|
HC NM LIVER SPLEEN
|
Facility
|
IP
|
$900.56
|
|
|
Service Code
|
CPT 78215
|
| Hospital Charge Code |
34100016
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$396.25 |
| Max. Negotiated Rate |
$810.50 |
| Rate for Payer: Aetna American Axle |
$585.36
|
| Rate for Payer: Aetna Commercial |
$765.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$585.36
|
| Rate for Payer: Cash Price |
$720.45
|
| Rate for Payer: Cofinity Commercial |
$630.39
|
| Rate for Payer: Cofinity Commercial |
$774.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$720.45
|
| Rate for Payer: Healthscope Commercial |
$810.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$630.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$675.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$765.48
|
| Rate for Payer: PHP Commercial |
$765.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$630.39
|
| Rate for Payer: Priority Health SBD |
$567.35
|
| Rate for Payer: UMR Bronson Commercial |
$396.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$675.42
|
|
|
HC NM LOCALIZATION TUMOR LMTD AREA
|
Facility
|
OP
|
$776.00
|
|
|
Service Code
|
CPT 78800
|
| Hospital Charge Code |
34100052
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$200.54 |
| Max. Negotiated Rate |
$1,154.12 |
| Rate for Payer: Aetna American Axle |
$504.40
|
| Rate for Payer: Aetna Commercial |
$659.60
|
| Rate for Payer: Aetna Medicare |
$381.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$504.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$458.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$458.26
|
| Rate for Payer: BCBS Complete |
$210.58
|
| Rate for Payer: BCBS MAPPO |
$366.61
|
| Rate for Payer: BCBS Trust/PPO |
$389.59
|
| Rate for Payer: BCN Medicare Advantage |
$366.61
|
| Rate for Payer: Cash Price |
$620.80
|
| Rate for Payer: Cash Price |
$620.80
|
| Rate for Payer: Cofinity Commercial |
$667.36
|
| Rate for Payer: Cofinity Commercial |
$543.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$620.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$366.61
|
| Rate for Payer: Healthscope Commercial |
$698.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$543.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$582.00
|
| Rate for Payer: Mclaren Medicaid |
$200.54
|
| Rate for Payer: Mclaren Medicare |
$366.61
|
| Rate for Payer: Meridian Medicaid |
$210.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$384.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$421.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$659.60
|
| Rate for Payer: PACE Medicare |
$348.28
|
| Rate for Payer: PACE SWMI |
$366.61
|
| Rate for Payer: PHP Commercial |
$659.60
|
| Rate for Payer: PHP Medicare Advantage |
$366.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$200.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$543.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,154.12
|
| Rate for Payer: Priority Health Medicare |
$366.61
|
| Rate for Payer: Priority Health Narrow Network |
$923.30
|
| Rate for Payer: Priority Health SBD |
$488.88
|
| Rate for Payer: Railroad Medicare Medicare |
$366.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$251.05
|
| Rate for Payer: UHC Core |
$832.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$366.61
|
| Rate for Payer: UHC Exchange |
$228.23
|
| Rate for Payer: UHC Medicare Advantage |
$377.61
|
| Rate for Payer: UMR Bronson Commercial |
$287.12
|
| Rate for Payer: VA VA |
$366.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$582.00
|
|
|
HC NM LOCALIZATION TUMOR LMTD AREA
|
Facility
|
IP
|
$776.00
|
|
|
Service Code
|
CPT 78800
|
| Hospital Charge Code |
34100052
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$341.44 |
| Max. Negotiated Rate |
$698.40 |
| Rate for Payer: Aetna American Axle |
$504.40
|
| Rate for Payer: Aetna Commercial |
$659.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$504.40
|
| Rate for Payer: Cash Price |
$620.80
|
| Rate for Payer: Cofinity Commercial |
$543.20
|
| Rate for Payer: Cofinity Commercial |
$667.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$620.80
|
| Rate for Payer: Healthscope Commercial |
$698.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$543.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$582.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$659.60
|
| Rate for Payer: PHP Commercial |
$659.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$543.20
|
| Rate for Payer: Priority Health SBD |
$488.88
|
| Rate for Payer: UMR Bronson Commercial |
$341.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$582.00
|
|
|
HC NM LOCALIZATION TUMOR MULTI AREA
|
Facility
|
IP
|
$1,263.46
|
|
|
Service Code
|
CPT 78801
|
| Hospital Charge Code |
34100054
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$555.92 |
| Max. Negotiated Rate |
$1,137.11 |
| Rate for Payer: Aetna American Axle |
$821.25
|
| Rate for Payer: Aetna Commercial |
$1,073.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$821.25
|
| Rate for Payer: Cash Price |
$1,010.77
|
| Rate for Payer: Cofinity Commercial |
$1,086.58
|
| Rate for Payer: Cofinity Commercial |
