|
HC LEUKEMIA LYMPHOMA PLASMA CELL
|
Facility
|
IP
|
$51.22
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31100013
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$22.54 |
| Max. Negotiated Rate |
$46.10 |
| Rate for Payer: Aetna American Axle |
$33.29
|
| Rate for Payer: Aetna Commercial |
$43.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.29
|
| Rate for Payer: Cash Price |
$40.98
|
| Rate for Payer: Cofinity Commercial |
$35.85
|
| Rate for Payer: Cofinity Commercial |
$44.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.98
|
| Rate for Payer: Healthscope Commercial |
$46.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.54
|
| Rate for Payer: PHP Commercial |
$43.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.85
|
| Rate for Payer: Priority Health SBD |
$32.27
|
| Rate for Payer: UMR Bronson Commercial |
$22.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.42
|
|
|
HC LEUK/LYMPH IMMUNOPHENO CMPT B
|
Facility
|
OP
|
$51.22
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31000008
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$15.25 |
| Max. Negotiated Rate |
$46.10 |
| Rate for Payer: Aetna American Axle |
$33.29
|
| Rate for Payer: Aetna Commercial |
$43.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.29
|
| Rate for Payer: BCBS Complete |
$20.49
|
| Rate for Payer: BCBS Trust/PPO |
$33.73
|
| Rate for Payer: Cash Price |
$40.98
|
| Rate for Payer: Cash Price |
$40.98
|
| Rate for Payer: Cofinity Commercial |
$44.05
|
| Rate for Payer: Cofinity Commercial |
$35.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.98
|
| Rate for Payer: Healthscope Commercial |
$46.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.54
|
| Rate for Payer: PHP Commercial |
$43.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.85
|
| Rate for Payer: Priority Health SBD |
$32.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.58
|
| Rate for Payer: UHC Core |
$15.25
|
| Rate for Payer: UHC Exchange |
$23.25
|
| Rate for Payer: UMR Bronson Commercial |
$18.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.42
|
|
|
HC LEUK/LYMPH IMMUNOPHENO CMPT B
|
Facility
|
IP
|
$51.22
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31000008
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$22.54 |
| Max. Negotiated Rate |
$46.10 |
| Rate for Payer: Aetna American Axle |
$33.29
|
| Rate for Payer: Aetna Commercial |
$43.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.29
|
| Rate for Payer: Cash Price |
$40.98
|
| Rate for Payer: Cofinity Commercial |
$35.85
|
| Rate for Payer: Cofinity Commercial |
$44.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.98
|
| Rate for Payer: Healthscope Commercial |
$46.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.54
|
| Rate for Payer: PHP Commercial |
$43.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.85
|
| Rate for Payer: Priority Health SBD |
$32.27
|
| Rate for Payer: UMR Bronson Commercial |
$22.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.42
|
|
|
HC LEUK/LYMPH IMMUNOPHENO CMPT C
|
Facility
|
IP
|
$51.22
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31000009
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$22.54 |
| Max. Negotiated Rate |
$46.10 |
| Rate for Payer: Aetna American Axle |
$33.29
|
| Rate for Payer: Aetna Commercial |
$43.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.29
|
| Rate for Payer: Cash Price |
$40.98
|
| Rate for Payer: Cofinity Commercial |
$35.85
|
| Rate for Payer: Cofinity Commercial |
$44.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.98
|
| Rate for Payer: Healthscope Commercial |
$46.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.54
|
| Rate for Payer: PHP Commercial |
$43.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.85
|
| Rate for Payer: Priority Health SBD |
$32.27
|
| Rate for Payer: UMR Bronson Commercial |
$22.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.42
|
|
|
HC LEUK/LYMPH IMMUNOPHENO CMPT C
|
Facility
|
OP
|
$51.22
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31000009
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$15.25 |
| Max. Negotiated Rate |
$46.10 |
| Rate for Payer: Aetna American Axle |
$33.29
|
| Rate for Payer: Aetna Commercial |
$43.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.29
|
| Rate for Payer: BCBS Complete |
$20.49
|
| Rate for Payer: BCBS Trust/PPO |
$33.73
|
| Rate for Payer: Cash Price |
$40.98
|
| Rate for Payer: Cash Price |
$40.98
|
| Rate for Payer: Cofinity Commercial |
$35.85
|
| Rate for Payer: Cofinity Commercial |
$44.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.98
|
| Rate for Payer: Healthscope Commercial |
$46.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.54
|
| Rate for Payer: PHP Commercial |
$43.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.85
|
| Rate for Payer: Priority Health SBD |
$32.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.58
|
| Rate for Payer: UHC Core |
$15.25
|
