|
HC MECONIUM DRUG SCRN EA
|
Facility
|
OP
|
$92.68
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000144
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.99 |
| Max. Negotiated Rate |
$95.77 |
| Rate for Payer: Aetna American Axle |
$60.24
|
| Rate for Payer: Aetna Commercial |
$78.78
|
| Rate for Payer: Aetna Medicare |
$64.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.68
|
| Rate for Payer: BCBS Complete |
$35.69
|
| Rate for Payer: BCBS MAPPO |
$62.14
|
| Rate for Payer: BCBS Trust/PPO |
$55.89
|
| Rate for Payer: BCN Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$74.14
|
| Rate for Payer: Cash Price |
$74.14
|
| Rate for Payer: Cofinity Commercial |
$64.88
|
| Rate for Payer: Cofinity Commercial |
$79.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Healthscope Commercial |
$83.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$64.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.51
|
| Rate for Payer: Mclaren Medicaid |
$33.99
|
| Rate for Payer: Mclaren Medicare |
$62.14
|
| Rate for Payer: Meridian Medicaid |
$35.69
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$65.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$78.78
|
| Rate for Payer: PACE Medicare |
$59.03
|
| Rate for Payer: PACE SWMI |
$62.14
|
| Rate for Payer: PHP Commercial |
$78.78
|
| Rate for Payer: PHP Medicare Advantage |
$62.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$48.58
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: Priority Health Narrow Network |
$38.86
|
| Rate for Payer: Priority Health SBD |
$58.39
|
| Rate for Payer: Railroad Medicare Medicare |
$62.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.57
|
| Rate for Payer: UHC Core |
$95.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.14
|
| Rate for Payer: UHC Exchange |
$62.14
|
| Rate for Payer: UHC Medicare Advantage |
$64.00
|
| Rate for Payer: UMR Bronson Commercial |
$34.29
|
| Rate for Payer: VA VA |
$62.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.51
|
|
|
HC MECONIUM DRUG SCRN EA
|
Facility
|
IP
|
$92.68
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000144
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.78 |
| Max. Negotiated Rate |
$83.41 |
| Rate for Payer: Aetna American Axle |
$60.24
|
| Rate for Payer: Aetna Commercial |
$78.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.24
|
| Rate for Payer: Cash Price |
$74.14
|
| Rate for Payer: Cofinity Commercial |
$64.88
|
| Rate for Payer: Cofinity Commercial |
$79.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.14
|
| Rate for Payer: Healthscope Commercial |
$83.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$64.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$78.78
|
| Rate for Payer: PHP Commercial |
$78.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.88
|
| Rate for Payer: Priority Health SBD |
$58.39
|
| Rate for Payer: UMR Bronson Commercial |
$40.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.51
|
|
|
HC MECONIUM DRUG SCRN MULTI DRUGS.
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100653
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$44.88 |
| Max. Negotiated Rate |
$91.80 |
| Rate for Payer: Aetna American Axle |
$66.30
|
| Rate for Payer: Aetna Commercial |
$86.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.30
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cofinity Commercial |
$71.40
|
| Rate for Payer: Cofinity Commercial |
$87.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.60
|
| Rate for Payer: Healthscope Commercial |
$91.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$71.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$86.70
|
| Rate for Payer: PHP Commercial |
$86.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.40
|
| Rate for Payer: Priority Health SBD |
$64.26
|
| Rate for Payer: UMR Bronson Commercial |
$44.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.50
|
|
|
HC MECONIUM DRUG SCRN MULTI DRUGS.
