|
HC IR VENOGRAM
|
Facility
|
OP
|
$1,100.68
|
|
|
Service Code
|
CPT 75820
|
| Hospital Charge Code |
32000203
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$105.76 |
| Max. Negotiated Rate |
$4,481.48 |
| Rate for Payer: Aetna American Axle |
$715.44
|
| Rate for Payer: Aetna Commercial |
$935.58
|
| Rate for Payer: Aetna Medicare |
$1,480.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$715.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,779.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,779.46
|
| Rate for Payer: BCBS Complete |
$817.70
|
| Rate for Payer: BCBS MAPPO |
$1,423.57
|
| Rate for Payer: BCBS Trust/PPO |
$114.66
|
| Rate for Payer: BCN Medicare Advantage |
$1,423.57
|
| Rate for Payer: Cash Price |
$880.54
|
| Rate for Payer: Cash Price |
$880.54
|
| Rate for Payer: Cofinity Commercial |
$946.58
|
| Rate for Payer: Cofinity Commercial |
$770.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$880.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,423.57
|
| Rate for Payer: Healthscope Commercial |
$990.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$770.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$825.51
|
| Rate for Payer: Mclaren Medicaid |
$778.69
|
| Rate for Payer: Mclaren Medicare |
$1,423.57
|
| Rate for Payer: Meridian Medicaid |
$817.70
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,494.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,637.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$935.58
|
| Rate for Payer: PACE Medicare |
$1,352.39
|
| Rate for Payer: PACE SWMI |
$1,423.57
|
| Rate for Payer: PHP Commercial |
$935.58
|
| Rate for Payer: PHP Medicare Advantage |
$1,423.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$778.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$770.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,481.48
|
| Rate for Payer: Priority Health Medicare |
$1,423.57
|
| Rate for Payer: Priority Health Narrow Network |
$3,585.18
|
| Rate for Payer: Priority Health SBD |
$693.43
|
| Rate for Payer: Railroad Medicare Medicare |
$1,423.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$116.34
|
| Rate for Payer: UHC Core |
$262.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,423.57
|
| Rate for Payer: UHC Exchange |
$105.76
|
| Rate for Payer: UHC Medicare Advantage |
$1,466.28
|
| Rate for Payer: UMR Bronson Commercial |
$407.25
|
| Rate for Payer: VA VA |
$1,423.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$825.51
|
|
|
HC IR VENOGRAM
|
Facility
|
IP
|
$1,100.68
|
|
|
Service Code
|
CPT 75820
|
| Hospital Charge Code |
32000203
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$484.30 |
| Max. Negotiated Rate |
$990.61 |
| Rate for Payer: Aetna American Axle |
$715.44
|
| Rate for Payer: Aetna Commercial |
$935.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$715.44
|
| Rate for Payer: Cash Price |
$880.54
|
| Rate for Payer: Cofinity Commercial |
$946.58
|
| Rate for Payer: Cofinity Commercial |
$770.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$880.54
|
| Rate for Payer: Healthscope Commercial |
$990.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$770.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$825.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$935.58
|
| Rate for Payer: PHP Commercial |
$935.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$770.48
|
| Rate for Payer: Priority Health SBD |
$693.43
|
| Rate for Payer: UMR Bronson Commercial |
$484.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$825.51
|
|
|
HC IR VENOGRAM BIL
|
Facility
|
IP
|
$1,400.83
|
|
|
Service Code
|
CPT 75822
|
| Hospital Charge Code |
32000204
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$616.37 |
| Max. Negotiated Rate |
$1,260.75 |
| Rate for Payer: Aetna American Axle |
$910.54
|
| Rate for Payer: Aetna Commercial |
$1,190.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$910.54
|
| Rate for Payer: Cash Price |
$1,120.66
|
| Rate for Payer: Cofinity Commercial |
$1,204.71
|
| Rate for Payer: Cofinity Commercial |
$980.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,120.66
|
| Rate for Payer: Healthscope Commercial |
$1,260.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$980.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,050.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,190.71
|
| Rate for Payer: PHP Commercial |
$1,190.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$980.58
|
| Rate for Payer: Priority Health SBD |
$882.52
|
| Rate for Payer: UMR Bronson Commercial |
$616.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,050.62
|
|
|
HC IR VENOGRAM BIL
|
Facility
|
OP
|
