|
HC NEUROSTIMULATOR TEST KIT LVL 25
|
Facility
|
OP
|
$2,500.00
|
|
|
Service Code
|
CPT C1897
|
| Hospital Charge Code |
27800138
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$925.00 |
| Max. Negotiated Rate |
$2,250.00 |
| Rate for Payer: Aetna American Axle |
$1,625.00
|
| Rate for Payer: Aetna Commercial |
$2,125.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,625.00
|
| Rate for Payer: BCBS Complete |
$1,000.00
|
| Rate for Payer: Cash Price |
$2,000.00
|
| Rate for Payer: Cofinity Commercial |
$1,750.00
|
| Rate for Payer: Cofinity Commercial |
$2,150.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,000.00
|
| Rate for Payer: Healthscope Commercial |
$2,250.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,750.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,875.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,125.00
|
| Rate for Payer: PHP Commercial |
$2,125.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,750.00
|
| Rate for Payer: Priority Health SBD |
$1,575.00
|
| Rate for Payer: UMR Bronson Commercial |
$925.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,875.00
|
|
|
HC NEUROSTIMULATOR TEST KIT LVL 25
|
Facility
|
IP
|
$2,500.00
|
|
|
Service Code
|
CPT C1897
|
| Hospital Charge Code |
27800138
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,100.00 |
| Max. Negotiated Rate |
$2,250.00 |
| Rate for Payer: Aetna American Axle |
$1,625.00
|
| Rate for Payer: Aetna Commercial |
$2,125.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,625.00
|
| Rate for Payer: Cash Price |
$2,000.00
|
| Rate for Payer: Cofinity Commercial |
$1,750.00
|
| Rate for Payer: Cofinity Commercial |
$2,150.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,000.00
|
| Rate for Payer: Healthscope Commercial |
$2,250.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,750.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,875.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,125.00
|
| Rate for Payer: PHP Commercial |
$2,125.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,750.00
|
| Rate for Payer: Priority Health SBD |
$1,575.00
|
| Rate for Payer: UMR Bronson Commercial |
$1,100.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,875.00
|
|
|
HC NEUTROPHIL OXIDATIVE BURST
|
Facility
|
OP
|
$155.25
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
31000003
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$28.12 |
| Max. Negotiated Rate |
$1,005.81 |
| Rate for Payer: Aetna American Axle |
$100.91
|
| Rate for Payer: Aetna Commercial |
$131.96
|
| Rate for Payer: Aetna Medicare |
$332.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$399.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$399.39
|
| Rate for Payer: BCBS Complete |
$183.53
|
| Rate for Payer: BCBS MAPPO |
$319.51
|
| Rate for Payer: BCBS Trust/PPO |
$105.47
|
| Rate for Payer: BCN Medicare Advantage |
$319.51
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cofinity Commercial |
$108.68
|
| Rate for Payer: Cofinity Commercial |
$133.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$319.51
|
| Rate for Payer: Healthscope Commercial |
$139.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$108.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$116.44
|
| Rate for Payer: Mclaren Medicaid |
$174.77
|
| Rate for Payer: Mclaren Medicare |
$319.51
|
| Rate for Payer: Meridian Medicaid |
$183.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$335.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$367.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$131.96
|
| Rate for Payer: PACE Medicare |
$303.53
|
| Rate for Payer: PACE SWMI |
$319.51
|
| Rate for Payer: PHP Commercial |
$131.96
|
| Rate for Payer: PHP Medicare Advantage |
$319.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$174.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,005.81
|
| Rate for Payer: Priority Health Medicare |
$319.51
|
| Rate for Payer: Priority Health Narrow Network |
$804.65
|
| Rate for Payer: Priority Health SBD |
$97.81
|
| Rate for Payer: Railroad Medicare Medicare |
$319.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.28
|
| Rate for Payer: UHC Core |
$28.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$319.51
|
| Rate for Payer: UHC Exchange |
$76.62
|
| Rate for Payer: UHC Medicare Advantage |
$329.10
|
| Rate for Payer: UMR Bronson Commercial |
$57.44
|
| Rate for Payer: VA VA |
$319.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$116.44
|
|
|
HC NEUTROPHIL OXIDATIVE BURST
|
Facility
|
IP
|
$155.25
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
31000003