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100653
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.99 |
| Max. Negotiated Rate |
$95.77 |
| Rate for Payer: Aetna American Axle |
$66.30
|
| Rate for Payer: Aetna Commercial |
$86.70
|
| Rate for Payer: Aetna Medicare |
$64.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.68
|
| Rate for Payer: BCBS Complete |
$35.69
|
| Rate for Payer: BCBS MAPPO |
$62.14
|
| Rate for Payer: BCBS Trust/PPO |
$55.89
|
| Rate for Payer: BCN Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cofinity Commercial |
$71.40
|
| Rate for Payer: Cofinity Commercial |
$87.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Healthscope Commercial |
$91.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$71.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.50
|
| Rate for Payer: Mclaren Medicaid |
$33.99
|
| Rate for Payer: Mclaren Medicare |
$62.14
|
| Rate for Payer: Meridian Medicaid |
$35.69
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$65.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$86.70
|
| Rate for Payer: PACE Medicare |
$59.03
|
| Rate for Payer: PACE SWMI |
$62.14
|
| Rate for Payer: PHP Commercial |
$86.70
|
| Rate for Payer: PHP Medicare Advantage |
$62.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$48.58
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: Priority Health Narrow Network |
$38.86
|
| Rate for Payer: Priority Health SBD |
$64.26
|
| Rate for Payer: Railroad Medicare Medicare |
$62.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.57
|
| Rate for Payer: UHC Core |
$95.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.14
|
| Rate for Payer: UHC Exchange |
$62.14
|
| Rate for Payer: UHC Medicare Advantage |
$64.00
|
| Rate for Payer: UMR Bronson Commercial |
$37.74
|
| Rate for Payer: VA VA |
$62.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.50
|
|
|
HC MECONIUM OPIATES CONFIRMATION
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
30100577
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$50.60 |
| Max. Negotiated Rate |
$103.50 |
| Rate for Payer: Aetna American Axle |
$74.75
|
| Rate for Payer: Aetna Commercial |
$97.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.75
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cofinity Commercial |
$80.50
|
| Rate for Payer: Cofinity Commercial |
$98.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.00
|
| Rate for Payer: Healthscope Commercial |
$103.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$80.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$97.75
|
| Rate for Payer: PHP Commercial |
$97.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.50
|
| Rate for Payer: Priority Health SBD |
$72.45
|
| Rate for Payer: UMR Bronson Commercial |
$50.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.25
|
|
|
HC MECONIUM OPIATES CONFIRMATION
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
30100577
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$41.98 |
| Max. Negotiated Rate |
$103.50 |
| Rate for Payer: Aetna American Axle |
$74.75
|
| Rate for Payer: Aetna Commercial |
$97.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.75
|
| Rate for Payer: BCBS Complete |
$46.00
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cofinity Commercial |
$98.90
|
| Rate for Payer: Cofinity Commercial |
$80.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.00
|
| Rate for Payer: Healthscope Commercial |
$103.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$80.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$97.75
|
| Rate for Payer: PHP Commercial |
$97.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.50
|
| Rate for Payer: Priority Health SBD |
$72.45
|
| Rate for Payer: UHC Core |
$41.98
|
| Rate for Payer: UMR Bronson Commercial |
$42.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.25
|
|
|
HC MECONIUM OXYCODONE CONFIRMATION
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
CPT 80365
|
| Hospital Charge Code |
30000104
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.91 |
| Max. Negotiated Rate |
$103.50 |
| Rate for Payer: Aetna American Axle |
$74.75
|
| Rate for Payer: Aetna Commercial |
$97.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.75
|
| Rate for Payer: BCBS Complete |
$46.00
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cofinity Commercial |
$80.50
|
| Rate for Payer: Cofinity Commercial |
$98.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.00
|
| Rate for Payer: Healthscope Commercial |
$103.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$80.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$97.75
|
| Rate for Payer: PHP Commercial |
$97.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.50
|
| Rate for Payer: Priority Health SBD |
$72.45
|
| Rate for Payer: UHC Core |
$31.91
|
| Rate for Payer: UMR Bronson Commercial |
$42.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.25
|
|
|
HC MECONIUM OXYCODONE CONFIRMATION
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
CPT 80365
|
| Hospital Charge Code |
30000104
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$50.60 |
| Max. Negotiated Rate |
$103.50 |
| Rate for Payer: Aetna American Axle |
$74.75
|
| Rate for Payer: Aetna Commercial |
