|
HC IODINE, S
|
Facility
|
OP
|
$61.20
|
|
|
Service Code
|
CPT 83789
|
| Hospital Charge Code |
30100687
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.78 |
| Max. Negotiated Rate |
$55.08 |
| Rate for Payer: Aetna American Axle |
$39.78
|
| Rate for Payer: Aetna Commercial |
$52.02
|
| Rate for Payer: Aetna Medicare |
$25.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.14
|
| Rate for Payer: BCBS Complete |
$13.85
|
| Rate for Payer: BCBS MAPPO |
$24.11
|
| Rate for Payer: BCBS Trust/PPO |
$21.68
|
| Rate for Payer: BCN Medicare Advantage |
$24.11
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cofinity Commercial |
$42.84
|
| Rate for Payer: Cofinity Commercial |
$52.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.11
|
| Rate for Payer: Healthscope Commercial |
$55.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.90
|
| Rate for Payer: Mclaren Medicaid |
$13.19
|
| Rate for Payer: Mclaren Medicare |
$24.11
|
| Rate for Payer: Meridian Medicaid |
$13.85
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$25.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.02
|
| Rate for Payer: PACE Medicare |
$22.90
|
| Rate for Payer: PACE SWMI |
$24.11
|
| Rate for Payer: PHP Commercial |
$52.02
|
| Rate for Payer: PHP Medicare Advantage |
$24.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.98
|
| Rate for Payer: Priority Health Medicare |
$24.11
|
| Rate for Payer: Priority Health Narrow Network |
$12.78
|
| Rate for Payer: Priority Health SBD |
$38.56
|
| Rate for Payer: Railroad Medicare Medicare |
$24.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.93
|
| Rate for Payer: UHC Core |
$29.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.11
|
| Rate for Payer: UHC Exchange |
$24.11
|
| Rate for Payer: UHC Medicare Advantage |
$24.83
|
| Rate for Payer: UMR Bronson Commercial |
$22.64
|
| Rate for Payer: VA VA |
$24.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.90
|
|
|
HC IOFLUPANE I-123 PER STUDY
|
Facility
|
IP
|
$5,330.03
|
|
|
Service Code
|
HCPCS A9584
|
| Hospital Charge Code |
34300035
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$2,345.21 |
| Max. Negotiated Rate |
$4,797.03 |
| Rate for Payer: Aetna American Axle |
$3,464.52
|
| Rate for Payer: Aetna Commercial |
$4,530.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,464.52
|
| Rate for Payer: Cash Price |
$4,264.02
|
| Rate for Payer: Cofinity Commercial |
$3,731.02
|
| Rate for Payer: Cofinity Commercial |
$4,583.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,264.02
|
| Rate for Payer: Healthscope Commercial |
$4,797.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,731.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,997.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,530.53
|
| Rate for Payer: PHP Commercial |
$4,530.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,731.02
|
| Rate for Payer: Priority Health SBD |
$3,357.92
|
| Rate for Payer: UMR Bronson Commercial |
$2,345.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,997.52
|
|
|
HC IOFLUPANE I-123 PER STUDY
|
Facility
|
OP
|
$5,330.03
|
|
|
Service Code
|
HCPCS A9584
|
| Hospital Charge Code |
34300035
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$1,367.55 |
| Max. Negotiated Rate |
$4,797.03 |
| Rate for Payer: Aetna American Axle |
$3,464.52
|
| Rate for Payer: Aetna Commercial |
$4,530.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,464.52
|
| Rate for Payer: BCBS Complete |
$2,132.01
|
| Rate for Payer: BCBS Trust/PPO |
$1,367.55
|
| Rate for Payer: Cash Price |
$4,264.02
|
| Rate for Payer: Cash Price |
$4,264.02
|
| Rate for Payer: Cofinity Commercial |
$3,731.02
|
| Rate for Payer: Cofinity Commercial |
$4,583.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,264.02
|
| Rate for Payer: Healthscope Commercial |
$4,797.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,731.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,997.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,530.53
|
| Rate for Payer: PHP Commercial |
$4,530.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,731.02
|
| Rate for Payer: Priority Health SBD |
$3,357.92
|
| Rate for Payer: UMR Bronson Commercial |
$1,972.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,997.52