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$68.31 |
| Max. Negotiated Rate |
$139.72 |
| Rate for Payer: Aetna American Axle |
$100.91
|
| Rate for Payer: Aetna Commercial |
$131.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.91
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cofinity Commercial |
$108.68
|
| Rate for Payer: Cofinity Commercial |
$133.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.20
|
| Rate for Payer: Healthscope Commercial |
$139.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$108.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$116.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$131.96
|
| Rate for Payer: PHP Commercial |
$131.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.68
|
| Rate for Payer: Priority Health SBD |
$97.81
|
| Rate for Payer: UMR Bronson Commercial |
$68.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$116.44
|
|
|
HC NEUTROPHIL OXIDATIVE BURST CMP
|
Facility
|
OP
|
$55.08
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31000012
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$15.25 |
| Max. Negotiated Rate |
$49.57 |
| Rate for Payer: Aetna American Axle |
$35.80
|
| Rate for Payer: Aetna Commercial |
$46.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.80
|
| Rate for Payer: BCBS Complete |
$22.03
|
| Rate for Payer: BCBS Trust/PPO |
$33.73
|
| Rate for Payer: Cash Price |
$44.06
|
| Rate for Payer: Cash Price |
$44.06
|
| Rate for Payer: Cofinity Commercial |
$38.56
|
| Rate for Payer: Cofinity Commercial |
$47.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.06
|
| Rate for Payer: Healthscope Commercial |
$49.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$38.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$46.82
|
| Rate for Payer: PHP Commercial |
$46.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.56
|
| Rate for Payer: Priority Health SBD |
$34.70
|
| 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 |
$20.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.31
|
|
|
HC NEUTROPHIL OXIDATIVE BURST CMP
|
Facility
|
IP
|
$55.08
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31000012
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$24.24 |
| Max. Negotiated Rate |
$49.57 |
| Rate for Payer: Aetna American Axle |
$35.80
|
| Rate for Payer: Aetna Commercial |
$46.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.80
|
| Rate for Payer: Cash Price |
$44.06
|
| Rate for Payer: Cofinity Commercial |
$38.56
|
| Rate for Payer: Cofinity Commercial |
$47.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.06
|
| Rate for Payer: Healthscope Commercial |
$49.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$38.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$46.82
|
| Rate for Payer: PHP Commercial |
$46.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.56
|
| Rate for Payer: Priority Health SBD |
$34.70
|
| Rate for Payer: UMR Bronson Commercial |
$24.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.31
|
|
|
HC NEW PATIENT VISIT 99202
|
Facility
|
OP
|
$169.02
|
|
|
Service Code
|
CPT 99202
|
| Hospital Charge Code |
51000077
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$152.12 |
| Rate for Payer: Aetna American Axle |
$109.86
|
| Rate for Payer: Aetna Commercial |
$143.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.86
|
| Rate for Payer: BCBS Complete |
$67.61
|
| Rate for Payer: BCBS Trust/PPO |
$137.59
|
| Rate for Payer: BCCCP Commercial |
$45.00
|
| Rate for Payer: Cash Price |
$135.22
|
| Rate for Payer: Cash Price |
$135.22
|
| Rate for Payer: Cofinity Commercial |
$118.31
|
| Rate for Payer: Cofinity Commercial |
$145.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.22
|
| Rate for Payer: Healthscope Commercial |
$152.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$118.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$126.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$143.67
|
| Rate for Payer: PHP Commercial |
$143.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.31
|
| Rate for Payer: Priority Health SBD |
$106.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.79
|
| Rate for Payer: UHC Exchange |
$46.17
|
| Rate for Payer: UMR Bronson Commercial |
$62.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$126.76
|
|
|
HC NEW PATIENT VISIT 99202
|
Facility
|
IP
|
$169.02
|
|
|
Service Code
|
CPT 99202
|
| Hospital Charge Code |
51000077
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$74.37 |
| Max. Negotiated Rate |
$152.12 |
| Rate for Payer: Aetna American Axle |
$109.86
|
| Rate for Payer: Aetna Commercial |