$97.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.75
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cofinity Commercial |
$80.50
|
| Rate for Payer: Cofinity Commercial |
$98.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.00
|
| Rate for Payer: Healthscope Commercial |
$103.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$80.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$97.75
|
| Rate for Payer: PHP Commercial |
$97.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.50
|
| Rate for Payer: Priority Health SBD |
$72.45
|
| Rate for Payer: UMR Bronson Commercial |
$50.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.25
|
|
|
HC MECONIUM THC CONFIRMATION
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
CPT 80349
|
| Hospital Charge Code |
30100567
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$50.60 |
| Max. Negotiated Rate |
$103.50 |
| Rate for Payer: Aetna American Axle |
$74.75
|
| Rate for Payer: Aetna Commercial |
$97.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.75
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cofinity Commercial |
$80.50
|
| Rate for Payer: Cofinity Commercial |
$98.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.00
|
| Rate for Payer: Healthscope Commercial |
$103.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$80.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$97.75
|
| Rate for Payer: PHP Commercial |
$97.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.50
|
| Rate for Payer: Priority Health SBD |
$72.45
|
| Rate for Payer: UMR Bronson Commercial |
$50.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.25
|
|
|
HC MECONIUM THC CONFIRMATION
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
CPT 80349
|
| Hospital Charge Code |
30100567
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.32 |
| Max. Negotiated Rate |
$103.50 |
| Rate for Payer: Aetna American Axle |
$74.75
|
| Rate for Payer: Aetna Commercial |
$97.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.75
|
| Rate for Payer: BCBS Complete |
$46.00
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cofinity Commercial |
$98.90
|
| Rate for Payer: Cofinity Commercial |
$80.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.00
|
| Rate for Payer: Healthscope Commercial |
$103.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$80.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$97.75
|
| Rate for Payer: PHP Commercial |
$97.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.50
|
| Rate for Payer: Priority Health SBD |
$72.45
|
| Rate for Payer: UHC Core |
$29.32
|
| Rate for Payer: UMR Bronson Commercial |
$42.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.25
|
|
|
HC MECONIUM TRAMADOL CONFIRMATION
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
CPT 80373
|
| Hospital Charge Code |
30000101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$50.60 |
| Max. Negotiated Rate |
$103.50 |
| Rate for Payer: Aetna American Axle |
$74.75
|
| Rate for Payer: Aetna Commercial |
$97.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.75
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cofinity Commercial |
$80.50
|
| Rate for Payer: Cofinity Commercial |
$98.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.00
|
| Rate for Payer: Healthscope Commercial |
$103.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$80.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$97.75
|
| Rate for Payer: PHP Commercial |
$97.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.50
|
| Rate for Payer: Priority Health SBD |
$72.45
|
| Rate for Payer: UMR Bronson Commercial |
$50.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.25
|
|
|
HC MECONIUM TRAMADOL CONFIRMATION
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
CPT 80373
|
| Hospital Charge Code |
30000101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.87 |
| Max. Negotiated Rate |
$103.50 |
| Rate for Payer: Aetna American Axle |
$74.75
|
| Rate for Payer: Aetna Commercial |
$97.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.75
|
| Rate for Payer: BCBS Complete |
$46.00
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cofinity Commercial |
$80.50
|
| Rate for Payer: Cofinity Commercial |
$98.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.00
|
| Rate for Payer: Healthscope Commercial |
$103.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$80.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$97.75
|
| Rate for Payer: PHP Commercial |
$97.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.50
|
| Rate for Payer: Priority Health SBD |
$72.45
|
| Rate for Payer: UHC Core |
$25.87
|
| Rate for Payer: UMR Bronson Commercial |
$42.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.25
|
|
|
HC MEDICAL NUTRITION TX EACH 15"
|
Facility
|
IP
|
$63.86
|
|
|
Service Code
|
HCPCS G0270
|
| Hospital Charge Code |
94200008
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$28.10 |
| Max. Negotiated Rate |
$57.47 |
| Rate for Payer: Aetna American Axle |
$41.51
|
| Rate for Payer: Aetna Commercial |
$54.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.51
|
| Rate for Payer: Cash Price |
$51.09
|
| Rate for Payer: Cofinity Commercial |
$44.70
|
| Rate for Payer: Cofinity Commercial |