$1,400.83
|
|
|
Service Code
|
CPT 75822
|
| Hospital Charge Code |
32000204
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$124.17 |
| Max. Negotiated Rate |
$4,481.48 |
| Rate for Payer: Aetna American Axle |
$910.54
|
| Rate for Payer: Aetna Commercial |
$1,190.71
|
| Rate for Payer: Aetna Medicare |
$1,480.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$910.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,779.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,779.46
|
| Rate for Payer: BCBS Complete |
$817.70
|
| Rate for Payer: BCBS MAPPO |
$1,423.57
|
| Rate for Payer: BCBS Trust/PPO |
$124.17
|
| Rate for Payer: BCN Medicare Advantage |
$1,423.57
|
| Rate for Payer: Cash Price |
$1,120.66
|
| Rate for Payer: Cash Price |
$1,120.66
|
| Rate for Payer: Cofinity Commercial |
$1,204.71
|
| Rate for Payer: Cofinity Commercial |
$980.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,120.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,423.57
|
| Rate for Payer: Healthscope Commercial |
$1,260.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$980.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,050.62
|
| Rate for Payer: Mclaren Medicaid |
$778.69
|
| Rate for Payer: Mclaren Medicare |
$1,423.57
|
| Rate for Payer: Meridian Medicaid |
$817.70
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,494.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,637.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,190.71
|
| Rate for Payer: PACE Medicare |
$1,352.39
|
| Rate for Payer: PACE SWMI |
$1,423.57
|
| Rate for Payer: PHP Commercial |
$1,190.71
|
| Rate for Payer: PHP Medicare Advantage |
$1,423.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$778.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$980.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,481.48
|
| Rate for Payer: Priority Health Medicare |
$1,423.57
|
| Rate for Payer: Priority Health Narrow Network |
$3,585.18
|
| Rate for Payer: Priority Health SBD |
$882.52
|
| Rate for Payer: Railroad Medicare Medicare |
$1,423.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$144.08
|
| Rate for Payer: UHC Core |
$262.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,423.57
|
| Rate for Payer: UHC Exchange |
$130.98
|
| Rate for Payer: UHC Medicare Advantage |
$1,466.28
|
| Rate for Payer: UMR Bronson Commercial |
$518.31
|
| Rate for Payer: VA VA |
$1,423.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,050.62
|
|
|
HC IR VENOGRAM RENAL BILAT SELECT
|
Facility
|
IP
|
$3,727.13
|
|
|
Service Code
|
CPT 75833
|
| Hospital Charge Code |
32000207
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,639.94 |
| Max. Negotiated Rate |
$3,354.42 |
| Rate for Payer: Aetna American Axle |
$2,422.63
|
| Rate for Payer: Aetna Commercial |
$3,168.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,422.63
|
| Rate for Payer: Cash Price |
$2,981.70
|
| Rate for Payer: Cofinity Commercial |
$2,608.99
|
| Rate for Payer: Cofinity Commercial |
$3,205.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,981.70
|
| Rate for Payer: Healthscope Commercial |
$3,354.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,608.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,795.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,168.06
|
| Rate for Payer: PHP Commercial |
$3,168.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,608.99
|
| Rate for Payer: Priority Health SBD |
$2,348.09
|
| Rate for Payer: UMR Bronson Commercial |
$1,639.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,795.35
|
|
|
HC IR VENOGRAM RENAL BILAT SELECT
|
Facility
|
OP
|
$3,727.13
|
|
|
Service Code
|
CPT 75833
|
| Hospital Charge Code |
32000207
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$145.38 |
| Max. Negotiated Rate |
$8,919.33 |
| Rate for Payer: Aetna American Axle |
$2,422.63
|
| Rate for Payer: Aetna Commercial |
$3,168.06
|
| Rate for Payer: Aetna Medicare |
$2,946.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,422.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,541.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,541.61
|
| Rate for Payer: BCBS Complete |
$1,627.44
|
| Rate for Payer: BCBS MAPPO |
$2,833.29
|
| Rate for Payer: BCBS Trust/PPO |
$148.23
|
| Rate for Payer: BCN Medicare Advantage |
$2,833.29
|
| Rate for Payer: Cash Price |
$2,981.70
|
| Rate for Payer: Cash Price |
$2,981.70
|
| Rate for Payer: Cofinity Commercial |
$2,608.99
|
| Rate for Payer: Cofinity Commercial |
$3,205.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,981.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,833.29
|
| Rate for Payer: Healthscope Commercial |