$143.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.86
|
| Rate for Payer: Cash Price |
$135.22
|
| Rate for Payer: Cofinity Commercial |
$118.31
|
| Rate for Payer: Cofinity Commercial |
$145.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.22
|
| Rate for Payer: Healthscope Commercial |
$152.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$118.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$126.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$143.67
|
| Rate for Payer: PHP Commercial |
$143.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.31
|
| Rate for Payer: Priority Health SBD |
$106.48
|
| Rate for Payer: UMR Bronson Commercial |
$74.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$126.76
|
|
|
HC NEW PATIENT VISIT 99203
|
Facility
|
IP
|
$205.10
|
|
|
Service Code
|
CPT 99203
|
| Hospital Charge Code |
51000078
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$90.24 |
| Max. Negotiated Rate |
$184.59 |
| Rate for Payer: Aetna American Axle |
$133.32
|
| Rate for Payer: Aetna Commercial |
$174.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$133.32
|
| Rate for Payer: Cash Price |
$164.08
|
| Rate for Payer: Cofinity Commercial |
$176.39
|
| Rate for Payer: Cofinity Commercial |
$143.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$164.08
|
| Rate for Payer: Healthscope Commercial |
$184.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$143.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$153.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$174.34
|
| Rate for Payer: PHP Commercial |
$174.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.57
|
| Rate for Payer: Priority Health SBD |
$129.21
|
| Rate for Payer: UMR Bronson Commercial |
$90.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$153.82
|
|
|
HC NEW PATIENT VISIT 99203
|
Facility
|
OP
|
$205.10
|
|
|
Service Code
|
CPT 99203
|
| Hospital Charge Code |
51000078
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$75.89 |
| Max. Negotiated Rate |
$184.59 |
| Rate for Payer: Aetna American Axle |
$133.32
|
| Rate for Payer: Aetna Commercial |
$174.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$133.32
|
| Rate for Payer: BCBS Complete |
$82.04
|
| Rate for Payer: BCBS Trust/PPO |
$181.83
|
| Rate for Payer: BCCCP Commercial |
$107.15
|
| Rate for Payer: Cash Price |
$164.08
|
| Rate for Payer: Cash Price |
$164.08
|
| Rate for Payer: Cofinity Commercial |
$176.39
|
| Rate for Payer: Cofinity Commercial |
$143.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$164.08
|
| Rate for Payer: Healthscope Commercial |
$184.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$143.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$153.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$174.34
|
| Rate for Payer: PHP Commercial |
$174.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.57
|
| Rate for Payer: Priority Health SBD |
$129.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$87.89
|
| Rate for Payer: UHC Exchange |
$79.90
|
| Rate for Payer: UMR Bronson Commercial |
$75.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$153.82
|
|
|
HC NEW PATIENT VISIT 99204
|
Facility
|
IP
|
$294.53
|
|
|
Service Code
|
CPT 99204
|
| Hospital Charge Code |
51000079
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$129.59 |
| Max. Negotiated Rate |
$265.08 |
| Rate for Payer: Aetna American Axle |
$191.44
|
| Rate for Payer: Aetna Commercial |
$250.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$191.44
|
| Rate for Payer: Cash Price |
$235.62
|
| Rate for Payer: Cofinity Commercial |
$206.17
|
| Rate for Payer: Cofinity Commercial |
$253.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$235.62
|
| Rate for Payer: Healthscope Commercial |
$265.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$206.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$220.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$250.35
|
| Rate for Payer: PHP Commercial |
$250.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$206.17
|
| Rate for Payer: Priority Health SBD |
$185.55
|
| Rate for Payer: UMR Bronson Commercial |
$129.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$220.90
|
|
|
HC NEW PATIENT VISIT 99204
|
Facility
|
OP
|
$294.53
|
|
|
Service Code
|
CPT 99204
|
| Hospital Charge Code |
51000079
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$107.15 |
| Max. Negotiated Rate |
$265.08 |
| Rate for Payer: Aetna American Axle |
$191.44
|
| Rate for Payer: Aetna Commercial |
$250.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$191.44
|
| Rate for Payer: BCBS Complete |