$54.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.09
|
| Rate for Payer: Healthscope Commercial |
$57.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$54.28
|
| Rate for Payer: PHP Commercial |
$54.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.70
|
| Rate for Payer: Priority Health SBD |
$40.23
|
| Rate for Payer: UMR Bronson Commercial |
$28.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.90
|
|
|
HC MEDICAL NUTRITION TX EACH 15"
|
Facility
|
OP
|
$63.86
|
|
|
Service Code
|
HCPCS G0270
|
| Hospital Charge Code |
94200008
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$10.89 |
| Max. Negotiated Rate |
$294.00 |
| Rate for Payer: Aetna American Axle |
$41.51
|
| Rate for Payer: Aetna Commercial |
$54.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.51
|
| Rate for Payer: BCBS Complete |
$25.54
|
| Rate for Payer: BCBS Trust/PPO |
$82.12
|
| Rate for Payer: Cash Price |
$51.09
|
| Rate for Payer: Cash Price |
$51.09
|
| Rate for Payer: Cash Price |
$51.09
|
| Rate for Payer: Cofinity Commercial |
$54.92
|
| Rate for Payer: Cofinity Commercial |
$44.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.09
|
| Rate for Payer: Healthscope Commercial |
$57.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$54.28
|
| Rate for Payer: PHP Commercial |
$54.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.61
|
| Rate for Payer: Priority Health Narrow Network |
$10.89
|
| Rate for Payer: Priority Health SBD |
$40.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.17
|
| Rate for Payer: UHC Core |
$294.00
|
| Rate for Payer: UHC Exchange |
$26.52
|
| Rate for Payer: UMR Bronson Commercial |
$23.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.90
|
|
|
HC MED PHYSIC DOS EVAL RAD EXPS
|
Facility
|
OP
|
$258.81
|
|
|
Service Code
|
CPT 76145
|
| Hospital Charge Code |
32000333
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$95.76 |
| Max. Negotiated Rate |
$1,729.41 |
| Rate for Payer: Aetna American Axle |
$168.23
|
| Rate for Payer: Aetna Commercial |
$219.99
|
| Rate for Payer: Aetna Medicare |
$495.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$595.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$595.52
|
| Rate for Payer: BCBS Complete |
$273.66
|
| Rate for Payer: BCBS MAPPO |
$476.42
|
| Rate for Payer: BCBS Trust/PPO |
$1,729.41
|
| Rate for Payer: BCN Medicare Advantage |
$476.42
|
| Rate for Payer: Cash Price |
$207.05
|
| Rate for Payer: Cash Price |
$207.05
|
| Rate for Payer: Cofinity Commercial |
$222.58
|
| Rate for Payer: Cofinity Commercial |
$181.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$207.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$476.42
|
| Rate for Payer: Healthscope Commercial |
$232.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$181.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$194.11
|
| Rate for Payer: Mclaren Medicaid |
$260.60
|
| Rate for Payer: Mclaren Medicare |
$476.42
|
| Rate for Payer: Meridian Medicaid |
$273.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$500.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$547.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$219.99
|
| Rate for Payer: PACE Medicare |
$452.60
|
| Rate for Payer: PACE SWMI |
$476.42
|
| Rate for Payer: PHP Commercial |
$219.99
|
| Rate for Payer: PHP Medicare Advantage |
$476.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$260.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$181.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,499.80
|
| Rate for Payer: Priority Health Medicare |
$476.42
|
| Rate for Payer: Priority Health Narrow Network |
$1,199.84
|
| Rate for Payer: Priority Health SBD |
$163.05
|
| Rate for Payer: Railroad Medicare Medicare |
$476.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$979.70
|
| Rate for Payer: UHC Core |
$262.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$476.42
|
| Rate for Payer: UHC Exchange |
$890.64
|
| Rate for Payer: UHC Medicare Advantage |
$490.71
|
| Rate for Payer: UMR Bronson Commercial |
$95.76
|
| Rate for Payer: VA VA |
$476.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$194.11
|
|
|
HC MED PHYSIC DOS EVAL RAD EXPS
|
Facility
|
IP
|
$258.81
|
|
|
Service Code
|
CPT 76145
|
| Hospital Charge Code |
32000333
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$113.88 |
| Max. Negotiated Rate |
$232.93 |
| Rate for Payer: Aetna American Axle |
$168.23
|
| Rate for Payer: Aetna Commercial |
$219.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.23
|
| Rate for Payer: Cash Price |
$207.05
|
| Rate for Payer: Cofinity Commercial |
$181.17
|
| Rate for Payer: Cofinity Commercial |
$222.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$207.05
|
| Rate for Payer: Healthscope Commercial |
$232.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$181.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$194.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$219.99
|
| Rate for Payer: PHP Commercial |
$219.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$181.17
|
| Rate for Payer: Priority Health SBD |
$163.05
|
| Rate for Payer: UMR Bronson Commercial |
$113.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$194.11
|
|
|
HC MED SURG ROOM & BOARD
|
Facility
|
IP
|
$3,291.02
|
|
| Hospital Charge Code |
