|
HC MASTECTOMY SLEEVE EA $450
|
Facility
|
OP
|
$450.00
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000019
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$161.76 |
| Max. Negotiated Rate |
$405.00 |
| Rate for Payer: Aetna American Axle |
$292.50
|
| Rate for Payer: Aetna Commercial |
$382.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$292.50
|
| Rate for Payer: BCBS Complete |
$180.00
|
| Rate for Payer: BCBS Trust/PPO |
$161.76
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cofinity Commercial |
$315.00
|
| Rate for Payer: Cofinity Commercial |
$387.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.00
|
| Rate for Payer: Healthscope Commercial |
$405.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$315.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$337.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$382.50
|
| Rate for Payer: PHP Commercial |
$382.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.00
|
| Rate for Payer: Priority Health SBD |
$283.50
|
| Rate for Payer: UMR Bronson Commercial |
$166.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$337.50
|
|
|
HC MASTECTOMY SLEEVE EA $450
|
Facility
|
IP
|
$450.00
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000019
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$198.00 |
| Max. Negotiated Rate |
$405.00 |
| Rate for Payer: Aetna American Axle |
$292.50
|
| Rate for Payer: Aetna Commercial |
$382.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$292.50
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cofinity Commercial |
$315.00
|
| Rate for Payer: Cofinity Commercial |
$387.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.00
|
| Rate for Payer: Healthscope Commercial |
$405.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$315.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$337.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$382.50
|
| Rate for Payer: PHP Commercial |
$382.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.00
|
| Rate for Payer: Priority Health SBD |
$283.50
|
| Rate for Payer: UMR Bronson Commercial |
$198.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$337.50
|
|
|
HC MASTECTOMY SLEEVE EA $50
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000020
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$18.50 |
| Max. Negotiated Rate |
$161.76 |
| Rate for Payer: Aetna American Axle |
$32.50
|
| Rate for Payer: Aetna Commercial |
$42.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.50
|
| Rate for Payer: BCBS Complete |
$20.00
|
| Rate for Payer: BCBS Trust/PPO |
$161.76
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cofinity Commercial |
$35.00
|
| Rate for Payer: Cofinity Commercial |
$43.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.00
|
| Rate for Payer: Healthscope Commercial |
$45.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$42.50
|
| Rate for Payer: PHP Commercial |
$42.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.00
|
| Rate for Payer: Priority Health SBD |
$31.50
|
| Rate for Payer: UMR Bronson Commercial |
$18.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.50
|
|
|
HC MASTECTOMY SLEEVE EA $50
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000020
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Aetna American Axle |
$32.50
|
| Rate for Payer: Aetna Commercial |
$42.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.50
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cofinity Commercial |
$35.00
|
| Rate for Payer: Cofinity Commercial |
$43.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.00
|
| Rate for Payer: Healthscope Commercial |
$45.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$42.50
|
| Rate for Payer: PHP Commercial |
$42.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.00
|
| Rate for Payer: Priority Health SBD |
$31.50
|
| Rate for Payer: UMR Bronson Commercial |
$22.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.50
|
|
|
HC MASTECTOMY SLEEVE EA $60
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000021
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$54.00 |
| Rate for Payer: Aetna American Axle |
$39.00
|
| Rate for Payer: Aetna Commercial |
$51.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cofinity Commercial |
$42.00
|
| Rate for Payer: Cofinity Commercial |
$51.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.00
|
| Rate for Payer: Healthscope Commercial |
$54.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.00
|
| Rate for Payer: PHP Commercial |
$51.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.00
|
| Rate for Payer: Priority Health SBD |
$37.80
|
| Rate for Payer: UMR Bronson Commercial |
$26.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.00
|
|
|
HC MASTECTOMY SLEEVE EA $60
