|
HC NM TC 99M TILMANOCEPT DX PER 0.5 MCI
|
Facility
|
OP
|
$938.10
|
|
|
Service Code
|
HCPCS A9520
|
| Hospital Charge Code |
34300033
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$347.10 |
| Max. Negotiated Rate |
$844.29 |
| Rate for Payer: Aetna American Axle |
$609.76
|
| Rate for Payer: Aetna Commercial |
$797.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$609.76
|
| Rate for Payer: BCBS Complete |
$375.24
|
| Rate for Payer: BCBS Trust/PPO |
$595.95
|
| Rate for Payer: Cash Price |
$750.48
|
| Rate for Payer: Cash Price |
$750.48
|
| Rate for Payer: Cofinity Commercial |
$656.67
|
| Rate for Payer: Cofinity Commercial |
$806.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$750.48
|
| Rate for Payer: Healthscope Commercial |
$844.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$656.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$703.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$797.38
|
| Rate for Payer: PHP Commercial |
$797.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$656.67
|
| Rate for Payer: Priority Health SBD |
$591.00
|
| Rate for Payer: UMR Bronson Commercial |
$347.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$703.58
|
|
|
HC NM THYROID CA METS IMGI131 TOTAL
|
Facility
|
OP
|
$1,238.67
|
|
|
Service Code
|
CPT 78018
|
| Hospital Charge Code |
34100006
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$262.80 |
| Max. Negotiated Rate |
$1,512.47 |
| Rate for Payer: Aetna American Axle |
$805.14
|
| Rate for Payer: Aetna Commercial |
$1,052.87
|
| Rate for Payer: Aetna Medicare |
$499.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$805.14
|
| 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 |
$477.65
|
| Rate for Payer: BCN Medicare Advantage |
$480.44
|
| Rate for Payer: Cash Price |
$990.94
|
| Rate for Payer: Cash Price |
$990.94
|
| Rate for Payer: Cofinity Commercial |
$867.07
|
| Rate for Payer: Cofinity Commercial |
$1,065.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$990.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$480.44
|
| Rate for Payer: Healthscope Commercial |
$1,114.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$867.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$929.00
|
| 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 |
$1,052.87
|
| Rate for Payer: PACE Medicare |
$456.42
|
| Rate for Payer: PACE SWMI |
$480.44
|
| Rate for Payer: PHP Commercial |
$1,052.87
|
| 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 |
$867.07
|
| 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 |
$780.36
|
| Rate for Payer: Railroad Medicare Medicare |
$480.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$306.88
|
| Rate for Payer: UHC Core |
$832.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$480.44
|
| Rate for Payer: UHC Exchange |
$278.98
|
| Rate for Payer: UHC Medicare Advantage |
$494.85
|
| Rate for Payer: UMR Bronson Commercial |
$458.31
|
| Rate for Payer: VA VA |
$480.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$929.00
|
|
|
HC NM THYROID CA METS IMGI131 TOTAL
|
Facility
|
IP
|
$1,238.67
|
|
|
Service Code
|
CPT 78018
|
| Hospital Charge Code |
34100006
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$545.01 |
| Max. Negotiated Rate |
$1,114.80 |
| Rate for Payer: Aetna American Axle |
$805.14
|
| Rate for Payer: Aetna Commercial |
$1,052.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$805.14
|
| Rate for Payer: Cash Price |
$990.94
|
| Rate for Payer: Cofinity Commercial |
$1,065.26
|
| Rate for Payer: Cofinity Commercial |
$867.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$990.94
|
| Rate for Payer: Healthscope Commercial |
$1,114.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$867.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$929.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,052.87
|
| Rate for Payer: PHP Commercial |
$1,052.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$867.07
|
| Rate for Payer: Priority Health SBD |
$780.36
|
| Rate for Payer: UMR Bronson Commercial |
$545.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$929.00
|
|
|
HC NM TUMOR LOCALIZATION SPECT 2 AREAS
|
Facility
|
OP
|
$1,946.46
|
|
|
Service Code
|
CPT 78831
|
| Hospital Charge Code |
34100081
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$639.17 |
| Max. Negotiated Rate |
$3,973.38 |
| Rate for Payer: Aetna American Axle |
$1,265.20
|
| Rate for Payer: Aetna Commercial |
$1,654.49
|
| Rate for Payer: Aetna Medicare |
