|
HC CYCLOSPORA DETECTION CMPT
|
Facility
|
IP
|
$48.90
|
|
|
Service Code
|
CPT 87207
|
| Hospital Charge Code |
30600108
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$21.52 |
| Max. Negotiated Rate |
$44.01 |
| Rate for Payer: Aetna American Axle |
$31.79
|
| Rate for Payer: Aetna Commercial |
$41.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.79
|
| Rate for Payer: Cash Price |
$39.12
|
| Rate for Payer: Cofinity Advantage |
$34.23
|
| Rate for Payer: Cofinity Commercial |
$42.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.12
|
| Rate for Payer: Healthscope Commercial |
$44.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.67
|
| Rate for Payer: PHP Commercial |
$41.56
|
| Rate for Payer: Priority Health SBD |
$30.81
|
| Rate for Payer: UMR Bronson Commercial |
$21.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.67
|
|
|
HC CYCLOSPORINE
|
Facility
|
OP
|
$42.45
|
|
|
Service Code
|
CPT 80158
|
| Hospital Charge Code |
30100025
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.44 |
| Max. Negotiated Rate |
$38.20 |
| Rate for Payer: Aetna American Axle |
$27.59
|
| Rate for Payer: Aetna Commercial |
$36.08
|
| Rate for Payer: Aetna Medicare |
$18.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.56
|
| Rate for Payer: BCBS Complete |
$9.91
|
| Rate for Payer: BCBS MAPPO |
$18.05
|
| Rate for Payer: BCBS Trust/PPO |
$20.87
|
| Rate for Payer: BCN Commercial |
$20.87
|
| Rate for Payer: BCN Medicare Advantage |
$18.05
|
| Rate for Payer: Cash Price |
$33.96
|
| Rate for Payer: Cash Price |
$33.96
|
| Rate for Payer: Cofinity Advantage |
$29.71
|
| Rate for Payer: Cofinity Commercial |
$36.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.05
|
| Rate for Payer: Healthscope Commercial |
$38.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.84
|
| Rate for Payer: Mclaren Medicaid |
$18.05
|
| Rate for Payer: Mclaren Medicare |
$18.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.95
|
| Rate for Payer: Meridian Medicaid |
$18.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.08
|
| Rate for Payer: Nomi Health Commercial |
$27.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.84
|
| Rate for Payer: PACE Medicare |
$17.15
|
| Rate for Payer: PACE SWMI |
$18.05
|
| Rate for Payer: PHP Commercial |
$36.08
|
| Rate for Payer: PHP Medicare Advantage |
$18.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$18.05
|
| Rate for Payer: Priority Health Medicare |
$18.05
|
| Rate for Payer: Priority Health SBD |
$26.74
|
| Rate for Payer: Priority Health Tiered Network |
$14.44
|
| Rate for Payer: Railroad Medicare Medicare |
$18.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.08
|
| Rate for Payer: UHC Core |
$27.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18.05
|
| Rate for Payer: UHC Exchange |
$27.08
|
| Rate for Payer: UHC Medicaid |
$9.44
|
| Rate for Payer: UHCCP Medicaid |
$9.44
|
| Rate for Payer: UMR Bronson Commercial |
$15.71
|
| Rate for Payer: VA VA |
$18.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.84
|
|
|
HC CYCLOSPORINE
|
Facility
|
IP
|
$42.45
|
|
|
Service Code
|
CPT 80158
|
| Hospital Charge Code |
30100025
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.68 |
| Max. Negotiated Rate |
$38.20 |
| Rate for Payer: Aetna American Axle |
$27.59
|
| Rate for Payer: Aetna Commercial |
$36.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.59
|
| Rate for Payer: Cash Price |
$33.96
|
| Rate for Payer: Cofinity Advantage |
$29.71
|
| Rate for Payer: Cofinity Commercial |
$36.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.96
|
| Rate for Payer: Healthscope Commercial |
$38.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.84
|
| Rate for Payer: PHP Commercial |
$36.08
|
| Rate for Payer: Priority Health SBD |
$26.74
|
| Rate for Payer: UMR Bronson Commercial |
$18.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.84
|
|
|
HC CYGNUS MATRIX 2X3 PER SQ CM
|
Facility
|
OP
|
$337.88
|
|
|
Service Code
|
HCPCS Q4199
|
| Hospital Charge Code |
63600266
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.85 |
| Max. Negotiated Rate |
$401.00 |
| Rate for Payer: Aetna American Axle |
$219.62
|
| Rate for Payer: Aetna Commercial |
$287.20
|
| Rate for Payer: Aetna Medicare |
$128.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$219.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.00
|
| Rate for Payer: BCBS Complete |
$68.10
|
| Rate for Payer: BCBS MAPPO |
$124.00
|
| Rate for Payer: BCN Medicare Advantage |
$124.00
|
| Rate for Payer: Cash Price |
$270.30
|
| Rate for Payer: Cash Price |
$270.30
|
| Rate for Payer: Cofinity Advantage |
$236.52
|
| Rate for Payer: Cofinity Commercial |
$290.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.00
|
| Rate for Payer: Healthscope Commercial |
$304.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$236.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$253.41
|
| Rate for Payer: Mclaren Medicaid |
$124.00
|
| Rate for Payer: Mclaren Medicare |
$124.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.20
|
| Rate for Payer: Meridian Medicaid |