| Rate for Payer: UHC Exchange |
$23.25
|
| Rate for Payer: UMR Bronson Commercial |
$18.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.42
|
|
|
HC LEUK/LYMPH IMMUNOPHENO CMPT D
|
Facility
|
IP
|
$53.75
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31000010
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$23.65 |
| Max. Negotiated Rate |
$48.38 |
| Rate for Payer: Aetna American Axle |
$34.94
|
| Rate for Payer: Aetna Commercial |
$45.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.94
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cofinity Commercial |
$37.62
|
| Rate for Payer: Cofinity Commercial |
$46.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.00
|
| Rate for Payer: Healthscope Commercial |
$48.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.69
|
| Rate for Payer: PHP Commercial |
$45.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.62
|
| Rate for Payer: Priority Health SBD |
$33.86
|
| Rate for Payer: UMR Bronson Commercial |
$23.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.31
|
|
|
HC LEUK/LYMPH IMMUNOPHENO CMPT D
|
Facility
|
OP
|
$53.75
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31000010
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$15.25 |
| Max. Negotiated Rate |
$48.38 |
| Rate for Payer: Aetna American Axle |
$34.94
|
| Rate for Payer: Aetna Commercial |
$45.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.94
|
| Rate for Payer: BCBS Complete |
$21.50
|
| Rate for Payer: BCBS Trust/PPO |
$33.73
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cofinity Commercial |
$46.22
|
| Rate for Payer: Cofinity Commercial |
$37.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.00
|
| Rate for Payer: Healthscope Commercial |
$48.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.69
|
| Rate for Payer: PHP Commercial |
$45.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.62
|
| Rate for Payer: Priority Health SBD |
$33.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.58
|
| Rate for Payer: UHC Core |
$15.25
|
| Rate for Payer: UHC Exchange |
$23.25
|
| Rate for Payer: UMR Bronson Commercial |
$19.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.31
|
|
|
HC LEUK LYMPHOMA IMMUNOPHEN TISSUE
|
Facility
|
IP
|
$51.22
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31100015
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$22.54 |
| Max. Negotiated Rate |
$46.10 |
| Rate for Payer: Aetna American Axle |
$33.29
|
| Rate for Payer: Aetna Commercial |
$43.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.29
|
| Rate for Payer: Cash Price |
$40.98
|
| Rate for Payer: Cofinity Commercial |
$35.85
|
| Rate for Payer: Cofinity Commercial |
$44.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.98
|
| Rate for Payer: Healthscope Commercial |
$46.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.54
|
| Rate for Payer: PHP Commercial |
$43.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.85
|
| Rate for Payer: Priority Health SBD |
$32.27
|
| Rate for Payer: UMR Bronson Commercial |
$22.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.42
|
|
|
HC LEUK LYMPHOMA IMMUNOPHEN TISSUE
|
Facility
|
OP
|
$51.22
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31100015
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$15.25 |
| Max. Negotiated Rate |
$46.10 |
| Rate for Payer: Aetna American Axle |
$33.29
|
| Rate for Payer: Aetna Commercial |
$43.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.29
|
| Rate for Payer: BCBS Complete |
$20.49
|
| Rate for Payer: BCBS Trust/PPO |
$33.73
|
| Rate for Payer: Cash Price |
$40.98
|
| Rate for Payer: Cash Price |
$40.98
|
| Rate for Payer: Cofinity Commercial |
$35.85
|
| Rate for Payer: Cofinity Commercial |
$44.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.98
|
| Rate for Payer: Healthscope Commercial |
$46.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.54
|
| Rate for Payer: PHP Commercial |
$43.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.85
|
| Rate for Payer: Priority Health SBD |
$32.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.58
|
| Rate for Payer: UHC Core |
$15.25
|
| Rate for Payer: UHC Exchange |
$23.25
|
| Rate for Payer: UMR Bronson Commercial |
$18.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.42
|
|
|
HC LEUKOTRIENE E4, U
|
Facility
|
OP
|
$255.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
30100715
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.78 |
| Max. Negotiated Rate |
$229.50 |
| Rate for Payer: Aetna American Axle |
$165.75
|
| Rate for Payer: Aetna Commercial |
$216.75
|
| Rate for Payer: Aetna Medicare |
$25.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.11
|
| Rate for Payer: BCBS Complete |
$13.84
|
| Rate for Payer: BCBS MAPPO |
$24.09
|
| Rate for Payer: BCBS Trust/PPO |
$21.67
|
| Rate for Payer: BCN Medicare Advantage |
$24.09
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cofinity Commercial |
$178.50
|