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000021
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$22.20 |
| Max. Negotiated Rate |
$161.76 |
| Rate for Payer: Aetna American Axle |
$39.00
|
| Rate for Payer: Aetna Commercial |
$51.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.00
|
| Rate for Payer: BCBS Complete |
$24.00
|
| Rate for Payer: BCBS Trust/PPO |
$161.76
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cofinity Commercial |
$42.00
|
| Rate for Payer: Cofinity Commercial |
$51.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.00
|
| Rate for Payer: Healthscope Commercial |
$54.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.00
|
| Rate for Payer: PHP Commercial |
$51.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.00
|
| Rate for Payer: Priority Health SBD |
$37.80
|
| Rate for Payer: UMR Bronson Commercial |
$22.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.00
|
|
|
HC MASTECTOMY SLEEVE EA $70
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000022
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$25.90 |
| Max. Negotiated Rate |
$161.76 |
| Rate for Payer: Aetna American Axle |
$45.50
|
| Rate for Payer: Aetna Commercial |
$59.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.50
|
| Rate for Payer: BCBS Complete |
$28.00
|
| Rate for Payer: BCBS Trust/PPO |
$161.76
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cofinity Commercial |
$49.00
|
| Rate for Payer: Cofinity Commercial |
$60.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.00
|
| Rate for Payer: Healthscope Commercial |
$63.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.50
|
| Rate for Payer: PHP Commercial |
$59.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.00
|
| Rate for Payer: Priority Health SBD |
$44.10
|
| Rate for Payer: UMR Bronson Commercial |
$25.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.50
|
|
|
HC MASTECTOMY SLEEVE EA $70
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000022
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$30.80 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Aetna American Axle |
$45.50
|
| Rate for Payer: Aetna Commercial |
$59.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.50
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cofinity Commercial |
$49.00
|
| Rate for Payer: Cofinity Commercial |
$60.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.00
|
| Rate for Payer: Healthscope Commercial |
$63.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.50
|
| Rate for Payer: PHP Commercial |
$59.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.00
|
| Rate for Payer: Priority Health SBD |
$44.10
|
| Rate for Payer: UMR Bronson Commercial |
$30.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.50
|
|
|
HC MASTECTOMY SLEEVE EA $80
|
Facility
|
OP
|
$80.00
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000023
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$29.60 |
| Max. Negotiated Rate |
$161.76 |
| Rate for Payer: Aetna American Axle |
$52.00
|
| Rate for Payer: Aetna Commercial |
$68.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.00
|
| Rate for Payer: BCBS Complete |
$32.00
|
| Rate for Payer: BCBS Trust/PPO |
$161.76
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cofinity Commercial |
$56.00
|
| Rate for Payer: Cofinity Commercial |
$68.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.00
|
| Rate for Payer: Healthscope Commercial |
$72.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$68.00
|
| Rate for Payer: PHP Commercial |
$68.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.00
|
| Rate for Payer: Priority Health SBD |
$50.40
|
| Rate for Payer: UMR Bronson Commercial |
$29.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.00
|
|
|
HC MASTECTOMY SLEEVE EA $80
|
Facility
|
IP
|
$80.00
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000023
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$35.20 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Aetna American Axle |
$52.00
|
| Rate for Payer: Aetna Commercial |
$68.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.00
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cofinity Commercial |
$56.00
|
| Rate for Payer: Cofinity Commercial |
$68.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.00
|
| Rate for Payer: Healthscope Commercial |
$72.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$68.00
|
| Rate for Payer: PHP Commercial |
$68.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.00
|
| Rate for Payer: Priority Health SBD |
$50.40
|
| Rate for Payer: UMR Bronson Commercial |
$35.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.00
|
|
|
HC MASTECTOMY SLEEVE EA $90
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000024
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$39.60 |