$130.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$287.20
|
| Rate for Payer: Nomi Health Commercial |
$372.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$253.41
|
| Rate for Payer: PACE Medicare |
$117.80
|
| Rate for Payer: PACE SWMI |
$124.00
|
| Rate for Payer: PHP Commercial |
$287.20
|
| Rate for Payer: PHP Medicare Advantage |
$124.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$401.00
|
| Rate for Payer: Priority Health Medicare |
$124.00
|
| Rate for Payer: Priority Health SBD |
$212.86
|
| Rate for Payer: Priority Health Tiered Network |
$320.80
|
| Rate for Payer: Railroad Medicare Medicare |
$124.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.78
|
| Rate for Payer: UHC Core |
$209.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$124.00
|
| Rate for Payer: UHC Exchange |
$209.78
|
| Rate for Payer: UHC Medicaid |
$64.85
|
| Rate for Payer: UHCCP Medicaid |
$64.85
|
| Rate for Payer: UMR Bronson Commercial |
$125.02
|
| Rate for Payer: VA VA |
$124.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$253.41
|
|
|
HC CYGNUS MATRIX 2X3 PER SQ CM
|
Facility
|
IP
|
$337.88
|
|
|
Service Code
|
HCPCS Q4199
|
| Hospital Charge Code |
63600266
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$148.67 |
| Max. Negotiated Rate |
$304.09 |
| Rate for Payer: Aetna American Axle |
$219.62
|
| Rate for Payer: Aetna Commercial |
$287.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$219.62
|
| Rate for Payer: Cash Price |
$270.30
|
| Rate for Payer: Cofinity Advantage |
$236.52
|
| Rate for Payer: Cofinity Commercial |
$290.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.30
|
| Rate for Payer: Healthscope Commercial |
$304.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$236.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$253.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$287.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$253.41
|
| Rate for Payer: PHP Commercial |
$287.20
|
| Rate for Payer: Priority Health SBD |
$212.86
|
| Rate for Payer: UMR Bronson Commercial |
$148.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$253.41
|
|
|
HC CYGNUS MATRIX 4X4 PER SQ CM
|
Facility
|
IP
|
$227.11
|
|
|
Service Code
|
HCPCS Q4199
|
| Hospital Charge Code |
63600267
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$99.93 |
| Max. Negotiated Rate |
$204.40 |
| Rate for Payer: Aetna American Axle |
$147.62
|
| Rate for Payer: Aetna Commercial |
$193.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$147.62
|
| Rate for Payer: Cash Price |
$181.69
|
| Rate for Payer: Cofinity Advantage |
$158.98
|
| Rate for Payer: Cofinity Commercial |
$195.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$181.69
|
| Rate for Payer: Healthscope Commercial |
$204.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$158.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$170.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$193.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$170.33
|
| Rate for Payer: PHP Commercial |
$193.04
|
| Rate for Payer: Priority Health SBD |
$143.08
|
| Rate for Payer: UMR Bronson Commercial |
$99.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$170.33
|
|
|
HC CYGNUS MATRIX 4X4 PER SQ CM
|
Facility
|
OP
|
$227.11
|
|
|
Service Code
|
HCPCS Q4199
|
| Hospital Charge Code |
63600267
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.85 |
| Max. Negotiated Rate |
$401.00 |
| Rate for Payer: Aetna American Axle |
$147.62
|
| Rate for Payer: Aetna Commercial |
$193.04
|
| Rate for Payer: Aetna Medicare |
$128.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$147.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.00
|
| Rate for Payer: BCBS Complete |
$68.10
|
| Rate for Payer: BCBS MAPPO |
$124.00
|
| Rate for Payer: BCN Medicare Advantage |
$124.00
|
| Rate for Payer: Cash Price |
$181.69
|
| Rate for Payer: Cash Price |
$181.69
|
| Rate for Payer: Cofinity Advantage |
$158.98
|
| Rate for Payer: Cofinity Commercial |
$195.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$181.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.00
|
| Rate for Payer: Healthscope Commercial |
$204.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$158.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$170.33
|
| Rate for Payer: Mclaren Medicaid |
$124.00
|
| Rate for Payer: Mclaren Medicare |
$124.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.20
|
| Rate for Payer: Meridian Medicaid |
$130.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$193.04
|
| Rate for Payer: Nomi Health Commercial |
$372.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$170.33
|
| Rate for Payer: PACE Medicare |
$117.80
|
| Rate for Payer: PACE SWMI |
$124.00
|
| Rate for Payer: PHP Commercial |
$193.04
|
| Rate for Payer: PHP Medicare Advantage |
$124.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$401.00
|
| Rate for Payer: Priority Health Medicare |
$124.00
|
| Rate for Payer: Priority Health SBD |
$143.08
|
| Rate for Payer: Priority Health Tiered Network |
$320.80
|
| Rate for Payer: Railroad Medicare Medicare |