$884.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,010.77
|
| Rate for Payer: Healthscope Commercial |
$1,137.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$884.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$947.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,073.94
|
| Rate for Payer: PHP Commercial |
$1,073.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$884.42
|
| Rate for Payer: Priority Health SBD |
$795.98
|
| Rate for Payer: UMR Bronson Commercial |
$555.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$947.60
|
|
|
HC NM LOCALIZATION TUMOR MULTI AREA
|
Facility
|
OP
|
$1,263.46
|
|
|
Service Code
|
CPT 78801
|
| Hospital Charge Code |
34100054
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$200.54 |
| Max. Negotiated Rate |
$1,154.12 |
| Rate for Payer: Aetna American Axle |
$821.25
|
| Rate for Payer: Aetna Commercial |
$1,073.94
|
| Rate for Payer: Aetna Medicare |
$381.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$821.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$458.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$458.26
|
| Rate for Payer: BCBS Complete |
$210.58
|
| Rate for Payer: BCBS MAPPO |
$366.61
|
| Rate for Payer: BCBS Trust/PPO |
$420.63
|
| Rate for Payer: BCN Medicare Advantage |
$366.61
|
| Rate for Payer: Cash Price |
$1,010.77
|
| Rate for Payer: Cash Price |
$1,010.77
|
| Rate for Payer: Cofinity Commercial |
$1,086.58
|
| Rate for Payer: Cofinity Commercial |
$884.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,010.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$366.61
|
| Rate for Payer: Healthscope Commercial |
$1,137.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$884.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$947.60
|
| Rate for Payer: Mclaren Medicaid |
$200.54
|
| Rate for Payer: Mclaren Medicare |
$366.61
|
| Rate for Payer: Meridian Medicaid |
$210.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$384.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$421.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,073.94
|
| Rate for Payer: PACE Medicare |
$348.28
|
| Rate for Payer: PACE SWMI |
$366.61
|
| Rate for Payer: PHP Commercial |
$1,073.94
|
| Rate for Payer: PHP Medicare Advantage |
$366.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$200.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$884.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,154.12
|
| Rate for Payer: Priority Health Medicare |
$366.61
|
| Rate for Payer: Priority Health Narrow Network |
$923.30
|
| Rate for Payer: Priority Health SBD |
$795.98
|
| Rate for Payer: Railroad Medicare Medicare |
$366.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$269.06
|
| Rate for Payer: UHC Core |
$832.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$366.61
|
| Rate for Payer: UHC Exchange |
$244.60
|
| Rate for Payer: UHC Medicare Advantage |
$377.61
|
| Rate for Payer: UMR Bronson Commercial |
$467.48
|
| Rate for Payer: VA VA |
$366.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$947.60
|
|
|
HC NM LOCALIZATION TUMOR WHOLE BODY
|
Facility
|
IP
|
$1,700.97
|
|
|
Service Code
|
CPT 78802
|
| Hospital Charge Code |
34100055
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$748.43 |
| Max. Negotiated Rate |
$1,530.87 |
| Rate for Payer: Aetna American Axle |
$1,105.63
|
| Rate for Payer: Aetna Commercial |
$1,445.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,105.63
|
| Rate for Payer: Cash Price |
$1,360.78
|
| Rate for Payer: Cofinity Commercial |
$1,190.68
|
| Rate for Payer: Cofinity Commercial |
$1,462.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,360.78
|
| Rate for Payer: Healthscope Commercial |
$1,530.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,190.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,275.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,445.82
|
| Rate for Payer: PHP Commercial |
$1,445.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,190.68
|
| Rate for Payer: Priority Health SBD |
$1,071.61
|
| Rate for Payer: UMR Bronson Commercial |
$748.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,275.73
|
|
|
HC NM LOCALIZATION TUMOR WHOLE BODY
|
Facility
|
OP
|
$1,700.97
|
|
|
Service Code
|
CPT 78802
|
| Hospital Charge Code |
34100055
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$276.36 |
| Max. Negotiated Rate |
$3,973.38 |
| Rate for Payer: Aetna American Axle |
$1,105.63
|
| Rate for Payer: Aetna Commercial |
$1,445.82
|
| Rate for Payer: Aetna Medicare |
$1,312.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,105.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,577.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,577.72
|
| Rate for Payer: BCBS Complete |
$725.00
|
| Rate for Payer: BCBS MAPPO |
$1,262.18
|
| Rate for Payer: BCBS Trust/PPO |
$477.65
|
| Rate for Payer: BCN Medicare Advantage |
$1,262.18
|
| Rate for Payer: Cash Price |
$1,360.78
|
| Rate for Payer: Cash Price |
$1,360.78
|
| Rate for Payer: Cofinity Commercial |
$1,190.68
|
| Rate for Payer: Cofinity Commercial |
$1,462.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,360.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,262.18