| Rate for Payer: Cofinity Commercial |
$219.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.09
|
| Rate for Payer: Healthscope Commercial |
$229.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$178.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$191.25
|
| Rate for Payer: Mclaren Medicaid |
$13.18
|
| Rate for Payer: Mclaren Medicare |
$24.09
|
| Rate for Payer: Meridian Medicaid |
$13.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$25.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$216.75
|
| Rate for Payer: PACE Medicare |
$22.89
|
| Rate for Payer: PACE SWMI |
$24.09
|
| Rate for Payer: PHP Commercial |
$216.75
|
| Rate for Payer: PHP Medicare Advantage |
$24.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.98
|
| Rate for Payer: Priority Health Medicare |
$24.09
|
| Rate for Payer: Priority Health Narrow Network |
$12.78
|
| Rate for Payer: Priority Health SBD |
$160.65
|
| Rate for Payer: Railroad Medicare Medicare |
$24.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.91
|
| Rate for Payer: UHC Core |
$29.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.09
|
| Rate for Payer: UHC Exchange |
$24.09
|
| Rate for Payer: UHC Medicare Advantage |
$24.81
|
| Rate for Payer: UMR Bronson Commercial |
$94.35
|
| Rate for Payer: VA VA |
$24.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$191.25
|
|
|
HC LEUKOTRIENE E4, U
|
Facility
|
IP
|
$255.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
30100715
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$112.20 |
| Max. Negotiated Rate |
$229.50 |
| Rate for Payer: Aetna American Axle |
$165.75
|
| Rate for Payer: Aetna Commercial |
$216.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.75
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cofinity Commercial |
$178.50
|
| Rate for Payer: Cofinity Commercial |
$219.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.00
|
| Rate for Payer: Healthscope Commercial |
$229.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$178.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$191.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$216.75
|
| Rate for Payer: PHP Commercial |
$216.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.50
|
| Rate for Payer: Priority Health SBD |
$160.65
|
| Rate for Payer: UMR Bronson Commercial |
$112.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$191.25
|
|
|
HC LEUPROLIDE ACETATE 3.75MG
|
Facility
|
OP
|
$1,010.92
|
|
|
Service Code
|
HCPCS J1950
|
| Hospital Charge Code |
63600142
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$374.04 |
| Max. Negotiated Rate |
$5,056.07 |
| Rate for Payer: Aetna American Axle |
$657.10
|
| Rate for Payer: Aetna Commercial |
$859.28
|
| Rate for Payer: Aetna Medicare |
$1,627.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$657.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,955.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,955.76
|
| Rate for Payer: BCBS Complete |
$898.71
|
| Rate for Payer: BCBS MAPPO |
$1,564.60
|
| Rate for Payer: BCBS Trust/PPO |
$5,056.07
|
| Rate for Payer: BCN Medicare Advantage |
$1,564.60
|
| Rate for Payer: Cash Price |
$808.74
|
| Rate for Payer: Cash Price |
$808.74
|
| Rate for Payer: Cofinity Commercial |
$869.39
|
| Rate for Payer: Cofinity Commercial |
$707.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$808.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,564.60
|
| Rate for Payer: Healthscope Commercial |
$909.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$707.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$758.19
|
| Rate for Payer: Mclaren Medicaid |
$855.84
|
| Rate for Payer: Mclaren Medicare |
$1,564.60
|
| Rate for Payer: Meridian Medicaid |
$898.71
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,642.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,799.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$859.28
|
| Rate for Payer: PACE Medicare |
$1,486.37
|
| Rate for Payer: PACE SWMI |
$1,564.60
|
| Rate for Payer: PHP Commercial |
$859.28
|
| Rate for Payer: PHP Medicare Advantage |
$1,564.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$855.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$707.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,476.78
|
| Rate for Payer: Priority Health Medicare |
$1,564.60
|
| Rate for Payer: Priority Health Narrow Network |
$3,581.42
|
| Rate for Payer: Priority Health SBD |
$636.88
|
| Rate for Payer: Railroad Medicare Medicare |
$1,564.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,564.60
|
| Rate for Payer: UHC Medicare Advantage |
$1,611.54
|
| Rate for Payer: UMR Bronson Commercial |
$374.04
|
| Rate for Payer: VA VA |
$1,564.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$758.19
|
|
|
HC LEUPROLIDE ACETATE 3.75MG
|
Facility
|
IP
|
$1,010.92
|
|
|
Service Code
|
HCPCS J1950
|
| Hospital Charge Code |
63600142
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$444.80 |
| Max. Negotiated Rate |