$3,354.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,608.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,795.35
|
| Rate for Payer: Mclaren Medicaid |
$1,549.81
|
| Rate for Payer: Mclaren Medicare |
$2,833.29
|
| Rate for Payer: Meridian Medicaid |
$1,627.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,974.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,258.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,168.06
|
| Rate for Payer: PACE Medicare |
$2,691.63
|
| Rate for Payer: PACE SWMI |
$2,833.29
|
| Rate for Payer: PHP Commercial |
$3,168.06
|
| Rate for Payer: PHP Medicare Advantage |
$2,833.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,549.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,608.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,919.33
|
| Rate for Payer: Priority Health Medicare |
$2,833.29
|
| Rate for Payer: Priority Health Narrow Network |
$7,135.46
|
| Rate for Payer: Priority Health SBD |
$2,348.09
|
| Rate for Payer: Railroad Medicare Medicare |
$2,833.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$159.92
|
| Rate for Payer: UHC Core |
$262.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,833.29
|
| Rate for Payer: UHC Exchange |
$145.38
|
| Rate for Payer: UHC Medicare Advantage |
$2,918.29
|
| Rate for Payer: UMR Bronson Commercial |
$1,379.04
|
| Rate for Payer: VA VA |
$2,833.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,795.35
|
|
|
HC IR VENOGRAM RENAL UNI SELECT
|
Facility
|
OP
|
$3,500.17
|
|
|
Service Code
|
CPT 75831
|
| Hospital Charge Code |
32000322
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$117.22 |
| Max. Negotiated Rate |
$8,919.33 |
| Rate for Payer: Aetna American Axle |
$2,275.11
|
| Rate for Payer: Aetna Commercial |
$2,975.14
|
| Rate for Payer: Aetna Medicare |
$2,946.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,275.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,541.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,541.61
|
| Rate for Payer: BCBS Complete |
$1,627.44
|
| Rate for Payer: BCBS MAPPO |
$2,833.29
|
| Rate for Payer: BCBS Trust/PPO |
$131.13
|
| Rate for Payer: BCN Medicare Advantage |
$2,833.29
|
| Rate for Payer: Cash Price |
$2,800.14
|
| Rate for Payer: Cash Price |
$2,800.14
|
| Rate for Payer: Cofinity Commercial |
$2,450.12
|
| Rate for Payer: Cofinity Commercial |
$3,010.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,800.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,833.29
|
| Rate for Payer: Healthscope Commercial |
$3,150.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,450.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,625.13
|
| Rate for Payer: Mclaren Medicaid |
$1,549.81
|
| Rate for Payer: Mclaren Medicare |
$2,833.29
|
| Rate for Payer: Meridian Medicaid |
$1,627.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,974.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,258.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,975.14
|
| Rate for Payer: PACE Medicare |
$2,691.63
|
| Rate for Payer: PACE SWMI |
$2,833.29
|
| Rate for Payer: PHP Commercial |
$2,975.14
|
| Rate for Payer: PHP Medicare Advantage |
$2,833.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,549.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,450.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,919.33
|
| Rate for Payer: Priority Health Medicare |
$2,833.29
|
| Rate for Payer: Priority Health Narrow Network |
$7,135.46
|
| Rate for Payer: Priority Health SBD |
$2,205.11
|
| Rate for Payer: Railroad Medicare Medicare |
$2,833.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$128.94
|
| Rate for Payer: UHC Core |
$262.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,833.29
|
| Rate for Payer: UHC Exchange |
$117.22
|
| Rate for Payer: UHC Medicare Advantage |
$2,918.29
|
| Rate for Payer: UMR Bronson Commercial |
$1,295.06
|
| Rate for Payer: VA VA |
$2,833.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,625.13
|
|
|
HC IR VENOGRAM RENAL UNI SELECT
|
Facility
|
IP
|
$3,500.17
|
|
|
Service Code
|
CPT 75831
|
| Hospital Charge Code |
32000322
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,540.07 |
| Max. Negotiated Rate |
$3,150.15 |
| Rate for Payer: Aetna American Axle |
$2,275.11
|
| Rate for Payer: Aetna Commercial |
$2,975.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,275.11
|
| Rate for Payer: Cash Price |
$2,800.14
|
| Rate for Payer: Cofinity Commercial |
$2,450.12
|
| Rate for Payer: Cofinity Commercial |
$3,010.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,800.14
|
| Rate for Payer: Healthscope Commercial |