| Max. Negotiated Rate |
$81.00 |
| Rate for Payer: Aetna American Axle |
$58.50
|
| Rate for Payer: Aetna Commercial |
$76.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.50
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cofinity Commercial |
$63.00
|
| Rate for Payer: Cofinity Commercial |
$77.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.00
|
| Rate for Payer: Healthscope Commercial |
$81.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$63.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.50
|
| Rate for Payer: PHP Commercial |
$76.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.00
|
| Rate for Payer: Priority Health SBD |
$56.70
|
| Rate for Payer: UMR Bronson Commercial |
$39.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.50
|
|
|
HC MASTECTOMY SLEEVE EA $90
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000024
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$33.30 |
| Max. Negotiated Rate |
$161.76 |
| Rate for Payer: Aetna American Axle |
$58.50
|
| Rate for Payer: Aetna Commercial |
$76.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.50
|
| Rate for Payer: BCBS Complete |
$36.00
|
| Rate for Payer: BCBS Trust/PPO |
$161.76
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cofinity Commercial |
$63.00
|
| Rate for Payer: Cofinity Commercial |
$77.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.00
|
| Rate for Payer: Healthscope Commercial |
$81.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$63.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.50
|
| Rate for Payer: PHP Commercial |
$76.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.00
|
| Rate for Payer: Priority Health SBD |
$56.70
|
| Rate for Payer: UMR Bronson Commercial |
$33.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.50
|
|
|
HC MASTOTOMY W/EXPLORATION OR DRAINAGE OF ABSCESS, DEEP
|
Facility
|
OP
|
$2,100.08
|
|
|
Service Code
|
CPT 19020
|
| Hospital Charge Code |
76100281
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$311.72 |
| Max. Negotiated Rate |
$4,536.73 |
| Rate for Payer: Aetna American Axle |
$1,365.05
|
| Rate for Payer: Aetna Commercial |
$1,785.07
|
| Rate for Payer: Aetna Medicare |
$1,498.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,365.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,801.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,801.41
|
| Rate for Payer: BCBS Complete |
$827.79
|
| Rate for Payer: BCBS MAPPO |
$1,441.13
|
| Rate for Payer: BCBS Trust/PPO |
$2,225.96
|
| Rate for Payer: BCN Medicare Advantage |
$1,441.13
|
| Rate for Payer: Cash Price |
$1,680.06
|
| Rate for Payer: Cash Price |
$1,680.06
|
| Rate for Payer: Cofinity Commercial |
$1,470.06
|
| Rate for Payer: Cofinity Commercial |
$1,806.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,680.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,441.13
|
| Rate for Payer: Healthscope Commercial |
$1,890.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,470.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,575.06
|
| Rate for Payer: Mclaren Medicaid |
$788.30
|
| Rate for Payer: Mclaren Medicare |
$1,441.13
|
| Rate for Payer: Meridian Medicaid |
$827.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,513.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,657.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,785.07
|
| Rate for Payer: PACE Medicare |
$1,369.07
|
| Rate for Payer: PACE SWMI |
$1,441.13
|
| Rate for Payer: PHP Commercial |
$1,785.07
|
| Rate for Payer: PHP Medicare Advantage |
$1,441.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$788.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,470.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,536.73
|
| Rate for Payer: Priority Health Medicare |
$1,441.13
|
| Rate for Payer: Priority Health Narrow Network |
$3,629.38
|
| Rate for Payer: Priority Health SBD |
$1,323.05
|
| Rate for Payer: Railroad Medicare Medicare |
$1,441.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$342.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,441.13
|
| Rate for Payer: UHC Exchange |
$311.72
|
| Rate for Payer: UHC Medicare Advantage |
$1,484.36
|
| Rate for Payer: UMR Bronson Commercial |
$777.03
|
| Rate for Payer: VA VA |
$1,441.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,575.06
|
|
|
HC MASTOTOMY W/EXPLORATION OR DRAINAGE OF ABSCESS, DEEP
|
Facility
|
IP
|
$2,100.08
|
|
|
Service Code
|
CPT 19020
|
| Hospital Charge Code |
76100281
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$924.04 |
| Max. Negotiated Rate |
$1,890.07 |
| Rate for Payer: Aetna American Axle |
$1,365.05
|
| Rate for Payer: Aetna Commercial |
$1,785.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,365.05
|
| Rate for Payer: Cash Price |
$1,680.06
|