$1,312.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,265.20
|
| 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 |
$1,095.29
|
| Rate for Payer: BCN Medicare Advantage |
$1,262.18
|
| Rate for Payer: Cash Price |
$1,557.17
|
| Rate for Payer: Cash Price |
$1,557.17
|
| Rate for Payer: Cofinity Commercial |
$1,362.52
|
| Rate for Payer: Cofinity Commercial |
$1,673.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,557.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,262.18
|
| Rate for Payer: Healthscope Commercial |
$1,751.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,362.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,459.84
|
| 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 |
$1,654.49
|
| Rate for Payer: PACE Medicare |
$1,199.07
|
| Rate for Payer: PACE SWMI |
$1,262.18
|
| Rate for Payer: PHP Commercial |
$1,654.49
|
| 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 |
$1,362.52
|
| 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 |
$1,226.27
|
| Rate for Payer: Railroad Medicare Medicare |
$1,262.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$703.09
|
| Rate for Payer: UHC Core |
$832.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,262.18
|
| Rate for Payer: UHC Exchange |
$639.17
|
| Rate for Payer: UHC Medicare Advantage |
$1,300.05
|
| Rate for Payer: UMR Bronson Commercial |
$720.19
|
| Rate for Payer: VA VA |
$1,262.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,459.84
|
|
|
HC NM TUMOR LOCALIZATION SPECT 2 AREAS
|
Facility
|
IP
|
$1,946.46
|
|
|
Service Code
|
CPT 78831
|
| Hospital Charge Code |
34100081
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$856.44 |
| Max. Negotiated Rate |
$1,751.81 |
| Rate for Payer: Aetna American Axle |
$1,265.20
|
| Rate for Payer: Aetna Commercial |
$1,654.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,265.20
|
| Rate for Payer: Cash Price |
$1,557.17
|
| Rate for Payer: Cofinity Commercial |
$1,362.52
|
| Rate for Payer: Cofinity Commercial |
$1,673.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,557.17
|
| Rate for Payer: Healthscope Commercial |
$1,751.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,362.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,459.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,654.49
|
| Rate for Payer: PHP Commercial |
$1,654.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,362.52
|
| Rate for Payer: Priority Health SBD |
$1,226.27
|
| Rate for Payer: UMR Bronson Commercial |
$856.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,459.84
|
|
|
HC NM TUMOR SCAN SPECT
|
Facility
|
IP
|
$1,936.98
|
|
|
Service Code
|
CPT 78803
|
| Hospital Charge Code |
34100056
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$852.27 |
| Max. Negotiated Rate |
$1,743.28 |
| Rate for Payer: Aetna American Axle |
$1,259.04
|
| Rate for Payer: Aetna Commercial |
$1,646.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,259.04
|
| Rate for Payer: Cash Price |
$1,549.58
|
| Rate for Payer: Cofinity Commercial |
$1,355.89
|
| Rate for Payer: Cofinity Commercial |
$1,665.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,549.58
|
| Rate for Payer: Healthscope Commercial |
$1,743.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,355.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,452.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,646.43
|
| Rate for Payer: PHP Commercial |
$1,646.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,355.89
|
| Rate for Payer: Priority Health SBD |
$1,220.30
|
| Rate for Payer: UMR Bronson Commercial |
$852.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,452.74
|
|
|
HC NM TUMOR SCAN SPECT
|
Facility
|
OP
|
$1,936.98
|
|
|
Service Code
|
CPT 78803
|
| Hospital Charge Code |
34100056
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$341.19 |
| Max. Negotiated Rate |
$3,973.38 |
| Rate for Payer: Aetna American Axle |
$1,259.04
|
| Rate for Payer: Aetna Commercial |
$1,646.43
|
| Rate for Payer: Aetna Medicare |
$1,312.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,259.04
|
| 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 |
$579.63
|
| Rate for Payer: BCN Medicare Advantage |
$1,262.18
|
| Rate for Payer: Cash Price |
$1,549.58
|
| Rate for Payer: Cash Price |
$1,549.58
|
| Rate for Payer: Cofinity Commercial |
$1,355.89
|
| Rate for Payer: Cofinity Commercial |
$1,665.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,549.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,262.18