$3,150.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,450.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,625.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,975.14
|
| Rate for Payer: PHP Commercial |
$2,975.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,450.12
|
| Rate for Payer: Priority Health SBD |
$2,205.11
|
| Rate for Payer: UMR Bronson Commercial |
$1,540.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,625.13
|
|
|
HC IR Z ABSCESS PERIANAL
|
Facility
|
IP
|
$1,184.66
|
|
|
Service Code
|
CPT 46050
|
| Hospital Charge Code |
36100369
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$521.25 |
| Max. Negotiated Rate |
$1,066.19 |
| Rate for Payer: Aetna American Axle |
$770.03
|
| Rate for Payer: Aetna Commercial |
$1,006.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$770.03
|
| Rate for Payer: Cash Price |
$947.73
|
| Rate for Payer: Cofinity Commercial |
$1,018.81
|
| Rate for Payer: Cofinity Commercial |
$829.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$947.73
|
| Rate for Payer: Healthscope Commercial |
$1,066.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$829.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$888.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,006.96
|
| Rate for Payer: PHP Commercial |
$1,006.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$829.26
|
| Rate for Payer: Priority Health SBD |
$746.34
|
| Rate for Payer: UMR Bronson Commercial |
$521.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$888.50
|
|
|
HC IR Z ABSCESS PERIANAL
|
Facility
|
OP
|
$1,184.66
|
|
|
Service Code
|
CPT 46050
|
| Hospital Charge Code |
36100369
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$100.52 |
| Max. Negotiated Rate |
$2,557.47 |
| Rate for Payer: Aetna American Axle |
$770.03
|
| Rate for Payer: Aetna Commercial |
$1,006.96
|
| Rate for Payer: Aetna Medicare |
$844.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$770.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,015.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,015.50
|
| Rate for Payer: BCBS Complete |
$466.64
|
| Rate for Payer: BCBS MAPPO |
$812.40
|
| Rate for Payer: BCBS Trust/PPO |
$951.97
|
| Rate for Payer: BCN Medicare Advantage |
$812.40
|
| Rate for Payer: Cash Price |
$947.73
|
| Rate for Payer: Cash Price |
$947.73
|
| Rate for Payer: Cofinity Commercial |
$829.26
|
| Rate for Payer: Cofinity Commercial |
$1,018.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$947.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$812.40
|
| Rate for Payer: Healthscope Commercial |
$1,066.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$829.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$888.50
|
| Rate for Payer: Mclaren Medicaid |
$444.38
|
| Rate for Payer: Mclaren Medicare |
$812.40
|
| Rate for Payer: Meridian Medicaid |
$466.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$853.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$934.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,006.96
|
| Rate for Payer: PACE Medicare |
$771.78
|
| Rate for Payer: PACE SWMI |
$812.40
|
| Rate for Payer: PHP Commercial |
$1,006.96
|
| Rate for Payer: PHP Medicare Advantage |
$812.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$444.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$829.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,557.47
|
| Rate for Payer: Priority Health Medicare |
$812.40
|
| Rate for Payer: Priority Health Narrow Network |
$2,045.98
|
| Rate for Payer: Priority Health SBD |
$746.34
|
| Rate for Payer: Railroad Medicare Medicare |
$812.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$110.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$812.40
|
| Rate for Payer: UHC Exchange |
$100.52
|
| Rate for Payer: UHC Medicare Advantage |
$836.77
|
| Rate for Payer: UMR Bronson Commercial |
$438.32
|
| Rate for Payer: VA VA |
$812.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$888.50
|
|
|
HC ISCHEMIA MODIFIED ALBUMIN
|
Facility
|
OP
|
$158.20
|
|
|
Service Code
|
CPT 82045
|
| Hospital Charge Code |
30100076
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.57 |
| Max. Negotiated Rate |
$142.38 |
| Rate for Payer: Aetna American Axle |
$102.83
|
| Rate for Payer: Aetna Commercial |
$134.47
|
| Rate for Payer: Aetna Medicare |
$35.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$42.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$42.42
|
| Rate for Payer: BCBS Complete |
$19.50
|
| Rate for Payer: BCBS MAPPO |
$33.94
|
| Rate for Payer: BCN Medicare Advantage |
$33.94
|
| Rate for Payer: Cash Price |
$126.56
|
| Rate for Payer: Cash Price |
$126.56
|
| Rate for Payer: Cofinity Commercial |
$110.74
|