$117.81
|
| Rate for Payer: BCBS Trust/PPO |
$243.24
|
| Rate for Payer: BCCCP Commercial |
$107.15
|
| Rate for Payer: Cash Price |
$235.62
|
| Rate for Payer: Cash Price |
$235.62
|
| Rate for Payer: Cofinity Commercial |
$253.30
|
| Rate for Payer: Cofinity Commercial |
$206.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$235.62
|
| Rate for Payer: Healthscope Commercial |
$265.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$206.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$220.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$250.35
|
| Rate for Payer: PHP Commercial |
$250.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$206.17
|
| Rate for Payer: Priority Health SBD |
$185.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$142.99
|
| Rate for Payer: UHC Exchange |
$129.99
|
| Rate for Payer: UMR Bronson Commercial |
$108.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$220.90
|
|
|
HC NEW PATIENT VISIT 99205
|
Facility
|
IP
|
$490.43
|
|
|
Service Code
|
CPT 99205
|
| Hospital Charge Code |
51000080
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$215.79 |
| Max. Negotiated Rate |
$441.39 |
| Rate for Payer: Aetna American Axle |
$318.78
|
| Rate for Payer: Aetna Commercial |
$416.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$318.78
|
| Rate for Payer: Cash Price |
$392.34
|
| Rate for Payer: Cofinity Commercial |
$343.30
|
| Rate for Payer: Cofinity Commercial |
$421.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$392.34
|
| Rate for Payer: Healthscope Commercial |
$441.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$343.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$367.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$416.87
|
| Rate for Payer: PHP Commercial |
$416.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$343.30
|
| Rate for Payer: Priority Health SBD |
$308.97
|
| Rate for Payer: UMR Bronson Commercial |
$215.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$367.82
|
|
|
HC NEW PATIENT VISIT 99205
|
Facility
|
OP
|
$490.43
|
|
|
Service Code
|
CPT 99205
|
| Hospital Charge Code |
51000080
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$107.15 |
| Max. Negotiated Rate |
$441.39 |
| Rate for Payer: Aetna American Axle |
$318.78
|
| Rate for Payer: Aetna Commercial |
$416.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$318.78
|
| Rate for Payer: BCBS Complete |
$196.17
|
| Rate for Payer: BCBS Trust/PPO |
$294.81
|
| Rate for Payer: BCCCP Commercial |
$107.15
|
| Rate for Payer: Cash Price |
$392.34
|
| Rate for Payer: Cash Price |
$392.34
|
| Rate for Payer: Cofinity Commercial |
$343.30
|
| Rate for Payer: Cofinity Commercial |
$421.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$392.34
|
| Rate for Payer: Healthscope Commercial |
$441.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$343.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$367.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$416.87
|
| Rate for Payer: PHP Commercial |
$416.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$343.30
|
| Rate for Payer: Priority Health SBD |
$308.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$194.50
|
| Rate for Payer: UHC Exchange |
$176.82
|
| Rate for Payer: UMR Bronson Commercial |
$181.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$367.82
|
|
|
HC NICOTINE AND METABOLITES BLD
|
Facility
|
OP
|
$61.00
|
|
|
Service Code
|
CPT 80323
|
| Hospital Charge Code |
30100599
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.57 |
| Max. Negotiated Rate |
$54.90 |
| Rate for Payer: Aetna American Axle |
$39.65
|
| Rate for Payer: Aetna Commercial |
$51.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.65
|
| Rate for Payer: BCBS Complete |
$24.40
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Cofinity Commercial |
$52.46
|
| Rate for Payer: Cofinity Commercial |
$42.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.80
|
| Rate for Payer: Healthscope Commercial |
$54.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.85
|
| Rate for Payer: PHP Commercial |
$51.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.70
|
| Rate for Payer: Priority Health SBD |
$38.43
|
| Rate for Payer: UHC Core |
$49.02
|
| Rate for Payer: UMR Bronson Commercial |
$22.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.75
|
|
|
HC NICOTINE AND METABOLITES BLD
|
Facility
|
IP
|
$61.00
|
|
|
Service Code
|
CPT 80323
|
| Hospital Charge Code |
30100599
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.84 |
| Max. Negotiated Rate |
$54.90 |
| Rate for Payer: Aetna American Axle |