|
| Rate for Payer: Healthscope Commercial |
$1,530.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,190.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,275.73
|
| Rate for Payer: Mclaren Medicaid |
$690.41
|
| Rate for Payer: Mclaren Medicare |
$1,262.18
|
| Rate for Payer: Meridian Medicaid |
$725.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,325.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,451.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,445.82
|
| Rate for Payer: PACE Medicare |
$1,199.07
|
| Rate for Payer: PACE SWMI |
$1,262.18
|
| Rate for Payer: PHP Commercial |
$1,445.82
|
| Rate for Payer: PHP Medicare Advantage |
$1,262.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$690.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,190.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,973.38
|
| Rate for Payer: Priority Health Medicare |
$1,262.18
|
| Rate for Payer: Priority Health Narrow Network |
$3,178.70
|
| Rate for Payer: Priority Health SBD |
$1,071.61
|
| Rate for Payer: Railroad Medicare Medicare |
$1,262.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$304.00
|
| Rate for Payer: UHC Core |
$832.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,262.18
|
| Rate for Payer: UHC Exchange |
$276.36
|
| Rate for Payer: UHC Medicare Advantage |
$1,300.05
|
| Rate for Payer: UMR Bronson Commercial |
$629.36
|
| Rate for Payer: VA VA |
$1,262.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,275.73
|
|
|
HC NM LUNG PERF DIFF FUNCT
|
Facility
|
IP
|
$817.10
|
|
|
Service Code
|
CPT 78599
|
| Hospital Charge Code |
34100037
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$359.52 |
| Max. Negotiated Rate |
$735.39 |
| Rate for Payer: Aetna American Axle |
$531.12
|
| Rate for Payer: Aetna Commercial |
$694.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$531.12
|
| Rate for Payer: Cash Price |
$653.68
|
| Rate for Payer: Cofinity Commercial |
$571.97
|
| Rate for Payer: Cofinity Commercial |
$702.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$653.68
|
| Rate for Payer: Healthscope Commercial |
$735.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$571.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$612.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$694.54
|
| Rate for Payer: PHP Commercial |
$694.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$571.97
|
| Rate for Payer: Priority Health SBD |
$514.77
|
| Rate for Payer: UMR Bronson Commercial |
$359.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$612.82
|
|
|
HC NM LUNG PERF DIFF FUNCT
|
Facility
|
OP
|
$817.10
|
|
|
Service Code
|
CPT 78599
|
| Hospital Charge Code |
34100037
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$200.54 |
| Max. Negotiated Rate |
$1,154.12 |
| Rate for Payer: Aetna American Axle |
$531.12
|
| Rate for Payer: Aetna Commercial |
$694.54
|
| Rate for Payer: Aetna Medicare |
$381.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$531.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$458.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$458.26
|
| Rate for Payer: BCBS Complete |
$210.58
|
| Rate for Payer: BCBS MAPPO |
$366.61
|
| Rate for Payer: BCN Medicare Advantage |
$366.61
|
| Rate for Payer: Cash Price |
$653.68
|
| Rate for Payer: Cash Price |
$653.68
|
| Rate for Payer: Cofinity Commercial |
$702.71
|
| Rate for Payer: Cofinity Commercial |
$571.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$653.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$366.61
|
| Rate for Payer: Healthscope Commercial |
$735.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$571.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$612.82
|
| Rate for Payer: Mclaren Medicaid |
$200.54
|
| Rate for Payer: Mclaren Medicare |
$366.61
|
| Rate for Payer: Meridian Medicaid |
$210.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$384.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$421.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$694.54
|
| Rate for Payer: PACE Medicare |
$348.28
|
| Rate for Payer: PACE SWMI |
$366.61
|
| Rate for Payer: PHP Commercial |
$694.54
|
| Rate for Payer: PHP Medicare Advantage |
$366.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$200.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$571.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,154.12
|
| Rate for Payer: Priority Health Medicare |
$366.61
|
| Rate for Payer: Priority Health Narrow Network |
$923.30
|
| Rate for Payer: Priority Health SBD |
$514.77
|
| Rate for Payer: Railroad Medicare Medicare |
$366.61
|
| Rate for Payer: UHC Core |
$832.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$366.61
|
| Rate for Payer: UHC Medicare Advantage |
$377.61
|
| Rate for Payer: UMR Bronson Commercial |
$302.33
|
| Rate for Payer: VA VA |
$366.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$612.82
|
|
|
HC NM LUNG PERFUSION EG PARTICULATE
|
Facility
|
OP
|
$1,000.76
|
|
|
Service Code
|
CPT 78580
|
| Hospital Charge Code |
34100032
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$200.54 |
| Max. Negotiated Rate |
$1,154.12 |
| Rate for Payer: Aetna American Axle |
$650.49