|
|
|
HC IOM EEG CAROTID ENDARTERECTOMY
|
Facility
|
OP
|
$1,272.44
|
|
|
Service Code
|
CPT 95955
|
| Hospital Charge Code |
74000014
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$186.97 |
| Max. Negotiated Rate |
$1,633.00 |
| Rate for Payer: Aetna American Axle |
$827.09
|
| Rate for Payer: Aetna Commercial |
$1,081.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$827.09
|
| Rate for Payer: BCBS Complete |
$508.98
|
| Rate for Payer: BCBS Trust/PPO |
$703.77
|
| Rate for Payer: Cash Price |
$1,017.95
|
| Rate for Payer: Cash Price |
$1,017.95
|
| Rate for Payer: Cash Price |
$1,017.95
|
| Rate for Payer: Cofinity Commercial |
$1,094.30
|
| Rate for Payer: Cofinity Commercial |
$890.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,017.95
|
| Rate for Payer: Healthscope Commercial |
$1,145.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$890.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$954.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,081.57
|
| Rate for Payer: PHP Commercial |
$1,081.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$890.71
|
| Rate for Payer: Priority Health SBD |
$801.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$205.67
|
| Rate for Payer: UHC Core |
$1,633.00
|
| Rate for Payer: UHC Exchange |
$186.97
|
| Rate for Payer: UMR Bronson Commercial |
$470.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$954.33
|
|
|
HC IOM EEG CAROTID ENDARTERECTOMY
|
Facility
|
IP
|
$1,272.44
|
|
|
Service Code
|
CPT 95955
|
| Hospital Charge Code |
74000014
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$559.87 |
| Max. Negotiated Rate |
$1,145.20 |
| Rate for Payer: Aetna American Axle |
$827.09
|
| Rate for Payer: Aetna Commercial |
$1,081.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$827.09
|
| Rate for Payer: Cash Price |
$1,017.95
|
| Rate for Payer: Cofinity Commercial |
$1,094.30
|
| Rate for Payer: Cofinity Commercial |
$890.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,017.95
|
| Rate for Payer: Healthscope Commercial |
$1,145.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$890.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$954.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,081.57
|
| Rate for Payer: PHP Commercial |
$1,081.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$890.71
|
| Rate for Payer: Priority Health SBD |
$801.64
|
| Rate for Payer: UMR Bronson Commercial |
$559.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$954.33
|
|
|
HC IOM INTRAOPERATIVE MONITOR/15 MINUTES
|
Facility
|
IP
|
$183.40
|
|
|
Service Code
|
CPT 95940
|
| Hospital Charge Code |
74000017
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$80.70 |
| Max. Negotiated Rate |
$165.06 |
| Rate for Payer: Aetna American Axle |
$119.21
|
| Rate for Payer: Aetna Commercial |
$155.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$119.21
|
| Rate for Payer: Cash Price |
$146.72
|
| Rate for Payer: Cofinity Commercial |
$128.38
|
| Rate for Payer: Cofinity Commercial |
$157.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.72
|
| Rate for Payer: Healthscope Commercial |
$165.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$128.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$137.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$155.89
|
| Rate for Payer: PHP Commercial |
$155.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.38
|
| Rate for Payer: Priority Health SBD |
$115.54
|
| Rate for Payer: UMR Bronson Commercial |
$80.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$137.55
|
|
|
HC IOM INTRAOPERATIVE MONITOR/15 MINUTES
|
Facility
|
OP
|
$183.40
|
|
|
Service Code
|
CPT 95940
|
| Hospital Charge Code |
74000017
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$31.11 |
| Max. Negotiated Rate |
$1,633.00 |
| Rate for Payer: Aetna American Axle |
$119.21
|
| Rate for Payer: Aetna Commercial |
$155.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$119.21
|
| Rate for Payer: BCBS Complete |
$73.36
|
| Rate for Payer: Cash Price |
$146.72
|
| Rate for Payer: Cash Price |
$146.72
|
| Rate for Payer: Cash Price |
$146.72
|
| Rate for Payer: Cofinity Commercial |
$128.38
|
| Rate for Payer: Cofinity Commercial |