$909.83 |
| Rate for Payer: Aetna American Axle |
$657.10
|
| Rate for Payer: Aetna Commercial |
$859.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$657.10
|
| Rate for Payer: Cash Price |
$808.74
|
| Rate for Payer: Cofinity Commercial |
$707.64
|
| Rate for Payer: Cofinity Commercial |
$869.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$808.74
|
| Rate for Payer: Healthscope Commercial |
$909.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$707.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$758.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$859.28
|
| Rate for Payer: PHP Commercial |
$859.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$707.64
|
| Rate for Payer: Priority Health SBD |
$636.88
|
| Rate for Payer: UMR Bronson Commercial |
$444.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$758.19
|
|
|
HC LEUPROLIDE ACETATE SUSPNSION/ 7.5MG
|
Facility
|
IP
|
$452.00
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
63600147
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$198.88 |
| Max. Negotiated Rate |
$406.80 |
| Rate for Payer: Aetna American Axle |
$293.80
|
| Rate for Payer: Aetna Commercial |
$384.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$293.80
|
| Rate for Payer: Cash Price |
$361.60
|
| Rate for Payer: Cofinity Commercial |
$316.40
|
| Rate for Payer: Cofinity Commercial |
$388.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$361.60
|
| Rate for Payer: Healthscope Commercial |
$406.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$316.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$339.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$384.20
|
| Rate for Payer: PHP Commercial |
$384.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$316.40
|
| Rate for Payer: Priority Health SBD |
$284.76
|
| Rate for Payer: UMR Bronson Commercial |
$198.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$339.00
|
|
|
HC LEUPROLIDE ACETATE SUSPNSION/ 7.5MG
|
Facility
|
OP
|
$452.00
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
63600147
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$99.17 |
| Max. Negotiated Rate |
$607.57 |
| Rate for Payer: Aetna American Axle |
$293.80
|
| Rate for Payer: Aetna Commercial |
$384.20
|
| Rate for Payer: Aetna Medicare |
$188.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$293.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$226.63
|
| Rate for Payer: Amish Plain Church Group Commercial |
$226.63
|
| Rate for Payer: BCBS Complete |
$104.14
|
| Rate for Payer: BCBS MAPPO |
$181.30
|
| Rate for Payer: BCBS Trust/PPO |
$607.57
|
| Rate for Payer: BCN Medicare Advantage |
$181.30
|
| Rate for Payer: Cash Price |
$361.60
|
| Rate for Payer: Cash Price |
$361.60
|
| Rate for Payer: Cofinity Commercial |
$316.40
|
| Rate for Payer: Cofinity Commercial |
$388.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$361.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$181.30
|
| Rate for Payer: Healthscope Commercial |
$406.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$316.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$339.00
|
| Rate for Payer: Mclaren Medicaid |
$99.17
|
| Rate for Payer: Mclaren Medicare |
$181.30
|
| Rate for Payer: Meridian Medicaid |
$104.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$190.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$208.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$384.20
|
| Rate for Payer: PACE Medicare |
$172.24
|
| Rate for Payer: PACE SWMI |
$181.30
|
| Rate for Payer: PHP Commercial |
$384.20
|
| Rate for Payer: PHP Medicare Advantage |
$181.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$99.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$316.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$489.52
|
| Rate for Payer: Priority Health Medicare |
$181.30
|
| Rate for Payer: Priority Health Narrow Network |
$391.62
|
| Rate for Payer: Priority Health SBD |
$284.76
|
| Rate for Payer: Railroad Medicare Medicare |
$181.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$181.30
|
| Rate for Payer: UHC Medicare Advantage |
$186.74
|
| Rate for Payer: UMR Bronson Commercial |
$167.24
|
| Rate for Payer: VA VA |
$181.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$339.00
|
|
|
HC LEVEL 0.5 INIT 30 MIN
|
Facility
|
OP
|
$895.03
|
|
| Hospital Charge Code |
36000060
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$331.16 |
| Max. Negotiated Rate |
$805.53 |
| Rate for Payer: Aetna American Axle |
$581.77
|
| Rate for Payer: Aetna Commercial |
$760.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$581.77
|
| Rate for Payer: BCBS Complete |
$358.01
|
| Rate for Payer: Cash Price |
$716.02
|
| Rate for Payer: Cofinity Commercial |
$626.52
|
| Rate for Payer: Cofinity Commercial |
$769.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$716.02
|
| Rate for Payer: Healthscope Commercial |