$39.65
|
| Rate for Payer: Aetna Commercial |
$51.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.65
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Cofinity Commercial |
$42.70
|
| Rate for Payer: Cofinity Commercial |
$52.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.80
|
| Rate for Payer: Healthscope Commercial |
$54.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.85
|
| Rate for Payer: PHP Commercial |
$51.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.70
|
| Rate for Payer: Priority Health SBD |
$38.43
|
| Rate for Payer: UMR Bronson Commercial |
$26.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.75
|
|
|
HC NICOTINE AND METABOLITES URN
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 80323
|
| Hospital Charge Code |
30100613
|
|
Hospital Revenue Code
|
301
|
| 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 |
$43.00
|
| Rate for Payer: Cofinity Commercial |
$35.00
|
| 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 NICOTINE AND METABOLITES URN
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 80323
|
| Hospital Charge Code |
30100613
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.50 |
| Max. Negotiated Rate |
$49.02 |
| 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: 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: UHC Core |
$49.02
|
| Rate for Payer: UMR Bronson Commercial |
$18.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.50
|
|
|
HC NICU LEVEL 2 R&B
|
Facility
|
IP
|
$3,363.24
|
|
| Hospital Charge Code |
17200001
|
|
Hospital Revenue Code
|
172
|
| Min. Negotiated Rate |
$1,479.83 |
| Max. Negotiated Rate |
$3,026.92 |
| Rate for Payer: Aetna American Axle |
$2,186.11
|
| Rate for Payer: Aetna Commercial |
$2,858.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,186.11
|
| Rate for Payer: Cash Price |
$2,690.59
|
| Rate for Payer: Cash Price |
$2,690.59
|
| Rate for Payer: Cofinity Commercial |
$2,892.39
|
| Rate for Payer: Cofinity Commercial |
$2,354.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,690.59
|
| Rate for Payer: Healthscope Commercial |
$3,026.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,354.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,522.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,858.75
|
| Rate for Payer: PHP Commercial |
$2,858.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,354.27
|
| Rate for Payer: Priority Health SBD |
$2,118.84
|
| Rate for Payer: UHC Exchange |
$2,032.00
|
| Rate for Payer: UMR Bronson Commercial |
$1,479.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,522.43
|
|
|
HC NICU LEVEL 3 R&B
|
Facility
|
IP
|
$4,986.03
|
|
| Hospital Charge Code |
17300001
|
|
Hospital Revenue Code
|
173
|
| Min. Negotiated Rate |
$2,193.85 |
| Max. Negotiated Rate |
$4,487.43 |
| Rate for Payer: Aetna American Axle |
$3,240.92
|
| Rate for Payer: Aetna Commercial |
$4,238.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,240.92
|
| Rate for Payer: Cash Price |
$3,988.82
|
| Rate for Payer: Cash Price |
$3,988.82
|
| Rate for Payer: Cofinity Commercial |
$3,490.22
|
| Rate for Payer: Cofinity Commercial |
$4,287.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,988.82
|
| Rate for Payer: Healthscope Commercial |
$4,487.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,490.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,739.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,238.13
|
| Rate for Payer: PHP Commercial |
$4,238.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,490.22
|
| Rate for Payer: Priority Health SBD |
$3,141.20
|
| Rate for Payer: UHC Exchange |
$2,835.00
|
| Rate for Payer: UMR Bronson Commercial |
$2,193.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,739.52
|
|
|
HC NICU LEVEL 4 R&B
|
Facility
|
IP
|
$5,221.18
|
|
| Hospital Charge Code |
17400001
|
|
Hospital Revenue Code
|
174
|
| Min. Negotiated Rate |
$2,297.32 |
| Max. Negotiated Rate |
$4,699.06 |
| Rate for Payer: Aetna American Axle |
$3,393.77
|
| Rate for Payer: Aetna Commercial |
$4,438.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,393.77
|
| Rate for Payer: Cash Price |
$4,176.94
|
| Rate for Payer: Cash Price |
$4,176.94
|
| Rate for Payer: Cofinity Commercial |
$4,490.21
|
| Rate for Payer: Cofinity Commercial |
$3,654.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,176.94
|
| Rate for Payer: Healthscope Commercial |
$4,699.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,654.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,915.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,438.00
|
| Rate for Payer: PHP Commercial |