|
| Rate for Payer: Aetna Commercial |
$850.65
|
| Rate for Payer: Aetna Medicare |
$381.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$650.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$458.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$458.26
|
| Rate for Payer: BCBS Complete |
$210.58
|
| Rate for Payer: BCBS MAPPO |
$366.61
|
| Rate for Payer: BCBS Trust/PPO |
$354.12
|
| Rate for Payer: BCN Medicare Advantage |
$366.61
|
| Rate for Payer: Cash Price |
$800.61
|
| Rate for Payer: Cash Price |
$800.61
|
| Rate for Payer: Cofinity Commercial |
$860.65
|
| Rate for Payer: Cofinity Commercial |
$700.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$800.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$366.61
|
| Rate for Payer: Healthscope Commercial |
$900.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$700.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$750.57
|
| Rate for Payer: Mclaren Medicaid |
$200.54
|
| Rate for Payer: Mclaren Medicare |
$366.61
|
| Rate for Payer: Meridian Medicaid |
$210.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$384.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$421.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$850.65
|
| Rate for Payer: PACE Medicare |
$348.28
|
| Rate for Payer: PACE SWMI |
$366.61
|
| Rate for Payer: PHP Commercial |
$850.65
|
| Rate for Payer: PHP Medicare Advantage |
$366.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$200.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$700.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,154.12
|
| Rate for Payer: Priority Health Medicare |
$366.61
|
| Rate for Payer: Priority Health Narrow Network |
$923.30
|
| Rate for Payer: Priority Health SBD |
$630.48
|
| Rate for Payer: Railroad Medicare Medicare |
$366.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$234.12
|
| Rate for Payer: UHC Core |
$832.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$366.61
|
| Rate for Payer: UHC Exchange |
$212.84
|
| Rate for Payer: UHC Medicare Advantage |
$377.61
|
| Rate for Payer: UMR Bronson Commercial |
$370.28
|
| Rate for Payer: VA VA |
$366.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$750.57
|
|
|
HC NM LUNG PERFUSION EG PARTICULATE
|
Facility
|
IP
|
$1,000.76
|
|
|
Service Code
|
CPT 78580
|
| Hospital Charge Code |
34100032
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$440.33 |
| Max. Negotiated Rate |
$900.68 |
| Rate for Payer: Aetna American Axle |
$650.49
|
| Rate for Payer: Aetna Commercial |
$850.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$650.49
|
| Rate for Payer: Cash Price |
$800.61
|
| Rate for Payer: Cofinity Commercial |
$700.53
|
| Rate for Payer: Cofinity Commercial |
$860.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$800.61
|
| Rate for Payer: Healthscope Commercial |
$900.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$700.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$750.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$850.65
|
| Rate for Payer: PHP Commercial |
$850.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$700.53
|
| Rate for Payer: Priority Health SBD |
$630.48
|
| Rate for Payer: UMR Bronson Commercial |
$440.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$750.57
|
|
|
HC NM LYMPHATIC SENTINAL NODE IMAGING
|
Facility
|
OP
|
$1,288.63
|
|
|
Service Code
|
CPT 78195
|
| Hospital Charge Code |
34100012
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$262.80 |
| Max. Negotiated Rate |
$1,512.47 |
| Rate for Payer: Aetna American Axle |
$837.61
|
| Rate for Payer: Aetna Commercial |
$1,095.34
|
| Rate for Payer: Aetna Medicare |
$499.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$837.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$600.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$600.55
|
| Rate for Payer: BCBS Complete |
$275.96
|
| Rate for Payer: BCBS MAPPO |
$480.44
|
| Rate for Payer: BCBS Trust/PPO |
$520.72
|
| Rate for Payer: BCN Medicare Advantage |
$480.44
|
| Rate for Payer: Cash Price |
$1,030.90
|
| Rate for Payer: Cash Price |
$1,030.90
|
| Rate for Payer: Cofinity Commercial |
$1,108.22
|
| Rate for Payer: Cofinity Commercial |
$902.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,030.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$480.44
|
| Rate for Payer: Healthscope Commercial |
$1,159.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$902.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$966.47
|
| Rate for Payer: Mclaren Medicaid |
$262.80
|
| Rate for Payer: Mclaren Medicare |
$480.44
|
| Rate for Payer: Meridian Medicaid |
$275.96
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$504.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$552.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,095.34
|
| Rate for Payer: PACE Medicare |
$456.42
|
| Rate for Payer: PACE SWMI |
$480.44
|
| Rate for Payer: PHP Commercial |
$1,095.34
|
| Rate for Payer: PHP Medicare Advantage |
$480.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$262.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$902.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,512.47