$157.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.72
|
| Rate for Payer: Healthscope Commercial |
$165.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$128.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$137.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$155.89
|
| Rate for Payer: PHP Commercial |
$155.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.38
|
| Rate for Payer: Priority Health SBD |
$115.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.22
|
| Rate for Payer: UHC Core |
$1,633.00
|
| Rate for Payer: UHC Exchange |
$31.11
|
| Rate for Payer: UMR Bronson Commercial |
$67.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$137.55
|
|
|
HC IOM STD PRASS PROBE
|
Facility
|
IP
|
$350.37
|
|
| Hospital Charge Code |
62200008
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$154.16 |
| Max. Negotiated Rate |
$315.33 |
| Rate for Payer: Aetna American Axle |
$227.74
|
| Rate for Payer: Aetna Commercial |
$297.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$227.74
|
| Rate for Payer: Cash Price |
$280.30
|
| Rate for Payer: Cofinity Commercial |
$245.26
|
| Rate for Payer: Cofinity Commercial |
$301.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$280.30
|
| Rate for Payer: Healthscope Commercial |
$315.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$245.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$262.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$297.81
|
| Rate for Payer: PHP Commercial |
$297.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.26
|
| Rate for Payer: Priority Health SBD |
$220.73
|
| Rate for Payer: UMR Bronson Commercial |
$154.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$262.78
|
|
|
HC IOM STD PRASS PROBE
|
Facility
|
OP
|
$350.37
|
|
| Hospital Charge Code |
62200008
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$129.64 |
| Max. Negotiated Rate |
$315.33 |
| Rate for Payer: Aetna American Axle |
$227.74
|
| Rate for Payer: Aetna Commercial |
$297.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$227.74
|
| Rate for Payer: BCBS Complete |
$140.15
|
| Rate for Payer: Cash Price |
$280.30
|
| Rate for Payer: Cofinity Commercial |
$245.26
|
| Rate for Payer: Cofinity Commercial |
$301.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$280.30
|
| Rate for Payer: Healthscope Commercial |
$315.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$245.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$262.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$297.81
|
| Rate for Payer: PHP Commercial |
$297.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.26
|
| Rate for Payer: Priority Health SBD |
$220.73
|
| Rate for Payer: UMR Bronson Commercial |
$129.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$262.78
|
|
|
HC IOM SUBDERMAL RECORDING ELECTR
|
Facility
|
OP
|
$15.06
|
|
| Hospital Charge Code |
62200009
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.57 |
| Max. Negotiated Rate |
$13.55 |
| Rate for Payer: Aetna American Axle |
$9.79
|
| Rate for Payer: Aetna Commercial |
$12.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.79
|
| Rate for Payer: BCBS Complete |
$6.02
|
| Rate for Payer: Cash Price |
$12.05
|
| Rate for Payer: Cofinity Commercial |
$10.54
|
| Rate for Payer: Cofinity Commercial |
$12.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$13.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.80
|
| Rate for Payer: PHP Commercial |
$12.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.54
|
| Rate for Payer: Priority Health SBD |
$9.49
|
| Rate for Payer: UMR Bronson Commercial |
$5.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.30
|
|
|
HC IOM SUBDERMAL RECORDING ELECTR
|
Facility
|
IP
|
$15.06
|
|
| Hospital Charge Code |
62200009
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.63 |
| Max. Negotiated Rate |
$13.55 |
| Rate for Payer: Aetna American Axle |
$9.79
|
| Rate for Payer: Aetna Commercial |
$12.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.79
|
| Rate for Payer: Cash Price |
$12.05
|
| Rate for Payer: Cofinity Commercial |
$10.54
|
| Rate for Payer: Cofinity Commercial |
$12.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$13.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.80