| Rate for Payer: Cofinity Commercial |
$136.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.94
|
| Rate for Payer: Healthscope Commercial |
$142.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$110.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$118.65
|
| Rate for Payer: Mclaren Medicaid |
$18.57
|
| Rate for Payer: Mclaren Medicare |
$33.94
|
| Rate for Payer: Meridian Medicaid |
$19.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$35.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$134.47
|
| Rate for Payer: PACE Medicare |
$32.24
|
| Rate for Payer: PACE SWMI |
$33.94
|
| Rate for Payer: PHP Commercial |
$134.47
|
| Rate for Payer: PHP Medicare Advantage |
$33.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$46.56
|
| Rate for Payer: Priority Health Medicare |
$33.94
|
| Rate for Payer: Priority Health Narrow Network |
$37.25
|
| Rate for Payer: Priority Health SBD |
$99.67
|
| Rate for Payer: Railroad Medicare Medicare |
$33.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.73
|
| Rate for Payer: UHC Core |
$55.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$33.94
|
| Rate for Payer: UHC Exchange |
$33.94
|
| Rate for Payer: UHC Medicare Advantage |
$34.96
|
| Rate for Payer: UMR Bronson Commercial |
$58.53
|
| Rate for Payer: VA VA |
$33.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$118.65
|
|
|
HC ISCHEMIA MODIFIED ALBUMIN
|
Facility
|
IP
|
$158.20
|
|
|
Service Code
|
CPT 82045
|
| Hospital Charge Code |
30100076
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$69.61 |
| Max. Negotiated Rate |
$142.38 |
| Rate for Payer: Aetna American Axle |
$102.83
|
| Rate for Payer: Aetna Commercial |
$134.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.83
|
| Rate for Payer: Cash Price |
$126.56
|
| Rate for Payer: Cofinity Commercial |
$136.05
|
| Rate for Payer: Cofinity Commercial |
$110.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.56
|
| Rate for Payer: Healthscope Commercial |
$142.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$110.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$118.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$134.47
|
| Rate for Payer: PHP Commercial |
$134.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.74
|
| Rate for Payer: Priority Health SBD |
$99.67
|
| Rate for Payer: UMR Bronson Commercial |
$69.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$118.65
|
|
|
HC ISLET ANTIGEN 2 ANTIBODY
|
Facility
|
IP
|
$54.06
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
30200412
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$23.79 |
| Max. Negotiated Rate |
$48.65 |
| Rate for Payer: Aetna American Axle |
$35.14
|
| Rate for Payer: Aetna Commercial |
$45.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.14
|
| Rate for Payer: Cash Price |
$43.25
|
| Rate for Payer: Cofinity Commercial |
$37.84
|
| Rate for Payer: Cofinity Commercial |
$46.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.25
|
| Rate for Payer: Healthscope Commercial |
$48.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.95
|
| Rate for Payer: PHP Commercial |
$45.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.84
|
| Rate for Payer: Priority Health SBD |
$34.06
|
| Rate for Payer: UMR Bronson Commercial |
$23.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.54
|
|
|
HC ISLET ANTIGEN 2 ANTIBODY
|
Facility
|
OP
|
$54.06
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
30200412
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.89 |
| Max. Negotiated Rate |
$48.65 |
| Rate for Payer: Aetna American Axle |
$35.14
|
| Rate for Payer: Aetna Commercial |
$45.95
|
| Rate for Payer: Aetna Medicare |
$24.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.46
|
| Rate for Payer: BCBS Complete |
$13.54
|
| Rate for Payer: BCBS MAPPO |
$23.57
|
| Rate for Payer: BCBS Trust/PPO |
$21.20
|
| Rate for Payer: BCN Medicare Advantage |
$23.57
|
| Rate for Payer: Cash Price |
$43.25
|
| Rate for Payer: Cash Price |
$43.25
|
| Rate for Payer: Cofinity Commercial |
$37.84
|
| Rate for Payer: Cofinity Commercial |
$46.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.57
|
| Rate for Payer: Healthscope Commercial |
$48.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.54
|
| Rate for Payer: Mclaren Medicaid |
$12.89
|
| Rate for Payer: Mclaren Medicare |
$23.57
|
| Rate for Payer: Meridian Medicaid |
$13.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$24.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.95
|
| Rate for Payer: PACE Medicare |
$22.39
|
| Rate for Payer: PACE SWMI |
$23.57
|
| Rate for Payer: PHP Commercial |
$45.95
|
| Rate for Payer: PHP Medicare Advantage |