$805.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$626.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$671.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$760.78
|
| Rate for Payer: PHP Commercial |
$760.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$626.52
|
| Rate for Payer: Priority Health SBD |
$563.87
|
| Rate for Payer: UMR Bronson Commercial |
$331.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$671.27
|
|
|
HC LEVEL 0.5 INIT 30 MIN
|
Facility
|
IP
|
$895.03
|
|
| Hospital Charge Code |
36000060
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$393.81 |
| Max. Negotiated Rate |
$805.53 |
| Rate for Payer: Aetna American Axle |
$581.77
|
| Rate for Payer: Aetna Commercial |
$760.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$581.77
|
| Rate for Payer: Cash Price |
$716.02
|
| Rate for Payer: Cofinity Commercial |
$626.52
|
| Rate for Payer: Cofinity Commercial |
$769.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$716.02
|
| Rate for Payer: Healthscope Commercial |
$805.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$626.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$671.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$760.78
|
| Rate for Payer: PHP Commercial |
$760.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$626.52
|
| Rate for Payer: Priority Health SBD |
$563.87
|
| Rate for Payer: UMR Bronson Commercial |
$393.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$671.27
|
|
|
HC LEVEL 0.5 SUBSQ 15 MIN
|
Facility
|
OP
|
$257.83
|
|
| Hospital Charge Code |
36000061
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$95.40 |
| Max. Negotiated Rate |
$232.05 |
| Rate for Payer: Aetna American Axle |
$167.59
|
| Rate for Payer: Aetna Commercial |
$219.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.59
|
| Rate for Payer: BCBS Complete |
$103.13
|
| Rate for Payer: Cash Price |
$206.26
|
| Rate for Payer: Cofinity Commercial |
$180.48
|
| Rate for Payer: Cofinity Commercial |
$221.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.26
|
| Rate for Payer: Healthscope Commercial |
$232.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$180.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$193.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$219.16
|
| Rate for Payer: PHP Commercial |
$219.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.48
|
| Rate for Payer: Priority Health SBD |
$162.43
|
| Rate for Payer: UMR Bronson Commercial |
$95.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$193.37
|
|
|
HC LEVEL 0.5 SUBSQ 15 MIN
|
Facility
|
IP
|
$257.83
|
|
| Hospital Charge Code |
36000061
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$113.45 |
| Max. Negotiated Rate |
$232.05 |
| Rate for Payer: Aetna American Axle |
$167.59
|
| Rate for Payer: Aetna Commercial |
$219.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.59
|
| Rate for Payer: Cash Price |
$206.26
|
| Rate for Payer: Cofinity Commercial |
$180.48
|
| Rate for Payer: Cofinity Commercial |
$221.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.26
|
| Rate for Payer: Healthscope Commercial |
$232.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$180.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$193.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$219.16
|
| Rate for Payer: PHP Commercial |
$219.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.48
|
| Rate for Payer: Priority Health SBD |
$162.43
|
| Rate for Payer: UMR Bronson Commercial |
$113.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$193.37
|
|
|
HC LEVEL 1 INIT 30 MIN
|
Facility
|
OP
|
$1,975.92
|
|
| Hospital Charge Code |
36000062
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$731.09 |
| Max. Negotiated Rate |
$1,778.33 |
| Rate for Payer: Aetna American Axle |
$1,284.35
|
| Rate for Payer: Aetna Commercial |
$1,679.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,284.35
|
| Rate for Payer: BCBS Complete |
$790.37
|
| Rate for Payer: Cash Price |
$1,580.74
|
| Rate for Payer: Cofinity Commercial |
$1,383.14
|
| Rate for Payer: Cofinity Commercial |
$1,699.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,580.74
|
| Rate for Payer: Healthscope Commercial |
$1,778.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,383.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,481.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,679.53
|
| Rate for Payer: PHP Commercial |
$1,679.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,383.14
|
| Rate for Payer: Priority Health SBD |
$1,244.83
|
| Rate for Payer: UMR Bronson Commercial |
$731.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,481.94
|
|
|
HC LEVEL 1 INIT 30 MIN
|
Facility
|
IP
|
$1,975.92
|
|
| Hospital Charge Code |
36000062
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$869.40 |
| Max. Negotiated Rate |
$1,778.33 |
| Rate for Payer: Aetna American Axle |
$1,284.35
|
| Rate for Payer: Aetna Commercial |
$1,679.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,284.35
|