11000001
|
|
Hospital Revenue Code
|
110
|
| Min. Negotiated Rate |
$1,448.05 |
| Max. Negotiated Rate |
$2,961.92 |
| Rate for Payer: Aetna American Axle |
$2,139.16
|
| Rate for Payer: Aetna Commercial |
$2,797.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,139.16
|
| Rate for Payer: Cash Price |
$2,632.82
|
| Rate for Payer: Cofinity Commercial |
$2,303.71
|
| Rate for Payer: Cofinity Commercial |
$2,830.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,632.82
|
| Rate for Payer: Healthscope Commercial |
$2,961.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,303.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,468.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,797.37
|
| Rate for Payer: PHP Commercial |
$2,797.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,303.71
|
| Rate for Payer: Priority Health SBD |
$2,073.34
|
| Rate for Payer: UMR Bronson Commercial |
$1,448.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,468.26
|
|
|
HC MED SURVEILLANCE SH
|
Facility
|
IP
|
$48.00
|
|
|
Service Code
|
HCPCS G0435
|
| Hospital Charge Code |
30200415
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$21.12 |
| Max. Negotiated Rate |
$43.20 |
| Rate for Payer: Aetna American Axle |
$31.20
|
| Rate for Payer: Aetna Commercial |
$40.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.20
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cofinity Commercial |
$33.60
|
| Rate for Payer: Cofinity Commercial |
$41.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.40
|
| Rate for Payer: Healthscope Commercial |
$43.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40.80
|
| Rate for Payer: PHP Commercial |
$40.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.60
|
| Rate for Payer: Priority Health SBD |
$30.24
|
| Rate for Payer: UMR Bronson Commercial |
$21.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.00
|
|
|
HC MED SURVEILLANCE SH
|
Facility
|
OP
|
$48.00
|
|
|
Service Code
|
HCPCS G0435
|
| Hospital Charge Code |
30200415
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.55 |
| Max. Negotiated Rate |
$43.20 |
| Rate for Payer: Aetna American Axle |
$31.20
|
| Rate for Payer: Aetna Commercial |
$40.80
|
| Rate for Payer: Aetna Medicare |
$12.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.98
|
| Rate for Payer: BCBS Complete |
$6.88
|
| Rate for Payer: BCBS MAPPO |
$11.98
|
| Rate for Payer: BCBS Trust/PPO |
$10.78
|
| Rate for Payer: BCN Medicare Advantage |
$11.98
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cofinity Commercial |
$41.28
|
| Rate for Payer: Cofinity Commercial |
$33.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.98
|
| Rate for Payer: Healthscope Commercial |
$43.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.00
|
| Rate for Payer: Mclaren Medicaid |
$6.55
|
| Rate for Payer: Mclaren Medicare |
$11.98
|
| Rate for Payer: Meridian Medicaid |
$6.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40.80
|
| Rate for Payer: PACE Medicare |
$11.38
|
| Rate for Payer: PACE SWMI |
$11.98
|
| Rate for Payer: PHP Commercial |
$40.80
|
| Rate for Payer: PHP Medicare Advantage |
$11.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.44
|
| Rate for Payer: Priority Health Medicare |
$11.98
|
| Rate for Payer: Priority Health Narrow Network |
$13.15
|
| Rate for Payer: Priority Health SBD |
$30.24
|
| Rate for Payer: Railroad Medicare Medicare |
$11.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.38
|
| Rate for Payer: UHC Core |
$19.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.98
|
| Rate for Payer: UHC Exchange |
$11.98
|
| Rate for Payer: UHC Medicare Advantage |
$12.34
|
| Rate for Payer: UMR Bronson Commercial |
$17.76
|
| Rate for Payer: VA VA |
$11.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.00
|
|
|
HC MEDTRONIC CRT ICD
|
Facility
|
OP
|
$29,376.00
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27500006
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$26,438.40 |
| Rate for Payer: Aetna American Axle |
$19,094.40
|
| Rate for Payer: Aetna Commercial |
$24,969.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19,094.40
|
| Rate for Payer: BCBS Complete |
$11,750.40
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: Cash Price |
$23,500.80
|
| Rate for Payer: Cash Price |
$23,500.80
|
| Rate for Payer: Cofinity Commercial |
$20,563.20
|
| Rate for Payer: Cofinity Commercial |
$25,263.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,500.80
|
| Rate for Payer: Healthscope Commercial |
$26,438.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20,563.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22,032.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24,969.60
|
| Rate for Payer: PHP Commercial |
$24,969.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20,563.20
|
| Rate for Payer: Priority Health SBD |
$18,506.88
|
| Rate for Payer: UMR Bronson Commercial |
$10,869.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22,032.00
|
|
|
HC MEDTRONIC CRT ICD
|
Facility
|
IP
|
$29,376.00
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27500006
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$12,925.44 |
| Max. Negotiated Rate |
$26,438.40 |
| Rate for Payer: Aetna American Axle |
$19,094.40
|
| Rate for Payer: Aetna Commercial |