$124.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.78
|
| Rate for Payer: UHC Core |
$209.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$124.00
|
| Rate for Payer: UHC Exchange |
$209.78
|
| Rate for Payer: UHC Medicaid |
$64.85
|
| Rate for Payer: UHCCP Medicaid |
$64.85
|
| Rate for Payer: UMR Bronson Commercial |
$84.03
|
| Rate for Payer: VA VA |
$124.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$170.33
|
|
|
HC CYGNUS MATRIX 4X6 PER SQ CM
|
Facility
|
OP
|
$159.89
|
|
|
Service Code
|
HCPCS Q4199
|
| Hospital Charge Code |
63600268
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$59.16 |
| Max. Negotiated Rate |
$401.00 |
| Rate for Payer: Aetna American Axle |
$103.93
|
| Rate for Payer: Aetna Commercial |
$135.91
|
| Rate for Payer: Aetna Medicare |
$128.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$103.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.00
|
| Rate for Payer: BCBS Complete |
$68.10
|
| Rate for Payer: BCBS MAPPO |
$124.00
|
| Rate for Payer: BCN Medicare Advantage |
$124.00
|
| Rate for Payer: Cash Price |
$127.91
|
| Rate for Payer: Cash Price |
$127.91
|
| Rate for Payer: Cofinity Advantage |
$111.92
|
| Rate for Payer: Cofinity Commercial |
$137.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.00
|
| Rate for Payer: Healthscope Commercial |
$143.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$111.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$119.92
|
| Rate for Payer: Mclaren Medicaid |
$124.00
|
| Rate for Payer: Mclaren Medicare |
$124.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.20
|
| Rate for Payer: Meridian Medicaid |
$130.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$135.91
|
| Rate for Payer: Nomi Health Commercial |
$372.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$119.92
|
| Rate for Payer: PACE Medicare |
$117.80
|
| Rate for Payer: PACE SWMI |
$124.00
|
| Rate for Payer: PHP Commercial |
$135.91
|
| Rate for Payer: PHP Medicare Advantage |
$124.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$401.00
|
| Rate for Payer: Priority Health Medicare |
$124.00
|
| Rate for Payer: Priority Health SBD |
$100.73
|
| Rate for Payer: Priority Health Tiered Network |
$320.80
|
| Rate for Payer: Railroad Medicare Medicare |
$124.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.78
|
| Rate for Payer: UHC Core |
$209.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$124.00
|
| Rate for Payer: UHC Exchange |
$209.78
|
| Rate for Payer: UHC Medicaid |
$64.85
|
| Rate for Payer: UHCCP Medicaid |
$64.85
|
| Rate for Payer: UMR Bronson Commercial |
$59.16
|
| Rate for Payer: VA VA |
$124.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$119.92
|
|
|
HC CYGNUS MATRIX 4X6 PER SQ CM
|
Facility
|
IP
|
$159.89
|
|
|
Service Code
|
HCPCS Q4199
|
| Hospital Charge Code |
63600268
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$70.35 |
| Max. Negotiated Rate |
$143.90 |
| Rate for Payer: Aetna American Axle |
$103.93
|
| Rate for Payer: Aetna Commercial |
$135.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$103.93
|
| Rate for Payer: Cash Price |
$127.91
|
| Rate for Payer: Cofinity Advantage |
$111.92
|
| Rate for Payer: Cofinity Commercial |
$137.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.91
|
| Rate for Payer: Healthscope Commercial |
$143.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$111.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$119.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$135.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$119.92
|
| Rate for Payer: PHP Commercial |
$135.91
|
| Rate for Payer: Priority Health SBD |
$100.73
|
| Rate for Payer: UMR Bronson Commercial |
$70.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$119.92
|
|
|
HC CYSTATIN C WITH ESTIMATED GFR
|
Facility
|
OP
|
$67.63
|
|
|
Service Code
|
CPT 82610
|
| Hospital Charge Code |
30100559
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.69 |
| Max. Negotiated Rate |
$60.87 |
| Rate for Payer: Aetna American Axle |
$43.96
|
| Rate for Payer: Aetna Commercial |
$57.49
|
| Rate for Payer: Aetna Medicare |
$19.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.15
|
| Rate for Payer: BCBS Complete |
$10.17
|
| Rate for Payer: BCBS MAPPO |
$18.52
|
| Rate for Payer: BCBS Trust/PPO |
$21.41
|
| Rate for Payer: BCN Commercial |
$21.41
|
| Rate for Payer: BCN Medicare Advantage |
$18.52
|
| Rate for Payer: Cash Price |
$54.10
|
| Rate for Payer: Cash Price |
$54.10
|
| Rate for Payer: Cofinity Advantage |
$47.34
|
| Rate for Payer: Cofinity Commercial |
$58.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.52
|
| Rate for Payer: Healthscope Commercial |
$60.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.72
|
| Rate for Payer: Mclaren Medicaid |
$18.52
|
| Rate for Payer: Mclaren Medicare |
$18.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.45
|
| Rate for Payer: Meridian Medicaid |
$19.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.49
|
| Rate for Payer: Nomi Health Commercial |
$27.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.72
|