|
| Rate for Payer: Priority Health Medicare |
$480.44
|
| Rate for Payer: Priority Health Narrow Network |
$1,209.98
|
| Rate for Payer: Priority Health SBD |
$811.84
|
| Rate for Payer: Railroad Medicare Medicare |
$480.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$349.74
|
| Rate for Payer: UHC Core |
$832.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$480.44
|
| Rate for Payer: UHC Exchange |
$317.95
|
| Rate for Payer: UHC Medicare Advantage |
$494.85
|
| Rate for Payer: UMR Bronson Commercial |
$476.79
|
| Rate for Payer: VA VA |
$480.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$966.47
|
|
|
HC NM LYMPHATIC SENTINAL NODE IMAGING
|
Facility
|
IP
|
$1,288.63
|
|
|
Service Code
|
CPT 78195
|
| Hospital Charge Code |
34100012
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$567.00 |
| Max. Negotiated Rate |
$1,159.77 |
| Rate for Payer: Aetna American Axle |
$837.61
|
| Rate for Payer: Aetna Commercial |
$1,095.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$837.61
|
| Rate for Payer: Cash Price |
$1,030.90
|
| Rate for Payer: Cofinity Commercial |
$1,108.22
|
| Rate for Payer: Cofinity Commercial |
$902.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,030.90
|
| Rate for Payer: Healthscope Commercial |
$1,159.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$902.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$966.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,095.34
|
| Rate for Payer: PHP Commercial |
$1,095.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$902.04
|
| Rate for Payer: Priority Health SBD |
$811.84
|
| Rate for Payer: UMR Bronson Commercial |
$567.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$966.47
|
|
|
HC NM MECKELS OR ABD
|
Facility
|
OP
|
$1,123.57
|
|
|
Service Code
|
CPT 78290
|
| Hospital Charge Code |
34100021
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$200.54 |
| Max. Negotiated Rate |
$1,154.12 |
| Rate for Payer: Aetna American Axle |
$730.32
|
| Rate for Payer: Aetna Commercial |
$955.03
|
| Rate for Payer: Aetna Medicare |
$381.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$730.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$458.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$458.26
|
| Rate for Payer: BCBS Complete |
$210.58
|
| Rate for Payer: BCBS MAPPO |
$366.61
|
| Rate for Payer: BCBS Trust/PPO |
$523.26
|
| Rate for Payer: BCN Medicare Advantage |
$366.61
|
| Rate for Payer: Cash Price |
$898.86
|
| Rate for Payer: Cash Price |
$898.86
|
| Rate for Payer: Cofinity Commercial |
$786.50
|
| Rate for Payer: Cofinity Commercial |
$966.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$898.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$366.61
|
| Rate for Payer: Healthscope Commercial |
$1,011.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$786.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$842.68
|
| Rate for Payer: Mclaren Medicaid |
$200.54
|
| Rate for Payer: Mclaren Medicare |
$366.61
|
| Rate for Payer: Meridian Medicaid |
$210.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$384.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$421.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$955.03
|
| Rate for Payer: PACE Medicare |
$348.28
|
| Rate for Payer: PACE SWMI |
$366.61
|
| Rate for Payer: PHP Commercial |
$955.03
|
| Rate for Payer: PHP Medicare Advantage |
$366.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$200.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$786.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,154.12
|
| Rate for Payer: Priority Health Medicare |
$366.61
|
| Rate for Payer: Priority Health Narrow Network |
$923.30
|
| Rate for Payer: Priority Health SBD |
$707.85
|
| Rate for Payer: Railroad Medicare Medicare |
$366.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$324.53
|
| Rate for Payer: UHC Core |
$832.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$366.61
|
| Rate for Payer: UHC Exchange |
$295.03
|
| Rate for Payer: UHC Medicare Advantage |
$377.61
|
| Rate for Payer: UMR Bronson Commercial |
$415.72
|
| Rate for Payer: VA VA |
$366.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$842.68
|
|
|
HC NM MECKELS OR ABD
|
Facility
|
IP
|
$1,123.57
|
|
|
Service Code
|
CPT 78290
|
| Hospital Charge Code |
34100021
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$494.37 |
| Max. Negotiated Rate |
$1,011.21 |
| Rate for Payer: Aetna American Axle |
$730.32
|
| Rate for Payer: Aetna Commercial |
$955.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$730.32
|
| Rate for Payer: Cash Price |
$898.86
|
| Rate for Payer: Cofinity Commercial |
$786.50
|
| Rate for Payer: Cofinity Commercial |
$966.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$898.86
|
| Rate for Payer: Healthscope Commercial |
$1,011.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$786.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$842.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$955.03
|
| Rate for Payer: PHP Commercial |
$955.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$786.50
|
| Rate for Payer: Priority Health SBD |
$707.85
|
| Rate for Payer: UMR Bronson Commercial |