$24,969.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19,094.40
|
| Rate for Payer: Cash Price |
$23,500.80
|
| Rate for Payer: Cofinity Commercial |
$20,563.20
|
| Rate for Payer: Cofinity Commercial |
$25,263.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,500.80
|
| Rate for Payer: Healthscope Commercial |
$26,438.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20,563.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22,032.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24,969.60
|
| Rate for Payer: PHP Commercial |
$24,969.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20,563.20
|
| Rate for Payer: Priority Health SBD |
$18,506.88
|
| Rate for Payer: UMR Bronson Commercial |
$12,925.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22,032.00
|
|
|
HC MEDTRONIC CRT LEAD
|
Facility
|
IP
|
$6,085.82
|
|
|
Service Code
|
HCPCS C1900
|
| Hospital Charge Code |
27800018
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,677.76 |
| Max. Negotiated Rate |
$5,477.24 |
| Rate for Payer: Aetna American Axle |
$3,955.78
|
| Rate for Payer: Aetna Commercial |
$5,172.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,955.78
|
| Rate for Payer: Cash Price |
$4,868.66
|
| Rate for Payer: Cofinity Commercial |
$4,260.07
|
| Rate for Payer: Cofinity Commercial |
$5,233.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,868.66
|
| Rate for Payer: Healthscope Commercial |
$5,477.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,260.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,564.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,172.95
|
| Rate for Payer: PHP Commercial |
$5,172.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,260.07
|
| Rate for Payer: Priority Health SBD |
$3,834.07
|
| Rate for Payer: UMR Bronson Commercial |
$2,677.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,564.36
|
|
|
HC MEDTRONIC CRT LEAD
|
Facility
|
OP
|
$6,085.82
|
|
|
Service Code
|
HCPCS C1900
|
| Hospital Charge Code |
27800018
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$5,477.24 |
| Rate for Payer: Aetna American Axle |
$3,955.78
|
| Rate for Payer: Aetna Commercial |
$5,172.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,955.78
|
| Rate for Payer: BCBS Complete |
$2,434.33
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: Cash Price |
$4,868.66
|
| Rate for Payer: Cash Price |
$4,868.66
|
| Rate for Payer: Cofinity Commercial |
$4,260.07
|
| Rate for Payer: Cofinity Commercial |
$5,233.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,868.66
|
| Rate for Payer: Healthscope Commercial |
$5,477.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,260.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,564.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,172.95
|
| Rate for Payer: PHP Commercial |
$5,172.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,260.07
|
| Rate for Payer: Priority Health SBD |
$3,834.07
|
| Rate for Payer: UMR Bronson Commercial |
$2,251.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,564.36
|
|
|
HC MEDTRONIC DUAL PACEMAKER
|
Facility
|
OP
|
$8,670.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27500007
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,207.90 |
| Max. Negotiated Rate |
$7,803.00 |
| Rate for Payer: Aetna American Axle |
$5,635.50
|
| Rate for Payer: Aetna Commercial |
$7,369.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,635.50
|
| Rate for Payer: BCBS Complete |
$3,468.00
|
| Rate for Payer: Cash Price |
$6,936.00
|
| Rate for Payer: Cofinity Commercial |
$6,069.00
|
| Rate for Payer: Cofinity Commercial |
$7,456.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,936.00
|
| Rate for Payer: Healthscope Commercial |
$7,803.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,069.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,502.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,369.50
|
| Rate for Payer: PHP Commercial |
$7,369.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,069.00
|
| Rate for Payer: Priority Health SBD |
$5,462.10
|
| Rate for Payer: UMR Bronson Commercial |
$3,207.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,502.50
|
|
|
HC MEDTRONIC DUAL PACEMAKER
|
Facility
|
IP
|
$8,670.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27500007
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,814.80 |
| Max. Negotiated Rate |
$7,803.00 |
| Rate for Payer: Aetna American Axle |
$5,635.50
|
| Rate for Payer: Aetna Commercial |
$7,369.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,635.50
|
| Rate for Payer: Cash Price |
$6,936.00
|
| Rate for Payer: Cofinity Commercial |
$6,069.00
|
| Rate for Payer: Cofinity Commercial |
$7,456.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,936.00
|
| Rate for Payer: Healthscope Commercial |
$7,803.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,069.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,502.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,369.50
|
| Rate for Payer: PHP Commercial |
$7,369.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,069.00
|
| Rate for Payer: Priority Health SBD |
$5,462.10
|
| Rate for Payer: UMR Bronson Commercial |
$3,814.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,502.50
|
|