|
| Rate for Payer: Healthscope Commercial |
$1,743.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,355.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,452.74
|
| 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 |
$1,646.43
|
| Rate for Payer: PACE Medicare |
$1,199.07
|
| Rate for Payer: PACE SWMI |
$1,262.18
|
| Rate for Payer: PHP Commercial |
$1,646.43
|
| 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 |
$1,355.89
|
| 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 |
$1,220.30
|
| Rate for Payer: Railroad Medicare Medicare |
$1,262.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$375.31
|
| Rate for Payer: UHC Core |
$832.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,262.18
|
| Rate for Payer: UHC Exchange |
$341.19
|
| Rate for Payer: UHC Medicare Advantage |
$1,300.05
|
| Rate for Payer: UMR Bronson Commercial |
$716.68
|
| Rate for Payer: VA VA |
$1,262.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,452.74
|
|
|
HC NM UNLISTED PROC ENDOCRINE S
|
Facility
|
OP
|
$1,722.73
|
|
|
Service Code
|
CPT 60699
|
| Hospital Charge Code |
36100267
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$637.41 |
| Max. Negotiated Rate |
$16,145.72 |
| Rate for Payer: Aetna American Axle |
$1,119.77
|
| Rate for Payer: Aetna Commercial |
$1,464.32
|
| Rate for Payer: Aetna Medicare |
$5,333.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,119.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,411.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,411.01
|
| Rate for Payer: BCBS Complete |
$2,945.99
|
| Rate for Payer: BCBS MAPPO |
$5,128.81
|
| Rate for Payer: BCBS Trust/PPO |
$3,739.39
|
| Rate for Payer: BCN Medicare Advantage |
$5,128.81
|
| Rate for Payer: Cash Price |
$1,378.18
|
| Rate for Payer: Cash Price |
$1,378.18
|
| Rate for Payer: Cofinity Commercial |
$1,481.55
|
| Rate for Payer: Cofinity Commercial |
$1,205.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,378.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,128.81
|
| Rate for Payer: Healthscope Commercial |
$1,550.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,205.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,292.05
|
| Rate for Payer: Mclaren Medicaid |
$2,805.46
|
| Rate for Payer: Mclaren Medicare |
$5,128.81
|
| Rate for Payer: Meridian Medicaid |
$2,945.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,385.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,898.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,464.32
|
| Rate for Payer: PACE Medicare |
$4,872.37
|
| Rate for Payer: PACE SWMI |
$5,128.81
|
| Rate for Payer: PHP Commercial |
$1,464.32
|
| Rate for Payer: PHP Medicare Advantage |
$5,128.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,805.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,205.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,145.72
|
| Rate for Payer: Priority Health Medicare |
$5,128.81
|
| Rate for Payer: Priority Health Narrow Network |
$12,916.58
|
| Rate for Payer: Priority Health SBD |
$1,085.32
|
| Rate for Payer: Railroad Medicare Medicare |
$5,128.81
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,128.81
|
| Rate for Payer: UHC Medicare Advantage |
$5,282.67
|
| Rate for Payer: UMR Bronson Commercial |
$637.41
|
| Rate for Payer: VA VA |
$5,128.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,292.05
|
|
|
HC NM UNLISTED PROC ENDOCRINE S
|
Facility
|
IP
|
$1,722.73
|
|
|
Service Code
|
CPT 60699
|
| Hospital Charge Code |
36100267
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$758.00 |
| Max. Negotiated Rate |
$1,550.46 |
| Rate for Payer: Aetna American Axle |
$1,119.77
|
| Rate for Payer: Aetna Commercial |
$1,464.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,119.77
|
| Rate for Payer: Cash Price |
$1,378.18
|
| Rate for Payer: Cofinity Commercial |
$1,205.91
|
| Rate for Payer: Cofinity Commercial |
$1,481.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,378.18
|
| Rate for Payer: Healthscope Commercial |
$1,550.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,205.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,292.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,464.32
|
| Rate for Payer: PHP Commercial |
$1,464.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,205.91
|
| Rate for Payer: Priority Health SBD |
$1,085.32
|
| Rate for Payer: UMR Bronson Commercial |