$4,438.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,654.83
|
| Rate for Payer: Priority Health SBD |
$3,289.34
|
| Rate for Payer: UHC Exchange |
$3,255.00
|
| Rate for Payer: UMR Bronson Commercial |
$2,297.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,915.88
|
|
|
HC NICU OBSERVATION PER HOUR
|
Facility
|
IP
|
$186.06
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200013
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$81.87 |
| Max. Negotiated Rate |
$167.45 |
| Rate for Payer: Aetna American Axle |
$120.94
|
| Rate for Payer: Aetna Commercial |
$158.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.94
|
| Rate for Payer: Cash Price |
$148.85
|
| Rate for Payer: Cofinity Commercial |
$130.24
|
| Rate for Payer: Cofinity Commercial |
$160.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.85
|
| Rate for Payer: Healthscope Commercial |
$167.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$130.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$158.15
|
| Rate for Payer: PHP Commercial |
$158.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.24
|
| Rate for Payer: Priority Health SBD |
$117.22
|
| Rate for Payer: UMR Bronson Commercial |
$81.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.54
|
|
|
HC NICU OBSERVATION PER HOUR
|
Facility
|
OP
|
$186.06
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200013
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$68.84 |
| Max. Negotiated Rate |
$4,092.00 |
| Rate for Payer: Aetna American Axle |
$120.94
|
| Rate for Payer: Aetna Commercial |
$158.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.94
|
| Rate for Payer: BCBS Complete |
$74.42
|
| Rate for Payer: BCBS Trust/PPO |
$118.88
|
| Rate for Payer: Cash Price |
$148.85
|
| Rate for Payer: Cash Price |
$148.85
|
| Rate for Payer: Cash Price |
$148.85
|
| Rate for Payer: Cofinity Commercial |
$130.24
|
| Rate for Payer: Cofinity Commercial |
$160.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.85
|
| Rate for Payer: Healthscope Commercial |
$167.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$130.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.54
|
| Rate for Payer: Meridian Medicaid |
$1,000.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$158.15
|
| Rate for Payer: PHP Commercial |
$158.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.24
|
| Rate for Payer: Priority Health SBD |
$117.22
|
| Rate for Payer: UHC Core |
$4,092.00
|
| Rate for Payer: UMR Bronson Commercial |
$68.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.54
|
|
|
HC NICU OR OB NURSERY R&B
|
Facility
|
IP
|
$2,250.16
|
|
| Hospital Charge Code |
17000001
|
|
Hospital Revenue Code
|
170
|
| Min. Negotiated Rate |
$919.00 |
| Max. Negotiated Rate |
$2,025.14 |
| Rate for Payer: Aetna American Axle |
$1,462.60
|
| Rate for Payer: Aetna Commercial |
$1,912.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,462.60
|
| Rate for Payer: Cash Price |
$1,800.13
|
| Rate for Payer: Cash Price |
$1,800.13
|
| Rate for Payer: Cofinity Commercial |
$1,575.11
|
| Rate for Payer: Cofinity Commercial |
$1,935.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,800.13
|
| Rate for Payer: Healthscope Commercial |
$2,025.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,575.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,687.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,912.64
|
| Rate for Payer: PHP Commercial |
$1,912.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,575.11
|
| Rate for Payer: Priority Health SBD |
$1,417.60
|
| Rate for Payer: UHC Exchange |
$919.00
|
| Rate for Payer: UMR Bronson Commercial |
$990.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,687.62
|
|
|
HC NIFOMETER
|
Facility
|
OP
|
$82.48
|
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$30.52 |
| Max. Negotiated Rate |
$74.23 |
| Rate for Payer: Aetna American Axle |
$53.61
|
| Rate for Payer: Aetna Commercial |
$70.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.61
|
| Rate for Payer: BCBS Complete |
$32.99
|
| Rate for Payer: Cash Price |
$65.98
|
| Rate for Payer: Cofinity Commercial |
$57.74
|
| Rate for Payer: Cofinity Commercial |
$70.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.98
|
| Rate for Payer: Healthscope Commercial |
$74.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$70.11
|
| Rate for Payer: PHP Commercial |
$70.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.74
|
| Rate for Payer: Priority Health SBD |
$51.96
|
| Rate for Payer: UMR Bronson Commercial |
$30.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.86
|
|
