |
$570.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$742.09
|
| Rate for Payer: BCBS Complete |
$456.67
|
| Rate for Payer: Cash Price |
$913.34
|
| Rate for Payer: Cofinity Commercial |
$799.17
|
| Rate for Payer: Cofinity Commercial |
$981.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$799.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$913.34
|
| Rate for Payer: Healthscope Commercial |
$1,027.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$799.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$856.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$970.42
|
| Rate for Payer: PHP Commercial |
$970.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$742.09
|
| Rate for Payer: Priority Health SBD |
$719.25
|
| Rate for Payer: UMR Bronson Commercial |
$422.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$856.25
|
|
|
HC ARRAY COMPARATIVE GENOMIC ACGH
|
Facility
|
OP
|
$1,597.01
|
|
|
Service Code
|
CPT 81228
|
| Hospital Charge Code |
31000094
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$182.78 |
| Max. Negotiated Rate |
$2,700.00 |
| Rate for Payer: Aetna American Axle |
$1,038.06
|
| Rate for Payer: Aetna Commercial |
$1,357.46
|
| Rate for Payer: Aetna Medicare |
$936.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,038.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,125.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,125.00
|
| Rate for Payer: BCBS Complete |
$506.52
|
| Rate for Payer: BCBS MAPPO |
$900.00
|
| Rate for Payer: BCBS Trust/PPO |
$629.16
|
| Rate for Payer: BCN Commercial |
$629.16
|
| Rate for Payer: BCN Medicare Advantage |
$900.00
|
| Rate for Payer: Cash Price |
$1,277.61
|
| Rate for Payer: Cash Price |
$1,277.61
|
| Rate for Payer: Cofinity Commercial |
$1,373.43
|
| Rate for Payer: Cofinity Commercial |
$1,117.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,117.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,277.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$900.00
|
| Rate for Payer: Healthscope Commercial |
$1,437.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,117.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,197.76
|
| Rate for Payer: Mclaren Medicaid |
$482.40
|
| Rate for Payer: Mclaren Medicare |
$900.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$945.00
|
| Rate for Payer: Meridian Medicaid |
$506.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,035.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,357.46
|
| Rate for Payer: Nomi Health Commercial |
$2,700.00
|
| Rate for Payer: PACE Medicare |
$855.00
|
| Rate for Payer: PACE SWMI |
$900.00
|
| Rate for Payer: PHP Commercial |
$1,357.46
|
| Rate for Payer: PHP Medicare Advantage |
$900.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$482.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,038.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$900.00
|
| Rate for Payer: Priority Health Medicare |
$900.00
|
| Rate for Payer: Priority Health Narrow Network |
$720.00
|
| Rate for Payer: Priority Health SBD |
$1,006.12
|
| Rate for Payer: Railroad Medicare Medicare |
$900.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,080.00
|
| Rate for Payer: UHC Core |
$182.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$900.00
|
| Rate for Payer: UHC Exchange |
$900.00
|
| Rate for Payer: UHC Medicare Advantage |
$900.00
|
| Rate for Payer: UHCCP Medicaid |
$482.40
|
| Rate for Payer: UMR Bronson Commercial |
$590.89
|
| Rate for Payer: VA VA |
$900.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,197.76
|
|
|
HC ARRAY COMPARATIVE GENOMIC ACGH
|
Facility
|
IP
|
$1,597.01
|
|
|
Service Code
|
CPT 81228
|
| Hospital Charge Code |
31000094
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$702.68 |
| Max. Negotiated Rate |
$1,437.31 |
| Rate for Payer: Aetna American Axle |
$1,038.06
|
| Rate for Payer: Aetna Commercial |
$1,357.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,038.06
|
| Rate for Payer: Cash Price |
$1,277.61
|
| Rate for Payer: Cofinity Commercial |
$1,117.91
|
| Rate for Payer: Cofinity Commercial |
$1,373.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,117.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,277.61
|
| Rate for Payer: Healthscope Commercial |
$1,437.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,117.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,197.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,357.46
|
| Rate for Payer: PHP Commercial |
$1,357.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,038.06
|
| Rate for Payer: Priority Health SBD |
$1,006.12
|
| Rate for Payer: UMR Bronson Commercial |
$702.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,197.76
|
|
|
HC ARRAY COMPARATIVE GENOMIC CMPT
|
Facility
|
OP
|
$1,412.70
|
|
|
Service Code
|
CPT 88399
|
| Hospital Charge Code |
31000061
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$11.43 |
| Max. Negotiated Rate |
$1,271.43 |
| Rate for Payer: Aetna American Axle |
$918.26
|
| Rate for Payer: Aetna Commercial |
$1,200.80
|
| Rate for Payer: Aetna Medicare |
$54.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$918.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$65.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$65.44
|
| Rate for Payer: BCBS Complete |
$29.46
|
| Rate for Payer: BCBS MAPPO |
$52.35
|
| Rate for Payer: BCBS Trust/PPO |