|
| Rate for Payer: PHP Commercial |
$12.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.54
|
| Rate for Payer: Priority Health SBD |
$9.49
|
| Rate for Payer: UMR Bronson Commercial |
$6.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.30
|
|
|
HC IONIZED CALCIUM
|
Facility
|
OP
|
$105.40
|
|
|
Service Code
|
CPT 82330
|
| Hospital Charge Code |
30100130
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.48 |
| Max. Negotiated Rate |
$94.86 |
| Rate for Payer: Aetna American Axle |
$68.51
|
| Rate for Payer: Aetna Commercial |
$89.59
|
| Rate for Payer: Aetna Medicare |
$14.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.10
|
| Rate for Payer: BCBS Complete |
$7.86
|
| Rate for Payer: BCBS MAPPO |
$13.68
|
| Rate for Payer: BCBS Trust/PPO |
$12.30
|
| Rate for Payer: BCN Medicare Advantage |
$13.68
|
| Rate for Payer: Cash Price |
$84.32
|
| Rate for Payer: Cash Price |
$84.32
|
| Rate for Payer: Cofinity Commercial |
$73.78
|
| Rate for Payer: Cofinity Commercial |
$90.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.68
|
| Rate for Payer: Healthscope Commercial |
$94.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$73.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.05
|
| Rate for Payer: Mclaren Medicaid |
$7.48
|
| Rate for Payer: Mclaren Medicare |
$13.68
|
| Rate for Payer: Meridian Medicaid |
$7.86
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$89.59
|
| Rate for Payer: PACE Medicare |
$13.00
|
| Rate for Payer: PACE SWMI |
$13.68
|
| Rate for Payer: PHP Commercial |
$89.59
|
| Rate for Payer: PHP Medicare Advantage |
$13.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.76
|
| Rate for Payer: Priority Health Medicare |
$13.68
|
| Rate for Payer: Priority Health Narrow Network |
$15.01
|
| Rate for Payer: Priority Health SBD |
$66.40
|
| Rate for Payer: Railroad Medicare Medicare |
$13.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.42
|
| Rate for Payer: UHC Core |
$22.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.68
|
| Rate for Payer: UHC Exchange |
$13.68
|
| Rate for Payer: UHC Medicare Advantage |
$14.09
|
| Rate for Payer: UMR Bronson Commercial |
$39.00
|
| Rate for Payer: VA VA |
$13.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.05
|
|
|
HC IONIZED CALCIUM
|
Facility
|
IP
|
$105.40
|
|
|
Service Code
|
CPT 82330
|
| Hospital Charge Code |
30100130
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$46.38 |
| Max. Negotiated Rate |
$94.86 |
| Rate for Payer: Aetna American Axle |
$68.51
|
| Rate for Payer: Aetna Commercial |
$89.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.51
|
| Rate for Payer: Cash Price |
$84.32
|
| Rate for Payer: Cofinity Commercial |
$73.78
|
| Rate for Payer: Cofinity Commercial |
$90.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.32
|
| Rate for Payer: Healthscope Commercial |
$94.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$73.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$89.59
|
| Rate for Payer: PHP Commercial |
$89.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.78
|
| Rate for Payer: Priority Health SBD |
$66.40
|
| Rate for Payer: UMR Bronson Commercial |
$46.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.05
|
|
|
HC IONTOPHORESIS EACH 15 MIN
|
Facility
|
IP
|
$104.04
|
|
|
Service Code
|
CPT 97033
|
| Hospital Charge Code |
42000016
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$45.78 |
| Max. Negotiated Rate |
$93.64 |
| Rate for Payer: Aetna American Axle |
$67.63
|
| Rate for Payer: Aetna Commercial |
$88.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.63
|
| Rate for Payer: Cash Price |
$83.23
|
| Rate for Payer: Cofinity Commercial |
$72.83
|
| Rate for Payer: Cofinity Commercial |
$89.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.23
|
| Rate for Payer: Healthscope Commercial |
$93.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$72.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$88.43
|
| Rate for Payer: PHP Commercial |
$88.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.83
|
| Rate for Payer: Priority Health SBD |
$65.55
|
| Rate for Payer: UMR Bronson Commercial |
$45.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.03
|
|
|