| Rate for Payer: PACE Medicare |
$17.59
|
| Rate for Payer: PACE SWMI |
$18.52
|
| Rate for Payer: PHP Commercial |
$57.49
|
| Rate for Payer: PHP Medicare Advantage |
$18.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$18.52
|
| Rate for Payer: Priority Health Medicare |
$18.52
|
| Rate for Payer: Priority Health SBD |
$42.61
|
| Rate for Payer: Priority Health Tiered Network |
$14.82
|
| Rate for Payer: Railroad Medicare Medicare |
$18.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.78
|
| Rate for Payer: UHC Core |
$27.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18.52
|
| Rate for Payer: UHC Exchange |
$27.78
|
| Rate for Payer: UHC Medicaid |
$9.69
|
| Rate for Payer: UHCCP Medicaid |
$9.69
|
| Rate for Payer: UMR Bronson Commercial |
$25.02
|
| Rate for Payer: VA VA |
$18.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.72
|
|
|
HC CYSTATIN C WITH ESTIMATED GFR
|
Facility
|
IP
|
$67.63
|
|
|
Service Code
|
CPT 82610
|
| Hospital Charge Code |
30100559
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.76 |
| Max. Negotiated Rate |
$60.87 |
| Rate for Payer: Aetna American Axle |
$43.96
|
| Rate for Payer: Aetna Commercial |
$57.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.96
|
| Rate for Payer: Cash Price |
$54.10
|
| Rate for Payer: Cofinity Advantage |
$47.34
|
| Rate for Payer: Cofinity Commercial |
$58.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.10
|
| Rate for Payer: Healthscope Commercial |
$60.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.72
|
| Rate for Payer: PHP Commercial |
$57.49
|
| Rate for Payer: Priority Health SBD |
$42.61
|
| Rate for Payer: UMR Bronson Commercial |
$29.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.72
|
|
|
HC CYSTATIN C WITH ESTIMATED GFR, SERUM
|
Facility
|
IP
|
$69.15
|
|
|
Service Code
|
CPT 82610
|
| Hospital Charge Code |
30100747
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.43 |
| Max. Negotiated Rate |
$62.23 |
| Rate for Payer: Aetna American Axle |
$44.95
|
| Rate for Payer: Aetna Commercial |
$58.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.95
|
| Rate for Payer: Cash Price |
$55.32
|
| Rate for Payer: Cofinity Advantage |
$48.41
|
| Rate for Payer: Cofinity Commercial |
$59.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.32
|
| Rate for Payer: Healthscope Commercial |
$62.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.86
|
| Rate for Payer: PHP Commercial |
$58.78
|
| Rate for Payer: Priority Health SBD |
$43.56
|
| Rate for Payer: UMR Bronson Commercial |
$30.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.86
|
|
|
HC CYSTATIN C WITH ESTIMATED GFR, SERUM
|
Facility
|
OP
|
$69.15
|
|
|
Service Code
|
CPT 82610
|
| Hospital Charge Code |
30100747
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.69 |
| Max. Negotiated Rate |
$62.23 |
| Rate for Payer: Aetna American Axle |
$44.95
|
| Rate for Payer: Aetna Commercial |
$58.78
|
| Rate for Payer: Aetna Medicare |
$19.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.15
|
| Rate for Payer: BCBS Complete |
$10.17
|
| Rate for Payer: BCBS MAPPO |
$18.52
|
| Rate for Payer: BCBS Trust/PPO |
$21.41
|
| Rate for Payer: BCN Commercial |
$21.41
|
| Rate for Payer: BCN Medicare Advantage |
$18.52
|
| Rate for Payer: Cash Price |
$55.32
|
| Rate for Payer: Cash Price |
$55.32
|
| Rate for Payer: Cofinity Advantage |
$48.41
|
| Rate for Payer: Cofinity Commercial |
$59.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.52
|
| Rate for Payer: Healthscope Commercial |
$62.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.86
|
| Rate for Payer: Mclaren Medicaid |
$18.52
|
| Rate for Payer: Mclaren Medicare |
$18.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.45
|
| Rate for Payer: Meridian Medicaid |
$19.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.78
|
| Rate for Payer: Nomi Health Commercial |
$27.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.86
|
| Rate for Payer: PACE Medicare |
$17.59
|
| Rate for Payer: PACE SWMI |
$18.52
|
| Rate for Payer: PHP Commercial |
$58.78
|
| Rate for Payer: PHP Medicare Advantage |
$18.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$18.52
|
| Rate for Payer: Priority Health Medicare |
$18.52
|
| Rate for Payer: Priority Health SBD |
$43.56
|
| Rate for Payer: Priority Health Tiered Network |
$14.82
|
| Rate for Payer: Railroad Medicare Medicare |
$18.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.78
|
| Rate for Payer: UHC Core |
$27.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18.52
|
| Rate for Payer: UHC Exchange |
$27.78
|
| Rate for Payer: UHC Medicaid |
$9.69
|
| Rate for Payer: UHCCP Medicaid |
$9.69
|
| Rate for Payer: UMR Bronson Commercial |
$25.59
|
| Rate for Payer: VA VA |
$18.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.86
|
|
|
HC CYSTIC FIBROSIS CARRIER DETECT
|
Facility
|
IP
|
$1,909.44
|
|
|
Service Code
|
CPT 81220
|
| Hospital Charge Code |
31000098
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$840.15 |
| Max. Negotiated Rate |
$1,718.50 |
| Rate for Payer: Aetna American Axle |
$1,241.14
|