$758.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,292.05
|
|
|
HC NM VENT AEROSOL/GAS AND PERFUS
|
Facility
|
OP
|
$1,633.68
|
|
|
Service Code
|
CPT 78582
|
| Hospital Charge Code |
34100068
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$262.80 |
| Max. Negotiated Rate |
$1,512.47 |
| Rate for Payer: Aetna American Axle |
$1,061.89
|
| Rate for Payer: Aetna Commercial |
$1,388.63
|
| Rate for Payer: Aetna Medicare |
$499.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,061.89
|
| 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 |
$493.49
|
| Rate for Payer: BCN Medicare Advantage |
$480.44
|
| Rate for Payer: Cash Price |
$1,306.94
|
| Rate for Payer: Cash Price |
$1,306.94
|
| Rate for Payer: Cofinity Commercial |
$1,143.58
|
| Rate for Payer: Cofinity Commercial |
$1,404.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,306.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$480.44
|
| Rate for Payer: Healthscope Commercial |
$1,470.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,143.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,225.26
|
| 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 |
$1,388.63
|
| Rate for Payer: PACE Medicare |
$456.42
|
| Rate for Payer: PACE SWMI |
$480.44
|
| Rate for Payer: PHP Commercial |
$1,388.63
|
| 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 |
$1,143.58
|
| 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 |
$1,029.22
|
| Rate for Payer: Railroad Medicare Medicare |
$480.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$327.77
|
| Rate for Payer: UHC Core |
$832.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$480.44
|
| Rate for Payer: UHC Exchange |
$297.97
|
| Rate for Payer: UHC Medicare Advantage |
$494.85
|
| Rate for Payer: UMR Bronson Commercial |
$604.46
|
| Rate for Payer: VA VA |
$480.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,225.26
|
|
|
HC NM VENT AEROSOL/GAS AND PERFUS
|
Facility
|
IP
|
$1,633.68
|
|
|
Service Code
|
CPT 78582
|
| Hospital Charge Code |
34100068
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$718.82 |
| Max. Negotiated Rate |
$1,470.31 |
| Rate for Payer: Aetna American Axle |
$1,061.89
|
| Rate for Payer: Aetna Commercial |
$1,388.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,061.89
|
| Rate for Payer: Cash Price |
$1,306.94
|
| Rate for Payer: Cofinity Commercial |
$1,143.58
|
| Rate for Payer: Cofinity Commercial |
$1,404.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,306.94
|
| Rate for Payer: Healthscope Commercial |
$1,470.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,143.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,225.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,388.63
|
| Rate for Payer: PHP Commercial |
$1,388.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,143.58
|
| Rate for Payer: Priority Health SBD |
$1,029.22
|
| Rate for Payer: UMR Bronson Commercial |
$718.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,225.26
|
|
|
HC NM VENTILATION AEROSOL OR GAS
|
Facility
|
IP
|
$1,195.27
|
|
|
Service Code
|
CPT 78579
|
| Hospital Charge Code |
34100071
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$525.92 |
| Max. Negotiated Rate |
$1,075.74 |
| Rate for Payer: Aetna American Axle |
$776.93
|
| Rate for Payer: Aetna Commercial |
$1,015.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$776.93
|
| Rate for Payer: Cash Price |
$956.22
|
| Rate for Payer: Cofinity Commercial |
$1,027.93
|
| Rate for Payer: Cofinity Commercial |
$836.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$956.22
|
| Rate for Payer: Healthscope Commercial |
$1,075.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$836.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$896.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,015.98
|
| Rate for Payer: PHP Commercial |
$1,015.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$836.69
|
| Rate for Payer: Priority Health SBD |
$753.02
|
| Rate for Payer: UMR Bronson Commercial |
$525.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$896.45
|
|
|
HC NM VENTILATION AEROSOL OR GAS
|
Facility
|
OP
|
$1,195.27
|
|
|
Service Code
|
CPT 78579
|
| Hospital Charge Code |
34100071
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$169.29 |
| Max. Negotiated Rate |
$1,154.12 |
| Rate for Payer: Aetna American Axle |
$776.93
|
| Rate for Payer: Aetna Commercial |
$1,015.98
|
| Rate for Payer: Aetna Medicare |
$381.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$776.93