| Rate for Payer: Cofinity Commercial |
$1,470.06
|
| Rate for Payer: Cofinity Commercial |
$1,806.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,680.06
|
| Rate for Payer: Healthscope Commercial |
$1,890.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,470.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,575.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,785.07
|
| Rate for Payer: PHP Commercial |
$1,785.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,470.06
|
| Rate for Payer: Priority Health SBD |
$1,323.05
|
| Rate for Payer: UMR Bronson Commercial |
$924.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,575.06
|
|
|
HC MATERNAL SCRN INTEGRATED SERUM 1
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
CPT 84163
|
| Hospital Charge Code |
30100641
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.13 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Aetna American Axle |
$71.50
|
| Rate for Payer: Aetna Commercial |
$93.50
|
| Rate for Payer: Aetna Medicare |
$15.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.81
|
| Rate for Payer: BCBS Complete |
$8.64
|
| Rate for Payer: BCBS MAPPO |
$15.05
|
| Rate for Payer: BCBS Trust/PPO |
$13.54
|
| Rate for Payer: BCN Medicare Advantage |
$15.05
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cofinity Commercial |
$77.00
|
| Rate for Payer: Cofinity Commercial |
$94.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.05
|
| Rate for Payer: Healthscope Commercial |
$99.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$77.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.50
|
| Rate for Payer: Mclaren Medicaid |
$8.23
|
| Rate for Payer: Mclaren Medicare |
$15.05
|
| Rate for Payer: Meridian Medicaid |
$8.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$93.50
|
| Rate for Payer: PACE Medicare |
$14.30
|
| Rate for Payer: PACE SWMI |
$15.05
|
| Rate for Payer: PHP Commercial |
$93.50
|
| Rate for Payer: PHP Medicare Advantage |
$15.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7.66
|
| Rate for Payer: Priority Health Medicare |
$15.05
|
| Rate for Payer: Priority Health Narrow Network |
$6.13
|
| Rate for Payer: Priority Health SBD |
$69.30
|
| Rate for Payer: Railroad Medicare Medicare |
$15.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.06
|
| Rate for Payer: UHC Core |
$24.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.05
|
| Rate for Payer: UHC Exchange |
$15.05
|
| Rate for Payer: UHC Medicare Advantage |
$15.50
|
| Rate for Payer: UMR Bronson Commercial |
$40.70
|
| Rate for Payer: VA VA |
$15.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.50
|
|
|
HC MATERNAL SCRN INTEGRATED SERUM 1
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
CPT 84163
|
| Hospital Charge Code |
30100641
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.40 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Aetna American Axle |
$71.50
|
| Rate for Payer: Aetna Commercial |
$93.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.50
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cofinity Commercial |
$77.00
|
| Rate for Payer: Cofinity Commercial |
$94.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.00
|
| Rate for Payer: Healthscope Commercial |
$99.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$77.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$93.50
|
| Rate for Payer: PHP Commercial |
$93.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.00
|
| Rate for Payer: Priority Health SBD |
$69.30
|
| Rate for Payer: UMR Bronson Commercial |
$48.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.50
|
|
|
HC MATERNAL SCRN INTEGRATED SERUM 2
|
Facility
|
OP
|
$237.60
|
|
|
Service Code
|
CPT 81511
|
| Hospital Charge Code |
30100654
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.53 |
| Max. Negotiated Rate |
$213.84 |
| Rate for Payer: Aetna American Axle |
$154.44
|
| Rate for Payer: Aetna Commercial |
$201.96
|
| Rate for Payer: Aetna Medicare |
$159.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$154.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$191.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$191.88
|
| Rate for Payer: BCBS Complete |
$88.17
|
| Rate for Payer: BCBS MAPPO |
$153.50
|
| Rate for Payer: BCBS Trust/PPO |
$138.05
|
| Rate for Payer: BCN Medicare Advantage |
$153.50
|
| Rate for Payer: Cash Price |
$190.08
|
| Rate for Payer: Cash Price |
$190.08
|
| Rate for Payer: Cofinity Commercial |
$204.34
|
| Rate for Payer: Cofinity Commercial |
$166.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$153.50
|
| Rate for Payer: Healthscope Commercial |
$213.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$166.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$178.20
|
| Rate for Payer: Mclaren Medicaid |
$83.96
|