| Rate for Payer: Aetna Commercial |
$1,623.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,241.14
|
| Rate for Payer: Cash Price |
$1,527.55
|
| Rate for Payer: Cofinity Advantage |
$1,336.61
|
| Rate for Payer: Cofinity Commercial |
$1,642.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,527.55
|
| Rate for Payer: Healthscope Commercial |
$1,718.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,336.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,432.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,623.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,432.08
|
| Rate for Payer: PHP Commercial |
$1,623.02
|
| Rate for Payer: Priority Health SBD |
$1,202.95
|
| Rate for Payer: UMR Bronson Commercial |
$840.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,432.08
|
|
|
HC CYSTIC FIBROSIS CARRIER DETECT
|
Facility
|
OP
|
$1,909.44
|
|
|
Service Code
|
CPT 81220
|
| Hospital Charge Code |
31000098
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$291.10 |
| Max. Negotiated Rate |
$1,718.50 |
| Rate for Payer: Aetna American Axle |
$1,241.14
|
| Rate for Payer: Aetna Commercial |
$1,623.02
|
| Rate for Payer: Aetna Medicare |
$578.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,241.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$695.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$695.75
|
| Rate for Payer: BCBS Complete |
$305.68
|
| Rate for Payer: BCBS MAPPO |
$556.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,233.04
|
| Rate for Payer: BCN Commercial |
$1,233.04
|
| Rate for Payer: BCN Medicare Advantage |
$556.60
|
| Rate for Payer: Cash Price |
$1,527.55
|
| Rate for Payer: Cash Price |
$1,527.55
|
| Rate for Payer: Cofinity Advantage |
$1,336.61
|
| Rate for Payer: Cofinity Commercial |
$1,642.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,527.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$556.60
|
| Rate for Payer: Healthscope Commercial |
$1,718.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,336.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,432.08
|
| Rate for Payer: Mclaren Medicaid |
$556.60
|
| Rate for Payer: Mclaren Medicare |
$556.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$584.43
|
| Rate for Payer: Meridian Medicaid |
$584.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$640.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$612.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,623.02
|
| Rate for Payer: Nomi Health Commercial |
$1,669.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,432.08
|
| Rate for Payer: PACE Medicare |
$528.77
|
| Rate for Payer: PACE SWMI |
$556.60
|
| Rate for Payer: PHP Commercial |
$1,623.02
|
| Rate for Payer: PHP Medicare Advantage |
$556.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$291.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$556.60
|
| Rate for Payer: Priority Health Medicare |
$556.60
|
| Rate for Payer: Priority Health SBD |
$1,202.95
|
| Rate for Payer: Priority Health Tiered Network |
$445.28
|
| Rate for Payer: Railroad Medicare Medicare |
$556.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$834.90
|
| Rate for Payer: UHC Core |
$834.90
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$556.60
|
| Rate for Payer: UHC Exchange |
$834.90
|
| Rate for Payer: UHC Medicaid |
$291.10
|
| Rate for Payer: UHCCP Medicaid |
$291.10
|
| Rate for Payer: UMR Bronson Commercial |
$706.49
|
| Rate for Payer: VA VA |
$556.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,432.08
|
|
|
HC CYSTINE 24HR URINE
|
Facility
|
OP
|
$93.64
|
|
|
Service Code
|
CPT 82136
|
| Hospital Charge Code |
30100090
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.26 |
| Max. Negotiated Rate |
$84.28 |
| Rate for Payer: Aetna American Axle |
$60.87
|
| Rate for Payer: Aetna Commercial |
$79.59
|
| Rate for Payer: Aetna Medicare |
$20.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.51
|
| Rate for Payer: BCBS Complete |
$10.77
|
| Rate for Payer: BCBS MAPPO |
$19.61
|
| Rate for Payer: BCBS Trust/PPO |
$22.67
|
| Rate for Payer: BCN Commercial |
$22.67
|
| Rate for Payer: BCN Medicare Advantage |
$19.61
|
| Rate for Payer: Cash Price |
$74.91
|
| Rate for Payer: Cash Price |
$74.91
|
| Rate for Payer: Cofinity Advantage |
$65.55
|
| Rate for Payer: Cofinity Commercial |
$80.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.61
|
| Rate for Payer: Healthscope Commercial |
$84.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$65.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.23
|
| Rate for Payer: Mclaren Medicaid |
$19.61
|
| Rate for Payer: Mclaren Medicare |
$19.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.59
|
| Rate for Payer: Meridian Medicaid |
$20.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$21.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.59
|
| Rate for Payer: Nomi Health Commercial |
$29.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.23
|
| Rate for Payer: PACE Medicare |
$18.63
|
| Rate for Payer: PACE SWMI |
$19.61
|
| Rate for Payer: PHP Commercial |
$79.59
|
| Rate for Payer: PHP Medicare Advantage |