HC IONTOPHORESIS EACH 15 MIN
|
Facility
|
OP
|
$104.04
|
|
|
Service Code
|
CPT 97033
|
| Hospital Charge Code |
42000016
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$13.84 |
| Max. Negotiated Rate |
$294.00 |
| Rate for Payer: Aetna American Axle |
$67.63
|
| Rate for Payer: Aetna Commercial |
$88.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.63
|
| Rate for Payer: BCBS Complete |
$41.62
|
| Rate for Payer: BCBS Trust/PPO |
$13.84
|
| Rate for Payer: Cash Price |
$83.23
|
| Rate for Payer: Cash Price |
$83.23
|
| Rate for Payer: Cash Price |
$83.23
|
| Rate for Payer: Cofinity Commercial |
$89.47
|
| Rate for Payer: Cofinity Commercial |
$72.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.23
|
| Rate for Payer: Healthscope Commercial |
$93.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$72.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$88.43
|
| Rate for Payer: PHP Commercial |
$88.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23.00
|
| Rate for Payer: Priority Health Narrow Network |
$18.40
|
| Rate for Payer: Priority Health SBD |
$65.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.89
|
| Rate for Payer: UHC Core |
$294.00
|
| Rate for Payer: UHC Exchange |
$18.99
|
| Rate for Payer: UMR Bronson Commercial |
$38.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.03
|
|
|
HC IP 1:1 HEMODIALYSIS
|
Facility
|
IP
|
$950.00
|
|
| Hospital Charge Code |
80100002
|
|
Hospital Revenue Code
|
801
|
| 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
|
|
|
HC IP 1:1 HEMODIALYSIS
|
Facility
|
OP
|
$950.00
|
|
| Hospital Charge Code |
80100002
|
|
Hospital Revenue Code
|
801
|
| 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 IP 2:1 HEMODIALYSIS
|
Facility
|
OP
|
$969.00
|
|
|
Service Code
|
HCPCS G0257
|
| Hospital Charge Code |
80100001
|
|
Hospital Revenue Code
|
801
|
| Min. Negotiated Rate |
$339.77 |
| Max. Negotiated Rate |
$1,955.39 |
| Rate for Payer: Aetna American Axle |
$629.85
|
| Rate for Payer: Aetna Commercial |
$823.65
|
| Rate for Payer: Aetna Medicare |
$646.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$629.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$776.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$776.44
|
| Rate for Payer: BCBS Complete |
$356.79
|
| Rate for Payer: BCBS MAPPO |
$621.15
|
| Rate for Payer: BCN Medicare Advantage |
$621.15
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cofinity Commercial |
$833.34
|
| Rate for Payer: Cofinity Commercial |
$678.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$775.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$621.15
|
| Rate for Payer: Healthscope Commercial |
$872.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$678.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$726.75
|
| Rate for Payer: Mclaren Medicaid |
$339.77
|
| Rate for Payer: Mclaren Medicare |
$621.15
|
| Rate for Payer: Meridian Medicaid |
$356.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$652.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$714.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$823.65
|
| Rate for Payer: PACE Medicare |
$590.09
|
| Rate for Payer: PACE SWMI |
$621.15
|
| Rate for Payer: PHP Commercial |
$823.65
|
| Rate for Payer: PHP Medicare Advantage |
$621.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$339.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$678.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,955.39
|
| Rate for Payer: Priority Health Medicare |
$621.15
|
| Rate for Payer: Priority Health Narrow Network |
$1,564.31
|
| Rate for Payer: Priority Health SBD |
$610.47
|
| Rate for Payer: Railroad Medicare Medicare |
$621.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$621.15
|
| Rate for Payer: UHC Medicare Advantage |
$639.78
|
| Rate for Payer: UMR Bronson Commercial |
$358.53
|
| Rate for Payer: VA VA |
$621.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$726.75
|
|
|
HC IP 2:1 HEMODIALYSIS
|
Facility
|
IP
|
$969.00
|
|
|
Service Code
|
HCPCS G0257
|
| Hospital Charge Code |
80100001
|
|
Hospital Revenue Code
|
801
|
| Min. Negotiated Rate |
$426.36 |
| Max. Negotiated Rate |
$872.10 |
| Rate for Payer: Aetna American Axle |
$629.85
|
| Rate for Payer: Aetna Commercial |