|
| 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 |
$291.41
|
| Rate for Payer: BCN Medicare Advantage |
$366.61
|
| Rate for Payer: Cash Price |
$956.22
|
| Rate for Payer: Cash Price |
$956.22
|
| Rate for Payer: Cofinity Commercial |
$836.69
|
| Rate for Payer: Cofinity Commercial |
$1,027.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$956.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$366.61
|
| Rate for Payer: Healthscope Commercial |
$1,075.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$836.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$896.45
|
| 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 |
$1,015.98
|
| Rate for Payer: PACE Medicare |
$348.28
|
| Rate for Payer: PACE SWMI |
$366.61
|
| Rate for Payer: PHP Commercial |
$1,015.98
|
| 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 |
$836.69
|
| 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 |
$753.02
|
| Rate for Payer: Railroad Medicare Medicare |
$366.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$186.22
|
| Rate for Payer: UHC Core |
$832.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$366.61
|
| Rate for Payer: UHC Exchange |
$169.29
|
| Rate for Payer: UHC Medicare Advantage |
$377.61
|
| Rate for Payer: UMR Bronson Commercial |
$442.25
|
| Rate for Payer: VA VA |
$366.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$896.45
|
|
|
HC NM VENTILATION PERFUS QUANT DIFF
|
Facility
|
IP
|
$1,633.68
|
|
|
Service Code
|
CPT 78598
|
| Hospital Charge Code |
34100070
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$718.82 |
| Max. Negotiated Rate |
$1,470.31 |
| Rate for Payer: Aetna American Axle |
$1,061.89
|
| Rate for Payer: Aetna Commercial |
$1,388.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,061.89
|
| Rate for Payer: Cash Price |
$1,306.94
|
| Rate for Payer: Cofinity Commercial |
$1,143.58
|
| Rate for Payer: Cofinity Commercial |
$1,404.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,306.94
|
| Rate for Payer: Healthscope Commercial |
$1,470.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,143.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,225.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,388.63
|
| Rate for Payer: PHP Commercial |
$1,388.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,143.58
|
| Rate for Payer: Priority Health SBD |
$1,029.22
|
| Rate for Payer: UMR Bronson Commercial |
$718.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,225.26
|
|
|
HC NM VENTILATION PERFUS QUANT DIFF
|
Facility
|
OP
|
$1,633.68
|
|
|
Service Code
|
CPT 78598
|
| Hospital Charge Code |
34100070
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$262.80 |
| Max. Negotiated Rate |
$1,512.47 |
| Rate for Payer: Aetna American Axle |
$1,061.89
|
| Rate for Payer: Aetna Commercial |
$1,388.63
|
| Rate for Payer: Aetna Medicare |
$499.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,061.89
|
| 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 |
$461.17
|
| Rate for Payer: BCN Medicare Advantage |
$480.44
|
| Rate for Payer: Cash Price |
$1,306.94
|
| Rate for Payer: Cash Price |
$1,306.94
|
| Rate for Payer: Cofinity Commercial |
$1,143.58
|
| Rate for Payer: Cofinity Commercial |
$1,404.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,306.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$480.44
|
| Rate for Payer: Healthscope Commercial |
$1,470.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,143.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,225.26
|
| 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 |
$1,388.63
|
| Rate for Payer: PACE Medicare |
$456.42
|
| Rate for Payer: PACE SWMI |
$480.44
|
| Rate for Payer: PHP Commercial |
$1,388.63
|
| 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 |
$1,143.58
|
| 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 |
$1,029.22
|
| Rate for Payer: Railroad Medicare Medicare |
$480.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$297.52
|
| Rate for Payer: UHC Core |
$832.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$480.44
|
| Rate for Payer: UHC Exchange |
$270.47
|
| Rate for Payer: UHC Medicare Advantage |
$494.85
|
| Rate for Payer: UMR Bronson Commercial |
$604.46
|
| Rate for Payer: VA VA |
$480.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,225.26
|
|
|
HC NM VOID CYSTO
|
Facility
|
IP
|
$1,048.31
|
|
|
Service Code
|
CPT 78740
|
| Hospital Charge Code |
34100049