| Rate for Payer: Cash Price |
$1,580.74
|
| Rate for Payer: Cofinity Commercial |
$1,383.14
|
| Rate for Payer: Cofinity Commercial |
$1,699.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,580.74
|
| Rate for Payer: Healthscope Commercial |
$1,778.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,383.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,481.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,679.53
|
| Rate for Payer: PHP Commercial |
$1,679.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,383.14
|
| Rate for Payer: Priority Health SBD |
$1,244.83
|
| Rate for Payer: UMR Bronson Commercial |
$869.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,481.94
|
|
|
HC LEVEL 1 SUBSQ 15 MIN
|
Facility
|
OP
|
$393.30
|
|
| Hospital Charge Code |
36000063
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$145.52 |
| Max. Negotiated Rate |
$353.97 |
| Rate for Payer: Aetna American Axle |
$255.64
|
| Rate for Payer: Aetna Commercial |
$334.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$255.64
|
| Rate for Payer: BCBS Complete |
$157.32
|
| Rate for Payer: Cash Price |
$314.64
|
| Rate for Payer: Cofinity Commercial |
$275.31
|
| Rate for Payer: Cofinity Commercial |
$338.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$314.64
|
| Rate for Payer: Healthscope Commercial |
$353.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$275.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$294.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$334.30
|
| Rate for Payer: PHP Commercial |
$334.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$275.31
|
| Rate for Payer: Priority Health SBD |
$247.78
|
| Rate for Payer: UMR Bronson Commercial |
$145.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$294.98
|
|
|
HC LEVEL 1 SUBSQ 15 MIN
|
Facility
|
IP
|
$393.30
|
|
| Hospital Charge Code |
36000063
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$173.05 |
| Max. Negotiated Rate |
$353.97 |
| Rate for Payer: Aetna American Axle |
$255.64
|
| Rate for Payer: Aetna Commercial |
$334.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$255.64
|
| Rate for Payer: Cash Price |
$314.64
|
| Rate for Payer: Cofinity Commercial |
$275.31
|
| Rate for Payer: Cofinity Commercial |
$338.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$314.64
|
| Rate for Payer: Healthscope Commercial |
$353.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$275.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$294.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$334.30
|
| Rate for Payer: PHP Commercial |
$334.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$275.31
|
| Rate for Payer: Priority Health SBD |
$247.78
|
| Rate for Payer: UMR Bronson Commercial |
$173.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$294.98
|
|
|
HC LEVEL 2 INIT 30 MIN
|
Facility
|
IP
|
$3,073.19
|
|
| Hospital Charge Code |
36000064
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,352.20 |
| Max. Negotiated Rate |
$2,765.87 |
| Rate for Payer: Aetna American Axle |
$1,997.57
|
| Rate for Payer: Aetna Commercial |
$2,612.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,997.57
|
| Rate for Payer: Cash Price |
$2,458.55
|
| Rate for Payer: Cofinity Commercial |
$2,151.23
|
| Rate for Payer: Cofinity Commercial |
$2,642.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,458.55
|
| Rate for Payer: Healthscope Commercial |
$2,765.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,151.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,304.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,612.21
|
| Rate for Payer: PHP Commercial |
$2,612.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,151.23
|
| Rate for Payer: Priority Health SBD |
$1,936.11
|
| Rate for Payer: UMR Bronson Commercial |
$1,352.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,304.89
|
|
|
HC LEVEL 2 INIT 30 MIN
|
Facility
|
OP
|
$3,073.19
|
|
| Hospital Charge Code |
36000064
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,137.08 |
| Max. Negotiated Rate |
$2,765.87 |
| Rate for Payer: Aetna American Axle |
$1,997.57
|
| Rate for Payer: Aetna Commercial |
$2,612.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,997.57
|
| Rate for Payer: BCBS Complete |
$1,229.28
|
| Rate for Payer: Cash Price |
$2,458.55
|
| Rate for Payer: Cofinity Commercial |
$2,151.23
|
| Rate for Payer: Cofinity Commercial |
$2,642.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,458.55
|
| Rate for Payer: Healthscope Commercial |
$2,765.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,151.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,304.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,612.21
|
| Rate for Payer: PHP Commercial |
$2,612.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,151.23
|
| Rate for Payer: Priority Health SBD |
$1,936.11
|
| Rate for Payer: UMR Bronson Commercial |
$1,137.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,304.89
|
|