$823.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$629.85
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cofinity Commercial |
$678.30
|
| Rate for Payer: Cofinity Commercial |
$833.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$775.20
|
| Rate for Payer: Healthscope Commercial |
$872.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$678.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$726.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$823.65
|
| Rate for Payer: PHP Commercial |
$823.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$678.30
|
| Rate for Payer: Priority Health SBD |
$610.47
|
| Rate for Payer: UMR Bronson Commercial |
$426.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$726.75
|
|
|
HC IPPB/IPV TREATMENT
|
Facility
|
IP
|
$135.92
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
41000015
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$59.80 |
| Max. Negotiated Rate |
$122.33 |
| Rate for Payer: Aetna American Axle |
$88.35
|
| Rate for Payer: Aetna Commercial |
$115.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.35
|
| Rate for Payer: Cash Price |
$108.74
|
| Rate for Payer: Cofinity Commercial |
$116.89
|
| Rate for Payer: Cofinity Commercial |
$95.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.74
|
| Rate for Payer: Healthscope Commercial |
$122.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$95.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$101.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$115.53
|
| Rate for Payer: PHP Commercial |
$115.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.14
|
| Rate for Payer: Priority Health SBD |
$85.63
|
| Rate for Payer: UMR Bronson Commercial |
$59.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$101.94
|
|
|
HC IPPB/IPV TREATMENT
|
Facility
|
OP
|
$135.92
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
41000015
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$7.86 |
| Max. Negotiated Rate |
$596.84 |
| Rate for Payer: Aetna American Axle |
$88.35
|
| Rate for Payer: Aetna Commercial |
$115.53
|
| Rate for Payer: Aetna Medicare |
$197.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$236.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$236.99
|
| Rate for Payer: BCBS Complete |
$108.90
|
| Rate for Payer: BCBS MAPPO |
$189.59
|
| Rate for Payer: BCBS Trust/PPO |
$43.58
|
| Rate for Payer: BCN Medicare Advantage |
$189.59
|
| Rate for Payer: Cash Price |
$108.74
|
| Rate for Payer: Cash Price |
$108.74
|
| Rate for Payer: Cash Price |
$108.74
|
| Rate for Payer: Cofinity Commercial |
$95.14
|
| Rate for Payer: Cofinity Commercial |
$116.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$189.59
|
| Rate for Payer: Healthscope Commercial |
$122.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$95.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$101.94
|
| Rate for Payer: Mclaren Medicaid |
$103.71
|
| Rate for Payer: Mclaren Medicare |
$189.59
|
| Rate for Payer: Meridian Medicaid |
$108.90
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$199.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$218.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$115.53
|
| Rate for Payer: PACE Medicare |
$180.11
|
| Rate for Payer: PACE SWMI |
$189.59
|
| Rate for Payer: PHP Commercial |
$115.53
|
| Rate for Payer: PHP Medicare Advantage |
$189.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$596.84
|
| Rate for Payer: Priority Health Medicare |
$189.59
|
| Rate for Payer: Priority Health Narrow Network |
$477.47
|
| Rate for Payer: Priority Health SBD |
$85.63
|
| Rate for Payer: Railroad Medicare Medicare |
$189.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.65
|
| Rate for Payer: UHC Core |
$294.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$189.59
|
| Rate for Payer: UHC Exchange |
$7.86
|
| Rate for Payer: UHC Medicare Advantage |
$195.28
|
| Rate for Payer: UMR Bronson Commercial |
$50.29
|
| Rate for Payer: VA VA |
$189.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$101.94
|
|
|
HC IPRATROPIUM BROMIDE, INHALATION SOLUTION, UNIT DOSE/MILLIGRAM
|
Facility
|
IP
|
$4.08
|
|
|
Service Code
|
CPT J7644
|
| Hospital Charge Code |
63600112