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$461.26 |
| Max. Negotiated Rate |
$943.48 |
| Rate for Payer: Aetna American Axle |
$681.40
|
| Rate for Payer: Aetna Commercial |
$891.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$681.40
|
| Rate for Payer: Cash Price |
$838.65
|
| Rate for Payer: Cofinity Commercial |
$733.82
|
| Rate for Payer: Cofinity Commercial |
$901.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$838.65
|
| Rate for Payer: Healthscope Commercial |
$943.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$733.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$786.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$891.06
|
| Rate for Payer: PHP Commercial |
$891.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$733.82
|
| Rate for Payer: Priority Health SBD |
$660.44
|
| Rate for Payer: UMR Bronson Commercial |
$461.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$786.23
|
|
|
HC NM VOID CYSTO
|
Facility
|
OP
|
$1,048.31
|
|
|
Service Code
|
CPT 78740
|
| Hospital Charge Code |
34100049
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$200.54 |
| Max. Negotiated Rate |
$1,154.12 |
| Rate for Payer: Aetna American Axle |
$681.40
|
| Rate for Payer: Aetna Commercial |
$891.06
|
| Rate for Payer: Aetna Medicare |
$381.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$681.40
|
| 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 |
$337.64
|
| Rate for Payer: BCN Medicare Advantage |
$366.61
|
| Rate for Payer: Cash Price |
$838.65
|
| Rate for Payer: Cash Price |
$838.65
|
| Rate for Payer: Cofinity Commercial |
$733.82
|
| Rate for Payer: Cofinity Commercial |
$901.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$838.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$366.61
|
| Rate for Payer: Healthscope Commercial |
$943.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$733.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$786.23
|
| 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 |
$891.06
|
| Rate for Payer: PACE Medicare |
$348.28
|
| Rate for Payer: PACE SWMI |
$366.61
|
| Rate for Payer: PHP Commercial |
$891.06
|
| 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 |
$733.82
|
| 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 |
$660.44
|
| Rate for Payer: Railroad Medicare Medicare |
$366.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$227.28
|
| Rate for Payer: UHC Core |
$832.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$366.61
|
| Rate for Payer: UHC Exchange |
$206.62
|
| Rate for Payer: UHC Medicare Advantage |
$377.61
|
| Rate for Payer: UMR Bronson Commercial |
$387.87
|
| Rate for Payer: VA VA |
$366.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$786.23
|
|
|
HC NM ZEVALIN Y-90 THERAPY
|
Facility
|
IP
|
$1,901.83
|
|
|
Service Code
|
CPT 79403
|
| Hospital Charge Code |
34100065
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$836.81 |
| Max. Negotiated Rate |
$1,711.65 |
| Rate for Payer: Aetna American Axle |
$1,236.19
|
| Rate for Payer: Aetna Commercial |
$1,616.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,236.19
|
| Rate for Payer: Cash Price |
$1,521.46
|
| Rate for Payer: Cofinity Commercial |
$1,635.57
|
| Rate for Payer: Cofinity Commercial |
$1,331.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,521.46
|
| Rate for Payer: Healthscope Commercial |
$1,711.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,331.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,426.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,616.56
|
| Rate for Payer: PHP Commercial |
$1,616.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,331.28
|
| Rate for Payer: Priority Health SBD |
$1,198.15
|
| Rate for Payer: UMR Bronson Commercial |
$836.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,426.37
|
|
|
HC NM ZEVALIN Y-90 THERAPY
|
Facility
|
OP
|
$1,901.83
|
|
|
Service Code
|
CPT 79403
|
| Hospital Charge Code |
34100065
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$120.96 |
| Max. Negotiated Rate |
$1,711.65 |
| Rate for Payer: Aetna American Axle |
$1,236.19
|
| Rate for Payer: Aetna Commercial |
$1,616.56
|
| Rate for Payer: Aetna Medicare |
$229.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,236.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$276.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$276.42
|
| Rate for Payer: BCBS Complete |
$127.02
|
| Rate for Payer: BCBS MAPPO |
$221.14
|
| Rate for Payer: BCBS Trust/PPO |
$177.37
|