$11.43
|
| Rate for Payer: BCN Commercial |
$11.43
|
| Rate for Payer: BCN Medicare Advantage |
$52.35
|
| Rate for Payer: Cash Price |
$1,130.16
|
| Rate for Payer: Cash Price |
$1,130.16
|
| Rate for Payer: Cofinity Commercial |
$988.89
|
| Rate for Payer: Cofinity Commercial |
$1,214.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$988.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,130.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$52.35
|
| Rate for Payer: Healthscope Commercial |
$1,271.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$988.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,059.52
|
| Rate for Payer: Mclaren Medicaid |
$28.06
|
| Rate for Payer: Mclaren Medicare |
$52.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$54.97
|
| Rate for Payer: Meridian Medicaid |
$29.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$60.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,200.80
|
| Rate for Payer: Nomi Health Commercial |
$157.05
|
| Rate for Payer: PACE Medicare |
$49.73
|
| Rate for Payer: PACE SWMI |
$52.35
|
| Rate for Payer: PHP Commercial |
$1,200.80
|
| Rate for Payer: PHP Medicare Advantage |
$52.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$28.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$918.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$164.53
|
| Rate for Payer: Priority Health Medicare |
$52.35
|
| Rate for Payer: Priority Health Narrow Network |
$131.62
|
| Rate for Payer: Priority Health SBD |
$890.00
|
| Rate for Payer: Railroad Medicare Medicare |
$52.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$147.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$52.35
|
| Rate for Payer: UHC Exchange |
$100.05
|
| Rate for Payer: UHC Medicare Advantage |
$52.35
|
| Rate for Payer: UHCCP Medicaid |
$28.06
|
| Rate for Payer: UMR Bronson Commercial |
$522.70
|
| Rate for Payer: VA VA |
$52.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,059.52
|
|
|
HC ARRAY COMPARATIVE GENOMIC CMPT
|
Facility
|
IP
|
$1,412.70
|
|
|
Service Code
|
CPT 88399
|
| Hospital Charge Code |
31000061
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$621.59 |
| Max. Negotiated Rate |
$1,271.43 |
| Rate for Payer: Aetna American Axle |
$918.26
|
| Rate for Payer: Aetna Commercial |
$1,200.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$918.26
|
| Rate for Payer: Cash Price |
$1,130.16
|
| Rate for Payer: Cofinity Commercial |
$1,214.92
|
| Rate for Payer: Cofinity Commercial |
$988.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$988.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,130.16
|
| Rate for Payer: Healthscope Commercial |
$1,271.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$988.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,059.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,200.80
|
| Rate for Payer: PHP Commercial |
$1,200.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$918.26
|
| Rate for Payer: Priority Health SBD |
$890.00
|
| Rate for Payer: UMR Bronson Commercial |
$621.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,059.52
|
|
|
HC ARSENIC
|
Facility
|
OP
|
$196.04
|
|
|
Service Code
|
CPT 82175
|
| Hospital Charge Code |
30100108
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.17 |
| Max. Negotiated Rate |
$1,096.80 |
| Rate for Payer: Aetna American Axle |
$127.43
|
| Rate for Payer: Aetna Commercial |
$166.63
|
| Rate for Payer: Aetna Medicare |
$19.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.71
|
| Rate for Payer: BCBS Complete |
$10.68
|
| Rate for Payer: BCBS MAPPO |
$18.97
|
| Rate for Payer: BCBS Trust/PPO |
$18.28
|
| Rate for Payer: BCN Commercial |
$18.28
|
| Rate for Payer: BCN Medicare Advantage |
$18.97
|
| Rate for Payer: Cash Price |
$156.83
|
| Rate for Payer: Cash Price |
$156.83
|
| Rate for Payer: Cofinity Commercial |
$168.59
|
| Rate for Payer: Cofinity Commercial |
$137.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$137.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.97
|
| Rate for Payer: Healthscope Commercial |
$176.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$137.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$147.03
|
| Rate for Payer: Mclaren Medicaid |
$10.17
|
| Rate for Payer: Mclaren Medicare |
$18.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.92
|
| Rate for Payer: Meridian Medicaid |
$10.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$166.63
|
| Rate for Payer: Nomi Health Commercial |
$28.46
|
| Rate for Payer: PACE Medicare |
$18.02
|
| Rate for Payer: PACE SWMI |
$18.97
|
| Rate for Payer: PHP Commercial |
$166.63
|
| Rate for Payer: PHP Medicare Advantage |
$18.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.52
|
| Rate for Payer: Priority Health Medicare |
$18.97
|
| Rate for Payer: Priority Health Narrow Network |
$15.62
|
| Rate for Payer: Priority Health SBD |
$123.51
|
| Rate for Payer: Railroad Medicare Medicare |
$18.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.76
|
| Rate for Payer: UHC Core |
$1,096.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.97
|
| Rate for Payer: UHC Exchange |
$18.97
|
| Rate for Payer: UHC Medicare Advantage |
$18.97
|
| Rate for Payer: UHCCP Medicaid |
$10.17
|
| Rate for Payer: UMR Bronson Commercial |
$72.53
|
| Rate for Payer: VA VA |
$18.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$147.03