$19.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$19.61
|
| Rate for Payer: Priority Health Medicare |
$19.61
|
| Rate for Payer: Priority Health SBD |
$58.99
|
| Rate for Payer: Priority Health Tiered Network |
$15.69
|
| Rate for Payer: Railroad Medicare Medicare |
$19.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.42
|
| Rate for Payer: UHC Core |
$29.42
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$19.61
|
| Rate for Payer: UHC Exchange |
$29.42
|
| Rate for Payer: UHC Medicaid |
$10.26
|
| Rate for Payer: UHCCP Medicaid |
$10.26
|
| Rate for Payer: UMR Bronson Commercial |
$34.65
|
| Rate for Payer: VA VA |
$19.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.23
|
|
|
HC CYSTINE 24HR URINE
|
Facility
|
IP
|
$93.64
|
|
|
Service Code
|
CPT 82136
|
| Hospital Charge Code |
30100090
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$41.20 |
| Max. Negotiated Rate |
$84.28 |
| Rate for Payer: Aetna American Axle |
$60.87
|
| Rate for Payer: Aetna Commercial |
$79.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.87
|
| Rate for Payer: Cash Price |
$74.91
|
| Rate for Payer: Cofinity Advantage |
$65.55
|
| Rate for Payer: Cofinity Commercial |
$80.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.91
|
| Rate for Payer: Healthscope Commercial |
$84.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$65.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.23
|
| Rate for Payer: PHP Commercial |
$79.59
|
| Rate for Payer: Priority Health SBD |
$58.99
|
| Rate for Payer: UMR Bronson Commercial |
$41.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.23
|
|
|
HC CYSTOGRAFIN DILUTE PER ML
|
Facility
|
IP
|
$0.29
|
|
|
Service Code
|
HCPCS Q9958
|
| Hospital Charge Code |
63600008
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Aetna American Axle |
$0.19
|
| Rate for Payer: Aetna Commercial |
$0.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.19
|
| Rate for Payer: Cash Price |
$0.23
|
| Rate for Payer: Cofinity Advantage |
$0.20
|
| Rate for Payer: Cofinity Commercial |
$0.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.23
|
| Rate for Payer: Healthscope Commercial |
$0.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.22
|
| Rate for Payer: PHP Commercial |
$0.25
|
| Rate for Payer: Priority Health SBD |
$0.18
|
| Rate for Payer: UMR Bronson Commercial |
$0.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.22
|
|
|
HC CYSTOGRAFIN DILUTE PER ML
|
Facility
|
OP
|
$0.29
|
|
|
Service Code
|
HCPCS Q9958
|
| Hospital Charge Code |
63600008
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Aetna American Axle |
$0.19
|
| Rate for Payer: Aetna Commercial |
$0.25
|
| Rate for Payer: Aetna Medicare |
$0.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.19
|
| Rate for Payer: BCBS Complete |
$0.12
|
| Rate for Payer: BCBS Trust/PPO |
$0.22
|
| Rate for Payer: BCN Commercial |
$0.22
|
| Rate for Payer: Cash Price |
$0.23
|
| Rate for Payer: Cash Price |
$0.23
|
| Rate for Payer: Cofinity Advantage |
$0.20
|
| Rate for Payer: Cofinity Commercial |
$0.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.23
|
| Rate for Payer: Healthscope Commercial |
$0.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.22
|
| Rate for Payer: PHP Commercial |
$0.25
|
| Rate for Payer: Priority Health SBD |
$0.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.12
|
| Rate for Payer: UHC Core |
$0.12
|
| Rate for Payer: UHC Exchange |
$0.12
|
| Rate for Payer: UMR Bronson Commercial |
$0.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.22
|
|
|
HC CYSTO INSERTION TRANSPROSTATIC IMPLANT 1-3 IMPLANTS
|
Facility
|
IP
|
$6,399.95
|
|
|
Service Code
|
HCPCS C9739
|
| Hospital Charge Code |
76100196
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,815.98 |
| Max. Negotiated Rate |
$5,759.95 |
| Rate for Payer: Aetna American Axle |
$4,159.97
|
| Rate for Payer: Aetna Commercial |
$5,439.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,159.97
|
| Rate for Payer: Cash Price |
$5,119.96
|
| Rate for Payer: Cofinity Advantage |
$4,479.97
|
| Rate for Payer: Cofinity Commercial |
$5,503.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,119.96
|
| Rate for Payer: Healthscope Commercial |
$5,759.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,479.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,799.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,439.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,799.96
|
| Rate for Payer: PHP Commercial |
$5,439.96
|
| Rate for Payer: Priority Health SBD |
$4,031.97
|
| Rate for Payer: UMR Bronson Commercial |
$2,815.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,799.96
|
|
|
HC CYSTO INSERTION TRANSPROSTATIC IMPLANT 1-3 IMPLANTS
|
Facility
|
OP
|
$6,399.95
|
|
|
Service Code
|
HCPCS C9739
|
| Hospital Charge Code |
76100196
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,367.98 |
| Max. Negotiated Rate |
$17,277.20 |
| Rate for Payer: Aetna American Axle |
$4,159.97
|
| Rate for Payer: Aetna Commercial |
$5,439.96
|
| Rate for Payer: Aetna Medicare |