| Rate for Payer: Mclaren Medicare |
$153.50
|
| Rate for Payer: Meridian Medicaid |
$88.17
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$161.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$176.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$201.96
|
| Rate for Payer: PACE Medicare |
$145.82
|
| Rate for Payer: PACE SWMI |
$153.50
|
| Rate for Payer: PHP Commercial |
$201.96
|
| Rate for Payer: PHP Medicare Advantage |
$153.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$83.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24.41
|
| Rate for Payer: Priority Health Medicare |
$153.50
|
| Rate for Payer: Priority Health Narrow Network |
$19.53
|
| Rate for Payer: Priority Health SBD |
$149.69
|
| Rate for Payer: Railroad Medicare Medicare |
$153.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$184.20
|
| Rate for Payer: UHC Core |
$184.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$153.50
|
| Rate for Payer: UHC Exchange |
$153.50
|
| Rate for Payer: UHC Medicare Advantage |
$158.10
|
| Rate for Payer: UMR Bronson Commercial |
$87.91
|
| Rate for Payer: VA VA |
$153.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$178.20
|
|
|
HC MATERNAL SCRN INTEGRATED SERUM 2
|
Facility
|
IP
|
$237.60
|
|
|
Service Code
|
CPT 81511
|
| Hospital Charge Code |
30100654
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$104.54 |
| Max. Negotiated Rate |
$213.84 |
| Rate for Payer: Aetna American Axle |
$154.44
|
| Rate for Payer: Aetna Commercial |
$201.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$154.44
|
| Rate for Payer: Cash Price |
$190.08
|
| Rate for Payer: Cofinity Commercial |
$166.32
|
| Rate for Payer: Cofinity Commercial |
$204.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.08
|
| Rate for Payer: Healthscope Commercial |
$213.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$166.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$178.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$201.96
|
| Rate for Payer: PHP Commercial |
$201.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.32
|
| Rate for Payer: Priority Health SBD |
$149.69
|
| Rate for Payer: UMR Bronson Commercial |
$104.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$178.20
|
|
|
HC MAXIMUM VOLUNTARY VENTILATION
|
Facility
|
OP
|
$120.23
|
|
|
Service Code
|
CPT 94200
|
| Hospital Charge Code |
46000022
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$14.73 |
| Max. Negotiated Rate |
$294.00 |
| Rate for Payer: Aetna American Axle |
$78.15
|
| Rate for Payer: Aetna Commercial |
$102.20
|
| Rate for Payer: Aetna Medicare |
$56.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$67.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$67.96
|
| Rate for Payer: BCBS Complete |
$31.23
|
| Rate for Payer: BCBS MAPPO |
$54.37
|
| Rate for Payer: BCBS Trust/PPO |
$60.33
|
| Rate for Payer: BCN Medicare Advantage |
$54.37
|
| Rate for Payer: Cash Price |
$96.18
|
| Rate for Payer: Cash Price |
$96.18
|
| Rate for Payer: Cash Price |
$96.18
|
| Rate for Payer: Cofinity Commercial |
$103.40
|
| Rate for Payer: Cofinity Commercial |
$84.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.37
|
| Rate for Payer: Healthscope Commercial |
$108.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$84.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.17
|
| Rate for Payer: Mclaren Medicaid |
$29.74
|
| Rate for Payer: Mclaren Medicare |
$54.37
|
| Rate for Payer: Meridian Medicaid |
$31.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$57.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$102.20
|
| Rate for Payer: PACE Medicare |
$51.65
|
| Rate for Payer: PACE SWMI |
$54.37
|
| Rate for Payer: PHP Commercial |
$102.20
|
| Rate for Payer: PHP Medicare Advantage |
$54.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$171.15
|
| Rate for Payer: Priority Health Medicare |
$54.37
|
| Rate for Payer: Priority Health Narrow Network |
$136.92
|
| Rate for Payer: Priority Health SBD |
$75.74
|
| Rate for Payer: Railroad Medicare Medicare |
$54.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.20
|
| Rate for Payer: UHC Core |
$294.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$54.37
|
| Rate for Payer: UHC Exchange |
$14.73
|
| Rate for Payer: UHC Medicare Advantage |
$56.00
|
| Rate for Payer: UMR Bronson Commercial |
$44.49
|
| Rate for Payer: VA VA |
$54.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.17
|
|
|
HC MAXIMUM VOLUNTARY VENTILATION
|
Facility
|
IP
|
$120.23
|
|
|
Service Code
|
CPT 94200
|
| Hospital Charge Code |
46000022
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$52.90 |
| Max. Negotiated Rate |
$108.21 |
| Rate for Payer: Aetna American Axle |
$78.15
|
| Rate for Payer: Aetna Commercial |
$102.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.15