|
|
|
HC ARSENIC
|
Facility
|
IP
|
$196.04
|
|
|
Service Code
|
CPT 82175
|
| Hospital Charge Code |
30100108
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$86.26 |
| Max. Negotiated Rate |
$176.44 |
| Rate for Payer: Aetna American Axle |
$127.43
|
| Rate for Payer: Aetna Commercial |
$166.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.43
|
| Rate for Payer: Cash Price |
$156.83
|
| Rate for Payer: Cofinity Commercial |
$137.23
|
| Rate for Payer: Cofinity Commercial |
$168.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$137.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.83
|
| Rate for Payer: Healthscope Commercial |
$176.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$137.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$147.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$166.63
|
| Rate for Payer: PHP Commercial |
$166.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.43
|
| Rate for Payer: Priority Health SBD |
$123.51
|
| Rate for Payer: UMR Bronson Commercial |
$86.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$147.03
|
|
|
HC ARSENIC 24HR U
|
Facility
|
IP
|
$114.24
|
|
|
Service Code
|
CPT 82175
|
| Hospital Charge Code |
30100679
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$50.27 |
| Max. Negotiated Rate |
$102.82 |
| Rate for Payer: Aetna American Axle |
$74.26
|
| Rate for Payer: Aetna Commercial |
$97.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.26
|
| Rate for Payer: Cash Price |
$91.39
|
| Rate for Payer: Cofinity Commercial |
$79.97
|
| Rate for Payer: Cofinity Commercial |
$98.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$79.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.39
|
| Rate for Payer: Healthscope Commercial |
$102.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$79.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.10
|
| Rate for Payer: PHP Commercial |
$97.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.26
|
| Rate for Payer: Priority Health SBD |
$71.97
|
| Rate for Payer: UMR Bronson Commercial |
$50.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.68
|
|
|
HC ARSENIC 24HR U
|
Facility
|
OP
|
$114.24
|
|
|
Service Code
|
CPT 82175
|
| Hospital Charge Code |
30100679
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.17 |
| Max. Negotiated Rate |
$1,096.80 |
| Rate for Payer: Aetna American Axle |
$74.26
|
| Rate for Payer: Aetna Commercial |
$97.10
|
| Rate for Payer: Aetna Medicare |
$19.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.71
|
| Rate for Payer: BCBS Complete |
$10.68
|
| Rate for Payer: BCBS MAPPO |
$18.97
|
| Rate for Payer: BCBS Trust/PPO |
$18.28
|
| Rate for Payer: BCN Commercial |
$18.28
|
| Rate for Payer: BCN Medicare Advantage |
$18.97
|
| Rate for Payer: Cash Price |
$91.39
|
| Rate for Payer: Cash Price |
$91.39
|
| Rate for Payer: Cofinity Commercial |
$98.25
|
| Rate for Payer: Cofinity Commercial |
$79.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$79.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.97
|
| Rate for Payer: Healthscope Commercial |
$102.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$79.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.68
|
| Rate for Payer: Mclaren Medicaid |
$10.17
|
| Rate for Payer: Mclaren Medicare |
$18.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.92
|
| Rate for Payer: Meridian Medicaid |
$10.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.10
|
| Rate for Payer: Nomi Health Commercial |
$28.46
|
| Rate for Payer: PACE Medicare |
$18.02
|
| Rate for Payer: PACE SWMI |
$18.97
|
| Rate for Payer: PHP Commercial |
$97.10
|
| Rate for Payer: PHP Medicare Advantage |
$18.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.52
|
| Rate for Payer: Priority Health Medicare |
$18.97
|
| Rate for Payer: Priority Health Narrow Network |
$15.62
|
| Rate for Payer: Priority Health SBD |
$71.97
|
| Rate for Payer: Railroad Medicare Medicare |
$18.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.76
|
| Rate for Payer: UHC Core |
$1,096.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.97
|
| Rate for Payer: UHC Exchange |
$18.97
|
| Rate for Payer: UHC Medicare Advantage |
$18.97
|
| Rate for Payer: UHCCP Medicaid |
$10.17
|
| Rate for Payer: UMR Bronson Commercial |
$42.27
|
| Rate for Payer: VA VA |
$18.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.68
|
|
|
HC ARSENIC URINE
|
Facility
|
IP
|
$65.28
|
|
|
Service Code
|
CPT 82175
|
| Hospital Charge Code |
30100110
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.72 |
| Max. Negotiated Rate |
$58.75 |
| Rate for Payer: Aetna American Axle |
$42.43
|
| Rate for Payer: Aetna Commercial |
$55.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.43
|
| Rate for Payer: Cash Price |
$52.22
|
| Rate for Payer: Cofinity Commercial |
$45.70
|
| Rate for Payer: Cofinity Commercial |
$56.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$45.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.22
|
| Rate for Payer: Healthscope Commercial |
$58.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.49
|
| Rate for Payer: PHP Commercial |
$55.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.43
|
| Rate for Payer: Priority Health SBD |
$41.13
|
| Rate for Payer: UMR Bronson Commercial |
$28.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.96
|
|