$494.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$842.68
|
|
|
HC NM MYOCARD PERF SPECT EF WM MU
|
Facility
|
OP
|
$5,027.66
|
|
|
Service Code
|
CPT 78452
|
| Hospital Charge Code |
34100029
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$425.35 |
| Max. Negotiated Rate |
$4,524.89 |
| Rate for Payer: Aetna American Axle |
$3,267.98
|
| Rate for Payer: Aetna Commercial |
$4,273.51
|
| Rate for Payer: Aetna Medicare |
$1,312.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,267.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,577.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,577.72
|
| Rate for Payer: BCBS Complete |
$725.00
|
| Rate for Payer: BCBS MAPPO |
$1,262.18
|
| Rate for Payer: BCBS Trust/PPO |
$688.60
|
| Rate for Payer: BCN Medicare Advantage |
$1,262.18
|
| Rate for Payer: Cash Price |
$4,022.13
|
| Rate for Payer: Cash Price |
$4,022.13
|
| Rate for Payer: Cofinity Commercial |
$4,323.79
|
| Rate for Payer: Cofinity Commercial |
$3,519.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,022.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,262.18
|
| Rate for Payer: Healthscope Commercial |
$4,524.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,519.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,770.74
|
| Rate for Payer: Mclaren Medicaid |
$690.41
|
| Rate for Payer: Mclaren Medicare |
$1,262.18
|
| Rate for Payer: Meridian Medicaid |
$725.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,325.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,451.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,273.51
|
| Rate for Payer: PACE Medicare |
$1,199.07
|
| Rate for Payer: PACE SWMI |
$1,262.18
|
| Rate for Payer: PHP Commercial |
$4,273.51
|
| Rate for Payer: PHP Medicare Advantage |
$1,262.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$690.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,519.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,973.38
|
| Rate for Payer: Priority Health Medicare |
$1,262.18
|
| Rate for Payer: Priority Health Narrow Network |
$3,178.70
|
| Rate for Payer: Priority Health SBD |
$3,167.43
|
| Rate for Payer: Railroad Medicare Medicare |
$1,262.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$467.88
|
| Rate for Payer: UHC Core |
$832.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,262.18
|
| Rate for Payer: UHC Exchange |
$425.35
|
| Rate for Payer: UHC Medicare Advantage |
$1,300.05
|
| Rate for Payer: UMR Bronson Commercial |
$1,860.23
|
| Rate for Payer: VA VA |
$1,262.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,770.74
|
|
|
HC NM MYOCARD PERF SPECT EF WM MU
|
Facility
|
IP
|
$5,027.66
|
|
|
Service Code
|
CPT 78452
|
| Hospital Charge Code |
34100029
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$2,212.17 |
| Max. Negotiated Rate |
$4,524.89 |
| Rate for Payer: Aetna American Axle |
$3,267.98
|
| Rate for Payer: Aetna Commercial |
$4,273.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,267.98
|
| Rate for Payer: Cash Price |
$4,022.13
|
| Rate for Payer: Cofinity Commercial |
$3,519.36
|
| Rate for Payer: Cofinity Commercial |
$4,323.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,022.13
|
| Rate for Payer: Healthscope Commercial |
$4,524.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,519.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,770.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,273.51
|
| Rate for Payer: PHP Commercial |
$4,273.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,519.36
|
| Rate for Payer: Priority Health SBD |
$3,167.43
|
| Rate for Payer: UMR Bronson Commercial |
$2,212.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,770.74
|
|
|
HC NM MYOCARD PERF SPECT EF WM SI
|
Facility
|
IP
|
$1,795.59
|
|
|
Service Code
|
CPT 78451
|
| Hospital Charge Code |
34100067
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$790.06 |
| Max. Negotiated Rate |
$1,616.03 |
| Rate for Payer: Aetna American Axle |
$1,167.13
|
| Rate for Payer: Aetna Commercial |
$1,526.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,167.13
|
| Rate for Payer: Cash Price |
$1,436.47
|
| Rate for Payer: Cofinity Commercial |
$1,256.91
|
| Rate for Payer: Cofinity Commercial |
$1,544.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,436.47
|
| Rate for Payer: Healthscope Commercial |
$1,616.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,256.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,346.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,526.25
|
| Rate for Payer: PHP Commercial |
$1,526.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,256.91
|
| Rate for Payer: Priority Health SBD |
$1,131.22
|
| Rate for Payer: UMR Bronson Commercial |
$790.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,346.69
|
|
|
HC NM MYOCARD PERF SPECT EF WM SI
|
Facility
|
OP
|
$1,795.59
|
|
|
Service Code
|
CPT 78451
|
| Hospital Charge Code |
34100067
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$307.47 |
| Max. Negotiated Rate |
$3,973.38 |
| Rate for Payer: Aetna American Axle |
$1,167.13
|
| Rate for Payer: Aetna Commercial |
$1,526.25
|
| Rate for Payer: Aetna Medicare |