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$3.67 |
| Rate for Payer: Aetna American Axle |
$2.65
|
| Rate for Payer: Aetna Commercial |
$3.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.65
|
| Rate for Payer: Cash Price |
$3.26
|
| Rate for Payer: Cofinity Commercial |
$2.86
|
| Rate for Payer: Cofinity Commercial |
$3.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.26
|
| Rate for Payer: Healthscope Commercial |
$3.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.47
|
| Rate for Payer: PHP Commercial |
$3.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.86
|
| Rate for Payer: Priority Health SBD |
$2.57
|
| Rate for Payer: UMR Bronson Commercial |
$1.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.06
|
|
|
HC IPRATROPIUM BROMIDE, INHALATION SOLUTION, UNIT DOSE/MILLIGRAM
|
Facility
|
OP
|
$4.08
|
|
|
Service Code
|
CPT J7644
|
| Hospital Charge Code |
63600112
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$3.67 |
| Rate for Payer: Aetna American Axle |
$2.65
|
| Rate for Payer: Aetna Commercial |
$3.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.65
|
| Rate for Payer: BCBS Complete |
$1.63
|
| Rate for Payer: BCBS Trust/PPO |
$0.31
|
| Rate for Payer: Cash Price |
$3.26
|
| Rate for Payer: Cash Price |
$3.26
|
| Rate for Payer: Cofinity Commercial |
$2.86
|
| Rate for Payer: Cofinity Commercial |
$3.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.26
|
| Rate for Payer: Healthscope Commercial |
$3.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.47
|
| Rate for Payer: PHP Commercial |
$3.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.32
|
| Rate for Payer: Priority Health Narrow Network |
$0.26
|
| Rate for Payer: Priority Health SBD |
$2.57
|
| Rate for Payer: UMR Bronson Commercial |
$1.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.06
|
|
|
HC IR ABSCESS DRAIN CATH PLACE
|
Facility
|
OP
|
$860.90
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
35000021
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$109.37 |
| Max. Negotiated Rate |
$1,048.00 |
| Rate for Payer: Aetna American Axle |
$559.58
|
| Rate for Payer: Aetna Commercial |
$731.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$559.58
|
| Rate for Payer: BCBS Complete |
$344.36
|
| Rate for Payer: BCBS Trust/PPO |
$110.22
|
| Rate for Payer: Cash Price |
$688.72
|
| Rate for Payer: Cash Price |
$688.72
|
| Rate for Payer: Cofinity Commercial |
$740.37
|
| Rate for Payer: Cofinity Commercial |
$602.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$688.72
|
| Rate for Payer: Healthscope Commercial |
$774.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$602.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$645.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$731.76
|
| Rate for Payer: PHP Commercial |
$731.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$602.63
|
| Rate for Payer: Priority Health SBD |
$542.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$120.31
|
| Rate for Payer: UHC Core |
$1,048.00
|
| Rate for Payer: UHC Exchange |
$109.37
|
| Rate for Payer: UMR Bronson Commercial |
$318.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$645.68
|
|
|
HC IR ABSCESS DRAIN CATH PLACE
|
Facility
|
IP
|
$860.90
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
35000021
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$378.80 |
| Max. Negotiated Rate |
$774.81 |
| Rate for Payer: Aetna American Axle |
$559.58
|
| Rate for Payer: Aetna Commercial |
$731.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$559.58
|
| Rate for Payer: Cash Price |
$688.72
|
| Rate for Payer: Cofinity Commercial |
$602.63
|
| Rate for Payer: Cofinity Commercial |
$740.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$688.72
|
| Rate for Payer: Healthscope Commercial |
$774.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$602.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$645.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$731.76
|
| Rate for Payer: PHP Commercial |
$731.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$602.63
|
| Rate for Payer: Priority Health SBD |
$542.37
|
| Rate for Payer: UMR Bronson Commercial |
$378.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$645.68
|
|