$23.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27.14
|
| Rate for Payer: Priority Health Medicare |
$23.57
|
| Rate for Payer: Priority Health Narrow Network |
$21.71
|
| Rate for Payer: Priority Health SBD |
$34.06
|
| Rate for Payer: Railroad Medicare Medicare |
$23.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.28
|
| Rate for Payer: UHC Core |
$32.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.57
|
| Rate for Payer: UHC Exchange |
$23.57
|
| Rate for Payer: UHC Medicare Advantage |
$24.28
|
| Rate for Payer: UMR Bronson Commercial |
$20.00
|
| Rate for Payer: VA VA |
$23.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.54
|
|
|
HC ISOAGGLUTININ TITER ANTI A
|
Facility
|
IP
|
$107.10
|
|
|
Service Code
|
CPT 86886
|
| Hospital Charge Code |
30200345
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$47.12 |
| Max. Negotiated Rate |
$96.39 |
| Rate for Payer: Aetna American Axle |
$69.62
|
| Rate for Payer: Aetna Commercial |
$91.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.62
|
| Rate for Payer: Cash Price |
$85.68
|
| Rate for Payer: Cofinity Commercial |
$74.97
|
| Rate for Payer: Cofinity Commercial |
$92.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.68
|
| Rate for Payer: Healthscope Commercial |
$96.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$74.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$91.04
|
| Rate for Payer: PHP Commercial |
$91.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.97
|
| Rate for Payer: Priority Health SBD |
$67.47
|
| Rate for Payer: UMR Bronson Commercial |
$47.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.32
|
|
|
HC ISOAGGLUTININ TITER ANTI A
|
Facility
|
OP
|
$107.10
|
|
|
Service Code
|
CPT 86886
|
| Hospital Charge Code |
30200345
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.66 |
| Max. Negotiated Rate |
$477.95 |
| Rate for Payer: Aetna American Axle |
$69.62
|
| Rate for Payer: Aetna Commercial |
$91.04
|
| Rate for Payer: Aetna Medicare |
$157.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$189.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$189.78
|
| Rate for Payer: BCBS Complete |
$87.21
|
| Rate for Payer: BCBS MAPPO |
$151.82
|
| Rate for Payer: BCBS Trust/PPO |
$4.66
|
| Rate for Payer: BCN Medicare Advantage |
$151.82
|
| Rate for Payer: Cash Price |
$85.68
|
| Rate for Payer: Cash Price |
$85.68
|
| Rate for Payer: Cofinity Commercial |
$92.11
|
| Rate for Payer: Cofinity Commercial |
$74.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$151.82
|
| Rate for Payer: Healthscope Commercial |
$96.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$74.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.32
|
| Rate for Payer: Mclaren Medicaid |
$83.05
|
| Rate for Payer: Mclaren Medicare |
$151.82
|
| Rate for Payer: Meridian Medicaid |
$87.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$159.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$174.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$91.04
|
| Rate for Payer: PACE Medicare |
$144.23
|
| Rate for Payer: PACE SWMI |
$151.82
|
| Rate for Payer: PHP Commercial |
$91.04
|
| Rate for Payer: PHP Medicare Advantage |
$151.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$83.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$477.95
|
| Rate for Payer: Priority Health Medicare |
$151.82
|
| Rate for Payer: Priority Health Narrow Network |
$382.36
|
| Rate for Payer: Priority Health SBD |
$67.47
|
| Rate for Payer: Railroad Medicare Medicare |
$151.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.22
|
| Rate for Payer: UHC Core |
$8.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$151.82
|
| Rate for Payer: UHC Exchange |
$5.18
|
| Rate for Payer: UHC Medicare Advantage |
$156.37
|
| Rate for Payer: UMR Bronson Commercial |
$39.63
|
| Rate for Payer: VA VA |
$151.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.32
|
|
|
HC ISOAGGLUTININ TITER ANTI B
|
Facility
|
OP
|
$107.10
|
|
|
Service Code
|
CPT 86886
|
| Hospital Charge Code |
30200346
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.66 |
| Max. Negotiated Rate |
$477.95 |
| Rate for Payer: Aetna American Axle |
$69.62
|
| Rate for Payer: Aetna Commercial |
$91.04
|
| Rate for Payer: Aetna Medicare |
$157.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$189.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$189.78
|
| Rate for Payer: BCBS Complete |
$87.21
|
| Rate for Payer: BCBS MAPPO |
$151.82
|
| Rate for Payer: BCBS Trust/PPO |
$4.66
|
| Rate for Payer: BCN Medicare Advantage |
$151.82
|
| Rate for Payer: Cash Price |
$85.68
|
| Rate for Payer: Cash Price |
$85.68
|