$1,312.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,167.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,577.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,577.72
|
| Rate for Payer: BCBS Complete |
$725.00
|
| Rate for Payer: BCBS MAPPO |
$1,262.18
|
| Rate for Payer: BCBS Trust/PPO |
$478.91
|
| Rate for Payer: BCN Medicare Advantage |
$1,262.18
|
| Rate for Payer: Cash Price |
$1,436.47
|
| Rate for Payer: Cash Price |
$1,436.47
|
| Rate for Payer: Cofinity Commercial |
$1,256.91
|
| Rate for Payer: Cofinity Commercial |
$1,544.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,436.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,262.18
|
| Rate for Payer: Healthscope Commercial |
$1,616.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,256.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,346.69
|
| Rate for Payer: Mclaren Medicaid |
$690.41
|
| Rate for Payer: Mclaren Medicare |
$1,262.18
|
| Rate for Payer: Meridian Medicaid |
$725.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,325.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,451.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,526.25
|
| Rate for Payer: PACE Medicare |
$1,199.07
|
| Rate for Payer: PACE SWMI |
$1,262.18
|
| Rate for Payer: PHP Commercial |
$1,526.25
|
| Rate for Payer: PHP Medicare Advantage |
$1,262.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$690.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,256.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,973.38
|
| Rate for Payer: Priority Health Medicare |
$1,262.18
|
| Rate for Payer: Priority Health Narrow Network |
$3,178.70
|
| Rate for Payer: Priority Health SBD |
$1,131.22
|
| Rate for Payer: Railroad Medicare Medicare |
$1,262.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$338.22
|
| Rate for Payer: UHC Core |
$832.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,262.18
|
| Rate for Payer: UHC Exchange |
$307.47
|
| Rate for Payer: UHC Medicare Advantage |
$1,300.05
|
| Rate for Payer: UMR Bronson Commercial |
$664.37
|
| Rate for Payer: VA VA |
$1,262.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,346.69
|
|
|
HC NMO/AQP4 FACS TITER SERUM
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
30200395
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.59 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Aetna American Axle |
$65.00
|
| Rate for Payer: Aetna Commercial |
$85.00
|
| Rate for Payer: Aetna Medicare |
$12.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: BCBS Complete |
$6.92
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$8.13
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cofinity Commercial |
$70.00
|
| Rate for Payer: Cofinity Commercial |
$86.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$90.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$70.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.00
|
| Rate for Payer: Mclaren Medicaid |
$6.59
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Medicaid |
$6.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$85.00
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$85.00
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.53
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health Narrow Network |
$13.22
|
| Rate for Payer: Priority Health SBD |
$63.00
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.46
|
| Rate for Payer: UHC Core |
$19.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.05
|
| Rate for Payer: UHC Exchange |
$12.05
|
| Rate for Payer: UHC Medicare Advantage |
$12.41
|
| Rate for Payer: UMR Bronson Commercial |
$37.00
|
| Rate for Payer: VA VA |
$12.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.00
|
|
|
HC NMO/AQP4 FACS TITER SERUM
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
30200395
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$44.00 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Aetna American Axle |
$65.00
|
| Rate for Payer: Aetna Commercial |
$85.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cofinity Commercial |
$70.00
|
| Rate for Payer: Cofinity Commercial |
$86.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.00
|
| Rate for Payer: Healthscope Commercial |
$90.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$70.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$85.00
|
| Rate for Payer: PHP Commercial |
$85.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.00
|
| Rate for Payer: Priority Health SBD |
$63.00
|
| Rate for Payer: UMR Bronson Commercial |
$44.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.00
|
|
|
HC NMO/AQP4-IGG CBA, S
|
Facility
|
OP
|
$345.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200422
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.59 |
| Max. Negotiated Rate |
$310.50 |
| Rate for Payer: Aetna American Axle |
$224.25
|
| Rate for Payer: Aetna Commercial |
$293.25
|
| Rate for Payer: Aetna Medicare |
$12.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$224.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: BCBS Complete |
$6.92
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$8.13