|
| Rate for Payer: Cash Price |
$96.18
|
| Rate for Payer: Cofinity Commercial |
$103.40
|
| Rate for Payer: Cofinity Commercial |
$84.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.18
|
| Rate for Payer: Healthscope Commercial |
$108.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$84.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$102.20
|
| Rate for Payer: PHP Commercial |
$102.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.16
|
| Rate for Payer: Priority Health SBD |
$75.74
|
| Rate for Payer: UMR Bronson Commercial |
$52.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.17
|
|
|
HC MAYO CHROMOGENIC FACTOR 8
|
Facility
|
IP
|
$331.60
|
|
|
Service Code
|
CPT 85130
|
| Hospital Charge Code |
30500105
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$145.90 |
| Max. Negotiated Rate |
$298.44 |
| Rate for Payer: Aetna American Axle |
$215.54
|
| Rate for Payer: Aetna Commercial |
$281.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$215.54
|
| Rate for Payer: Cash Price |
$265.28
|
| Rate for Payer: Cofinity Commercial |
$232.12
|
| Rate for Payer: Cofinity Commercial |
$285.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$265.28
|
| Rate for Payer: Healthscope Commercial |
$298.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$232.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$248.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$281.86
|
| Rate for Payer: PHP Commercial |
$281.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.12
|
| Rate for Payer: Priority Health SBD |
$208.91
|
| Rate for Payer: UMR Bronson Commercial |
$145.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$248.70
|
|
|
HC MAYO CHROMOGENIC FACTOR 8
|
Facility
|
OP
|
$331.60
|
|
|
Service Code
|
CPT 85130
|
| Hospital Charge Code |
30500105
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.45 |
| Max. Negotiated Rate |
$298.44 |
| Rate for Payer: Aetna American Axle |
$215.54
|
| Rate for Payer: Aetna Commercial |
$281.86
|
| Rate for Payer: Aetna Medicare |
$12.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$215.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.86
|
| Rate for Payer: BCBS Complete |
$6.83
|
| Rate for Payer: BCBS MAPPO |
$11.89
|
| Rate for Payer: BCBS Trust/PPO |
$10.70
|
| Rate for Payer: BCN Medicare Advantage |
$11.89
|
| Rate for Payer: Cash Price |
$265.28
|
| Rate for Payer: Cash Price |
$265.28
|
| Rate for Payer: Cofinity Commercial |
$232.12
|
| Rate for Payer: Cofinity Commercial |
$285.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$265.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.89
|
| Rate for Payer: Healthscope Commercial |
$298.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$232.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$248.70
|
| Rate for Payer: Mclaren Medicaid |
$6.50
|
| Rate for Payer: Mclaren Medicare |
$11.89
|
| Rate for Payer: Meridian Medicaid |
$6.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$281.86
|
| Rate for Payer: PACE Medicare |
$11.30
|
| Rate for Payer: PACE SWMI |
$11.89
|
| Rate for Payer: PHP Commercial |
$281.86
|
| Rate for Payer: PHP Medicare Advantage |
$11.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.56
|
| Rate for Payer: Priority Health Medicare |
$11.89
|
| Rate for Payer: Priority Health Narrow Network |
$4.45
|
| Rate for Payer: Priority Health SBD |
$208.91
|
| Rate for Payer: Railroad Medicare Medicare |
$11.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.27
|
| Rate for Payer: UHC Core |
$19.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.89
|
| Rate for Payer: UHC Exchange |
$11.89
|
| Rate for Payer: UHC Medicare Advantage |
$12.25
|
| Rate for Payer: UMR Bronson Commercial |
$122.69
|
| Rate for Payer: VA VA |
$11.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$248.70
|
|
|
HC MAYO CHROMOGENIC FACTOR 9
|
Facility
|
OP
|
$351.53
|
|
|
Service Code
|
CPT 85130
|
| Hospital Charge Code |
30500104
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.45 |
| Max. Negotiated Rate |
$316.38 |
| Rate for Payer: Aetna American Axle |
$228.49
|
| Rate for Payer: Aetna Commercial |
$298.80
|
| Rate for Payer: Aetna Medicare |
$12.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$228.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.86
|
| Rate for Payer: BCBS Complete |
$6.83
|
| Rate for Payer: BCBS MAPPO |
$11.89
|
| Rate for Payer: BCBS Trust/PPO |
$10.70
|
| Rate for Payer: BCN Medicare Advantage |
$11.89
|
| Rate for Payer: Cash Price |
$281.22
|
| Rate for Payer: Cash Price |
$281.22
|
| Rate for Payer: Cofinity Commercial |
$246.07
|
| Rate for Payer: Cofinity Commercial |
$302.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$281.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.89
|
| Rate for Payer: Healthscope Commercial |