| Rate for Payer: Cofinity Commercial |
$74.97
|
| Rate for Payer: Cofinity Commercial |
$92.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$151.82
|
| Rate for Payer: Healthscope Commercial |
$96.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$74.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.32
|
| Rate for Payer: Mclaren Medicaid |
$83.05
|
| Rate for Payer: Mclaren Medicare |
$151.82
|
| Rate for Payer: Meridian Medicaid |
$87.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$159.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$174.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$91.04
|
| Rate for Payer: PACE Medicare |
$144.23
|
| Rate for Payer: PACE SWMI |
$151.82
|
| Rate for Payer: PHP Commercial |
$91.04
|
| Rate for Payer: PHP Medicare Advantage |
$151.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$83.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$477.95
|
| Rate for Payer: Priority Health Medicare |
$151.82
|
| Rate for Payer: Priority Health Narrow Network |
$382.36
|
| Rate for Payer: Priority Health SBD |
$67.47
|
| Rate for Payer: Railroad Medicare Medicare |
$151.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.22
|
| Rate for Payer: UHC Core |
$8.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$151.82
|
| Rate for Payer: UHC Exchange |
$5.18
|
| Rate for Payer: UHC Medicare Advantage |
$156.37
|
| Rate for Payer: UMR Bronson Commercial |
$39.63
|
| Rate for Payer: VA VA |
$151.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.32
|
|
|
HC ISOAGGLUTININ TITER ANTI B
|
Facility
|
IP
|
$107.10
|
|
|
Service Code
|
CPT 86886
|
| Hospital Charge Code |
30200346
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$47.12 |
| Max. Negotiated Rate |
$96.39 |
| Rate for Payer: Aetna American Axle |
$69.62
|
| Rate for Payer: Aetna Commercial |
$91.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.62
|
| Rate for Payer: Cash Price |
$85.68
|
| Rate for Payer: Cofinity Commercial |
$74.97
|
| Rate for Payer: Cofinity Commercial |
$92.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.68
|
| Rate for Payer: Healthscope Commercial |
$96.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$74.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$91.04
|
| Rate for Payer: PHP Commercial |
$91.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.97
|
| Rate for Payer: Priority Health SBD |
$67.47
|
| Rate for Payer: UMR Bronson Commercial |
$47.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.32
|
|
|
HC ISOPROPANOL LVL
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
30100580
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.22 |
| Max. Negotiated Rate |
$140.40 |
| Rate for Payer: Aetna American Axle |
$101.40
|
| Rate for Payer: Aetna Commercial |
$132.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.40
|
| Rate for Payer: BCBS Complete |
$62.40
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cofinity Commercial |
$109.20
|
| Rate for Payer: Cofinity Commercial |
$134.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.80
|
| Rate for Payer: Healthscope Commercial |
$140.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$109.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$117.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$132.60
|
| Rate for Payer: PHP Commercial |
$132.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.20
|
| Rate for Payer: Priority Health SBD |
$98.28
|
| Rate for Payer: UHC Core |
$28.22
|
| Rate for Payer: UMR Bronson Commercial |
$57.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117.00
|
|
|
HC ISOPROPANOL LVL
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
30100580
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$68.64 |
| Max. Negotiated Rate |
$140.40 |
| Rate for Payer: Aetna American Axle |
$101.40
|
| Rate for Payer: Aetna Commercial |
$132.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.40
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cofinity Commercial |
$109.20
|
| Rate for Payer: Cofinity Commercial |
$134.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.80
|
| Rate for Payer: Healthscope Commercial |
$140.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$109.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$117.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$132.60
|
| Rate for Payer: PHP Commercial |
$132.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.20
|
| Rate for Payer: Priority Health SBD |
$98.28
|
| Rate for Payer: UMR Bronson Commercial |
$68.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117.00
|
|
|
HC ISOVUE 200M PER ML
|
Facility
|
IP
|
$2.35
|
|
|
Service Code
|
HCPCS Q9966