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$276.00
|
| Rate for Payer: Cash Price |
$276.00
|
| Rate for Payer: Cofinity Commercial |
$296.70
|
| Rate for Payer: Cofinity Commercial |
$241.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$276.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$310.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$241.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$258.75
|
| Rate for Payer: Mclaren Medicaid |
$6.59
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Medicaid |
$6.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$293.25
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$293.25
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.53
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health Narrow Network |
$13.22
|
| Rate for Payer: Priority Health SBD |
$217.35
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.46
|
| Rate for Payer: UHC Core |
$19.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.05
|
| Rate for Payer: UHC Exchange |
$12.05
|
| Rate for Payer: UHC Medicare Advantage |
$12.41
|
| Rate for Payer: UMR Bronson Commercial |
$127.65
|
| Rate for Payer: VA VA |
$12.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$258.75
|
|
|
HC NMO/AQP4-IGG CBA, S
|
Facility
|
IP
|
$345.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200422
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$151.80 |
| Max. Negotiated Rate |
$310.50 |
| Rate for Payer: Aetna American Axle |
$224.25
|
| Rate for Payer: Aetna Commercial |
$293.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$224.25
|
| Rate for Payer: Cash Price |
$276.00
|
| Rate for Payer: Cofinity Commercial |
$241.50
|
| Rate for Payer: Cofinity Commercial |
$296.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$276.00
|
| Rate for Payer: Healthscope Commercial |
$310.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$241.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$258.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$293.25
|
| Rate for Payer: PHP Commercial |
$293.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.50
|
| Rate for Payer: Priority Health SBD |
$217.35
|
| Rate for Payer: UMR Bronson Commercial |
$151.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$258.75
|
|
|
HC NMO/AQUAPO 4 IGG CBA
|
Facility
|
OP
|
$344.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200394
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.59 |
| Max. Negotiated Rate |
$309.60 |
| Rate for Payer: Aetna American Axle |
$223.60
|
| Rate for Payer: Aetna Commercial |
$292.40
|
| Rate for Payer: Aetna Medicare |
$12.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$223.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: BCBS Complete |
$6.92
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$8.13
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$275.20
|
| Rate for Payer: Cash Price |
$275.20
|
| Rate for Payer: Cofinity Commercial |
$295.84
|
| Rate for Payer: Cofinity Commercial |
$240.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$275.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$309.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$240.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$258.00
|
| Rate for Payer: Mclaren Medicaid |
$6.59
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Medicaid |
$6.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$292.40
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$292.40
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$240.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.53
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health Narrow Network |
$13.22
|
| Rate for Payer: Priority Health SBD |
$216.72
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.46
|
| Rate for Payer: UHC Core |
$19.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.05
|
| Rate for Payer: UHC Exchange |
$12.05
|
| Rate for Payer: UHC Medicare Advantage |
$12.41
|
| Rate for Payer: UMR Bronson Commercial |
$127.28
|
| Rate for Payer: VA VA |
$12.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$258.00
|
|
|
HC NMO/AQUAPO 4 IGG CBA
|
Facility
|
IP
|
$344.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200394
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$151.36 |
| Max. Negotiated Rate |
$309.60 |
| Rate for Payer: Aetna American Axle |
$223.60
|
| Rate for Payer: Aetna Commercial |
$292.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$223.60
|
| Rate for Payer: Cash Price |
$275.20
|
| Rate for Payer: Cofinity Commercial |
$240.80
|
| Rate for Payer: Cofinity Commercial |
$295.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$275.20
|
| Rate for Payer: Healthscope Commercial |
$309.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$240.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$258.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$292.40
|
| Rate for Payer: PHP Commercial |
$292.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$240.80
|
| Rate for Payer: Priority Health SBD |
$216.72
|
| Rate for Payer: UMR Bronson Commercial |
$151.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$258.00
|
|