$316.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$246.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$263.65
|
| Rate for Payer: Mclaren Medicaid |
$6.50
|
| Rate for Payer: Mclaren Medicare |
$11.89
|
| Rate for Payer: Meridian Medicaid |
$6.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$298.80
|
| Rate for Payer: PACE Medicare |
$11.30
|
| Rate for Payer: PACE SWMI |
$11.89
|
| Rate for Payer: PHP Commercial |
$298.80
|
| Rate for Payer: PHP Medicare Advantage |
$11.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$246.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.56
|
| Rate for Payer: Priority Health Medicare |
$11.89
|
| Rate for Payer: Priority Health Narrow Network |
$4.45
|
| Rate for Payer: Priority Health SBD |
$221.46
|
| Rate for Payer: Railroad Medicare Medicare |
$11.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.27
|
| Rate for Payer: UHC Core |
$19.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.89
|
| Rate for Payer: UHC Exchange |
$11.89
|
| Rate for Payer: UHC Medicare Advantage |
$12.25
|
| Rate for Payer: UMR Bronson Commercial |
$130.07
|
| Rate for Payer: VA VA |
$11.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$263.65
|
|
|
HC MAYO CHROMOGENIC FACTOR 9
|
Facility
|
IP
|
$351.53
|
|
|
Service Code
|
CPT 85130
|
| Hospital Charge Code |
30500104
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$154.67 |
| Max. Negotiated Rate |
$316.38 |
| Rate for Payer: Aetna American Axle |
$228.49
|
| Rate for Payer: Aetna Commercial |
$298.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$228.49
|
| Rate for Payer: Cash Price |
$281.22
|
| Rate for Payer: Cofinity Commercial |
$302.32
|
| Rate for Payer: Cofinity Commercial |
$246.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$281.22
|
| Rate for Payer: Healthscope Commercial |
$316.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$246.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$263.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$298.80
|
| Rate for Payer: PHP Commercial |
$298.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$246.07
|
| Rate for Payer: Priority Health SBD |
$221.46
|
| Rate for Payer: UMR Bronson Commercial |
$154.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$263.65
|
|
|
HC MAYOCOMPLETE MYELOID NEOPLASMS, NGS
|
Facility
|
OP
|
$1,925.00
|
|
|
Service Code
|
CPT 81450
|
| Hospital Charge Code |
31000084
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$107.80 |
| Max. Negotiated Rate |
$1,732.50 |
| Rate for Payer: Aetna American Axle |
$1,251.25
|
| Rate for Payer: Aetna Commercial |
$1,636.25
|
| Rate for Payer: Aetna Medicare |
$789.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,251.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$949.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$949.41
|
| Rate for Payer: BCBS Complete |
$436.27
|
| Rate for Payer: BCBS MAPPO |
$759.53
|
| Rate for Payer: BCBS Trust/PPO |
$910.75
|
| Rate for Payer: BCN Medicare Advantage |
$759.53
|
| Rate for Payer: Cash Price |
$1,540.00
|
| Rate for Payer: Cash Price |
$1,540.00
|
| Rate for Payer: Cofinity Commercial |
$1,655.50
|
| Rate for Payer: Cofinity Commercial |
$1,347.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,540.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$759.53
|
| Rate for Payer: Healthscope Commercial |
$1,732.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,347.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,443.75
|
| Rate for Payer: Mclaren Medicaid |
$415.46
|
| Rate for Payer: Mclaren Medicare |
$759.53
|
| Rate for Payer: Meridian Medicaid |
$436.27
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$797.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$873.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,636.25
|
| Rate for Payer: PACE Medicare |
$721.55
|
| Rate for Payer: PACE SWMI |
$759.53
|
| Rate for Payer: PHP Commercial |
$1,636.25
|
| Rate for Payer: PHP Medicare Advantage |
$759.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$415.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,347.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$652.94
|
| Rate for Payer: Priority Health Medicare |
$759.53
|
| Rate for Payer: Priority Health Narrow Network |
$522.35
|
| Rate for Payer: Priority Health SBD |
$1,212.75
|
| Rate for Payer: Railroad Medicare Medicare |
$759.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$911.44
|
| Rate for Payer: UHC Core |
$107.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$759.53
|
| Rate for Payer: UHC Exchange |
$759.53
|
| Rate for Payer: UHC Medicare Advantage |
$782.32
|
| Rate for Payer: UMR Bronson Commercial |
$712.25
|
| Rate for Payer: VA VA |
$759.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,443.75
|
|