$5,556.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,159.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,678.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,678.15
|
| Rate for Payer: BCBS Complete |
$2,934.11
|
| Rate for Payer: BCBS MAPPO |
$5,342.52
|
| Rate for Payer: BCBS Trust/PPO |
$8,135.49
|
| Rate for Payer: BCN Commercial |
$8,135.49
|
| Rate for Payer: BCN Medicare Advantage |
$5,342.52
|
| Rate for Payer: Cash Price |
$5,119.96
|
| Rate for Payer: Cash Price |
$5,119.96
|
| Rate for Payer: Cash Price |
$5,119.96
|
| Rate for Payer: Cofinity Advantage |
$4,479.97
|
| Rate for Payer: Cofinity Commercial |
$5,503.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,119.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,342.52
|
| Rate for Payer: Healthscope Commercial |
$5,759.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,479.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,799.96
|
| Rate for Payer: Mclaren Medicaid |
$5,342.52
|
| Rate for Payer: Mclaren Medicare |
$5,342.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,609.65
|
| Rate for Payer: Meridian Medicaid |
$5,609.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,143.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$5,876.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,439.96
|
| Rate for Payer: Nomi Health Commercial |
$16,027.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,799.96
|
| Rate for Payer: PACE Medicare |
$5,075.39
|
| Rate for Payer: PACE SWMI |
$5,342.52
|
| Rate for Payer: PHP Commercial |
$5,439.96
|
| Rate for Payer: PHP Medicare Advantage |
$5,342.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,794.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$17,277.20
|
| Rate for Payer: Priority Health Medicare |
$5,342.52
|
| Rate for Payer: Priority Health SBD |
$4,031.97
|
| Rate for Payer: Priority Health Tiered Network |
$13,821.76
|
| Rate for Payer: Railroad Medicare Medicare |
$5,342.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,159.97
|
| Rate for Payer: UHC Core |
$3,334.37
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,342.52
|
| Rate for Payer: UHC Exchange |
$2,515.18
|
| Rate for Payer: UHC Medicaid |
$2,794.14
|
| Rate for Payer: UHCCP Medicaid |
$2,794.14
|
| Rate for Payer: UMR Bronson Commercial |
$2,367.98
|
| Rate for Payer: VA VA |
$5,342.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,799.96
|
|
|
HC CYSTO INSERTION TRANSPROSTATIC IMPLANT 4 OR MORE IMPLANTS
|
Facility
|
OP
|
$12,842.64
|
|
|
Service Code
|
HCPCS C9740
|
| Hospital Charge Code |
76100197
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$4,751.78 |
| Max. Negotiated Rate |
$30,503.59 |
| Rate for Payer: Aetna American Axle |
$8,347.72
|
| Rate for Payer: Aetna Commercial |
$10,916.24
|
| Rate for Payer: Aetna Medicare |
$9,809.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,347.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,790.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,790.52
|
| Rate for Payer: BCBS Complete |
$5,180.29
|
| Rate for Payer: BCBS MAPPO |
$9,432.42
|
| Rate for Payer: BCBS Trust/PPO |
$11,229.85
|
| Rate for Payer: BCN Commercial |
$11,229.85
|
| Rate for Payer: BCN Medicare Advantage |
$9,432.42
|
| Rate for Payer: Cash Price |
$10,274.11
|
| Rate for Payer: Cash Price |
$10,274.11
|
| Rate for Payer: Cash Price |
$10,274.11
|
| Rate for Payer: Cofinity Advantage |
$8,989.85
|
| Rate for Payer: Cofinity Commercial |
$11,044.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,274.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,432.42
|
| Rate for Payer: Healthscope Commercial |
$11,558.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8,989.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,631.98
|
| Rate for Payer: Mclaren Medicaid |
$9,432.42
|
| Rate for Payer: Mclaren Medicare |
$9,432.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9,904.04
|
| Rate for Payer: Meridian Medicaid |
$9,904.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,847.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$10,375.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,916.24
|
| Rate for Payer: Nomi Health Commercial |
$28,297.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9,631.98
|
| Rate for Payer: PACE Medicare |
$8,960.80
|
| Rate for Payer: PACE SWMI |
$9,432.42
|
| Rate for Payer: PHP Commercial |
$10,916.24
|
| Rate for Payer: PHP Medicare Advantage |
$9,432.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,933.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$30,503.59
|
| Rate for Payer: Priority Health Medicare |
$9,432.42
|
| Rate for Payer: Priority Health SBD |
$8,090.86
|
| Rate for Payer: Priority Health Tiered Network |
$24,402.87
|
| Rate for Payer: Railroad Medicare Medicare |
$9,432.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,347.72
|
| Rate for Payer: UHC Core |
$6,691.02
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9,432.42
|
| Rate for Payer: UHC Exchange |
$5,047.16
|
| Rate for Payer: UHC Medicaid |
$4,933.16
|
| Rate for Payer: UHCCP Medicaid |
$4,933.16
|