|
| Hospital Charge Code |
63600033
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$2.12 |
| Rate for Payer: Aetna American Axle |
$1.53
|
| Rate for Payer: Aetna Commercial |
$2.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.53
|
| Rate for Payer: Cash Price |
$1.88
|
| Rate for Payer: Cofinity Commercial |
$1.64
|
| Rate for Payer: Cofinity Commercial |
$2.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.88
|
| Rate for Payer: Healthscope Commercial |
$2.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.00
|
| Rate for Payer: PHP Commercial |
$2.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.64
|
| Rate for Payer: Priority Health SBD |
$1.48
|
| Rate for Payer: UMR Bronson Commercial |
$1.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.76
|
|
|
HC ISOVUE 200M PER ML
|
Facility
|
OP
|
$2.35
|
|
|
Service Code
|
HCPCS Q9966
|
| Hospital Charge Code |
63600033
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$2.12 |
| Rate for Payer: Aetna American Axle |
$1.53
|
| Rate for Payer: Aetna Commercial |
$2.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.53
|
| Rate for Payer: BCBS Complete |
$0.94
|
| Rate for Payer: BCBS Trust/PPO |
$0.44
|
| Rate for Payer: Cash Price |
$1.88
|
| Rate for Payer: Cash Price |
$1.88
|
| Rate for Payer: Cofinity Commercial |
$2.02
|
| Rate for Payer: Cofinity Commercial |
$1.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.88
|
| Rate for Payer: Healthscope Commercial |
$2.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.00
|
| Rate for Payer: PHP Commercial |
$2.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.64
|
| Rate for Payer: Priority Health SBD |
$1.48
|
| Rate for Payer: UMR Bronson Commercial |
$0.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.76
|
|
|
HC ISOVUE 200 PER ML
|
Facility
|
OP
|
$4.37
|
|
|
Service Code
|
HCPCS Q9966
|
| Hospital Charge Code |
63600011
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$3.93 |
| Rate for Payer: Aetna American Axle |
$2.84
|
| Rate for Payer: Aetna Commercial |
$3.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.84
|
| Rate for Payer: BCBS Complete |
$1.75
|
| Rate for Payer: BCBS Trust/PPO |
$0.44
|
| Rate for Payer: Cash Price |
$3.50
|
| Rate for Payer: Cash Price |
$3.50
|
| Rate for Payer: Cofinity Commercial |
$3.06
|
| Rate for Payer: Cofinity Commercial |
$3.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.50
|
| Rate for Payer: Healthscope Commercial |
$3.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.71
|
| Rate for Payer: PHP Commercial |
$3.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.06
|
| Rate for Payer: Priority Health SBD |
$2.75
|
| Rate for Payer: UMR Bronson Commercial |
$1.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.28
|
|
|
HC ISOVUE 200 PER ML
|
Facility
|
IP
|
$4.37
|
|
|
Service Code
|
HCPCS Q9966
|
| Hospital Charge Code |
63600011
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.92 |
| Max. Negotiated Rate |
$3.93 |
| Rate for Payer: Aetna American Axle |
$2.84
|
| Rate for Payer: Aetna Commercial |
$3.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.84
|
| Rate for Payer: Cash Price |
$3.50
|
| Rate for Payer: Cofinity Commercial |
$3.06
|
| Rate for Payer: Cofinity Commercial |
$3.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.50
|
| Rate for Payer: Healthscope Commercial |
$3.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.71
|
| Rate for Payer: PHP Commercial |
$3.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.06
|
| Rate for Payer: Priority Health SBD |
$2.75
|
| Rate for Payer: UMR Bronson Commercial |
$1.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.28
|
|
|
HC ISOVUE 300M PER ML
|
Facility
|
OP
|
$1.90
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
63600034
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$1.71 |
| Rate for Payer: Aetna American Axle |
$1.24
|
| Rate for Payer: Aetna Commercial |
$1.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.24
|
| Rate for Payer: BCBS Complete |
$0.76
|
| Rate for Payer: BCBS Trust/PPO |
$0.14
|
| Rate for Payer: Cash Price |
$1.52
|
| Rate for Payer: Cash Price |
$1.52
|
| Rate for Payer: Cofinity Commercial |
$1.63
|
| Rate for Payer: Cofinity Commercial |
$1.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.52
|
| Rate for Payer: Healthscope Commercial |
$1.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.62
|
| Rate for Payer: PHP Commercial |
$1.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.33
|
| Rate for Payer: Priority Health SBD |
$1.20
|
| Rate for Payer: UMR Bronson Commercial |
$0.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.42
|
|