| Rate for Payer: UMR Bronson Commercial |
$4,751.78
|
| Rate for Payer: VA VA |
$9,432.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,631.98
|
|
|
HC CYSTO INSERTION TRANSPROSTATIC IMPLANT 4 OR MORE IMPLANTS
|
Facility
|
IP
|
$12,842.64
|
|
|
Service Code
|
HCPCS C9740
|
| Hospital Charge Code |
76100197
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$5,650.76 |
| Max. Negotiated Rate |
$11,558.38 |
| Rate for Payer: Aetna American Axle |
$8,347.72
|
| Rate for Payer: Aetna Commercial |
$10,916.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,347.72
|
| Rate for Payer: Cash Price |
$10,274.11
|
| Rate for Payer: Cofinity Advantage |
$8,989.85
|
| Rate for Payer: Cofinity Commercial |
$11,044.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,274.11
|
| Rate for Payer: Healthscope Commercial |
$11,558.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8,989.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,631.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,916.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9,631.98
|
| Rate for Payer: PHP Commercial |
$10,916.24
|
| Rate for Payer: Priority Health SBD |
$8,090.86
|
| Rate for Payer: UMR Bronson Commercial |
$5,650.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,631.98
|
|
|
HC CYSTOMETROGRAM W/VP & UP
|
Facility
|
OP
|
$1,808.00
|
|
|
Service Code
|
CPT 51729
|
| Hospital Charge Code |
76100345
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$344.21 |
| Max. Negotiated Rate |
$2,246.88 |
| Rate for Payer: Aetna American Axle |
$1,175.20
|
| Rate for Payer: Aetna Commercial |
$1,536.80
|
| Rate for Payer: Aetna Medicare |
$722.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,175.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$868.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$868.49
|
| Rate for Payer: BCBS Complete |
$381.58
|
| Rate for Payer: BCBS MAPPO |
$694.79
|
| Rate for Payer: BCBS Trust/PPO |
$344.21
|
| Rate for Payer: BCN Commercial |
$344.21
|
| Rate for Payer: BCN Medicare Advantage |
$694.79
|
| Rate for Payer: Cash Price |
$1,446.40
|
| Rate for Payer: Cash Price |
$1,446.40
|
| Rate for Payer: Cash Price |
$1,446.40
|
| Rate for Payer: Cofinity Advantage |
$1,265.60
|
| Rate for Payer: Cofinity Commercial |
$1,554.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,446.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$694.79
|
| Rate for Payer: Healthscope Commercial |
$1,627.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,265.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,356.00
|
| Rate for Payer: Mclaren Medicaid |
$694.79
|
| Rate for Payer: Mclaren Medicare |
$694.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$729.53
|
| Rate for Payer: Meridian Medicaid |
$729.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$799.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$764.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,536.80
|
| Rate for Payer: Nomi Health Commercial |
$2,084.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,356.00
|
| Rate for Payer: PACE Medicare |
$660.05
|
| Rate for Payer: PACE SWMI |
$694.79
|
| Rate for Payer: PHP Commercial |
$1,536.80
|
| Rate for Payer: PHP Medicare Advantage |
$694.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$363.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,246.88
|
| Rate for Payer: Priority Health Medicare |
$694.79
|
| Rate for Payer: Priority Health SBD |
$1,139.04
|
| Rate for Payer: Priority Health Tiered Network |
$1,797.50
|
| Rate for Payer: Railroad Medicare Medicare |
$694.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,175.20
|
| Rate for Payer: UHC Core |
$941.97
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$694.79
|
| Rate for Payer: UHC Exchange |
$710.54
|
| Rate for Payer: UHC Medicaid |
$363.38
|
| Rate for Payer: UHCCP Medicaid |
$363.38
|
| Rate for Payer: UMR Bronson Commercial |
$668.96
|
| Rate for Payer: VA VA |
$694.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,356.00
|
|
|
HC CYSTOMETROGRAM W/VP & UP
|
Facility
|
IP
|
$1,808.00
|
|
|
Service Code
|
CPT 51729
|
| Hospital Charge Code |
76100345
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$795.52 |
| Max. Negotiated Rate |
$1,627.20 |
| Rate for Payer: Aetna American Axle |
$1,175.20
|
| Rate for Payer: Aetna Commercial |
$1,536.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,175.20
|
| Rate for Payer: Cash Price |
$1,446.40
|
| Rate for Payer: Cofinity Advantage |
$1,265.60
|
| Rate for Payer: Cofinity Commercial |
$1,554.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,446.40
|
| Rate for Payer: Healthscope Commercial |
$1,627.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,265.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,356.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,536.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,356.00
|
| Rate for Payer: PHP Commercial |
$1,536.80
|
| Rate for Payer: Priority Health SBD |
$1,139.04
|
| Rate for Payer: UMR Bronson Commercial |
$795.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,356.00
|
|