| Rate for Payer: BCN Medicare Advantage |
$221.14
|
| Rate for Payer: Cash Price |
$1,521.46
|
| Rate for Payer: Cash Price |
$1,521.46
|
| Rate for Payer: Cofinity Commercial |
$1,635.57
|
| Rate for Payer: Cofinity Commercial |
$1,331.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,521.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$221.14
|
| Rate for Payer: Healthscope Commercial |
$1,711.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,331.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,426.37
|
| Rate for Payer: Mclaren Medicaid |
$120.96
|
| Rate for Payer: Mclaren Medicare |
$221.14
|
| Rate for Payer: Meridian Medicaid |
$127.02
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$232.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$254.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,616.56
|
| Rate for Payer: PACE Medicare |
$210.08
|
| Rate for Payer: PACE SWMI |
$221.14
|
| Rate for Payer: PHP Commercial |
$1,616.56
|
| Rate for Payer: PHP Medicare Advantage |
$221.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$120.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,331.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$696.16
|
| Rate for Payer: Priority Health Medicare |
$221.14
|
| Rate for Payer: Priority Health Narrow Network |
$556.93
|
| Rate for Payer: Priority Health SBD |
$1,198.15
|
| Rate for Payer: Railroad Medicare Medicare |
$221.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$225.84
|
| Rate for Payer: UHC Core |
$832.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$221.14
|
| Rate for Payer: UHC Exchange |
$205.31
|
| Rate for Payer: UHC Medicare Advantage |
$227.77
|
| Rate for Payer: UMR Bronson Commercial |
$703.68
|
| Rate for Payer: VA VA |
$221.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,426.37
|
|
|
HC NO IMPLANT/INSERT DEVICE W/DEVICE-INTENS PROC
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
HCPCS C1890
|
| Hospital Charge Code |
27800125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$0.90 |
| Rate for Payer: Aetna American Axle |
$0.65
|
| Rate for Payer: Aetna Commercial |
$0.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.65
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cofinity Commercial |
$0.70
|
| Rate for Payer: Cofinity Commercial |
$0.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.80
|
| Rate for Payer: Healthscope Commercial |
$0.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$0.85
|
| Rate for Payer: PHP Commercial |
$0.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.70
|
| Rate for Payer: Priority Health SBD |
$0.63
|
| Rate for Payer: UMR Bronson Commercial |
$0.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.75
|
|
|
HC NO IMPLANT/INSERT DEVICE W/DEVICE-INTENS PROC
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
HCPCS C1890
|
| Hospital Charge Code |
27800125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$0.90 |
| Rate for Payer: Aetna American Axle |
$0.65
|
| Rate for Payer: Aetna Commercial |
$0.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.65
|
| Rate for Payer: BCBS Complete |
$0.40
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cofinity Commercial |
$0.70
|
| Rate for Payer: Cofinity Commercial |
$0.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.80
|
| Rate for Payer: Healthscope Commercial |
$0.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$0.85
|
| Rate for Payer: PHP Commercial |
$0.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.70
|
| Rate for Payer: Priority Health SBD |
$0.63
|
| Rate for Payer: UMR Bronson Commercial |
$0.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.75
|
|
|
HC NONCONC SLIDES W/INTERP
|
Facility
|
OP
|
$85.59
|
|
|
Service Code
|
CPT 88104
|
| Hospital Charge Code |
31100001
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$19.50 |
| Max. Negotiated Rate |
$112.22 |
| Rate for Payer: Aetna American Axle |
$55.63
|
| Rate for Payer: Aetna Commercial |
$72.75
|
| Rate for Payer: Aetna Medicare |
$37.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$44.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$44.56
|
| Rate for Payer: BCBS Complete |
$20.48
|
| Rate for Payer: BCBS MAPPO |
$35.65
|
| Rate for Payer: BCBS Trust/PPO |
$60.34
|
| Rate for Payer: BCN Medicare Advantage |
$35.65
|
| Rate for Payer: Cash Price |
$68.47
|
| Rate for Payer: Cash Price |
$68.47
|
| Rate for Payer: Cofinity Commercial |
$73.61
|
| Rate for Payer: Cofinity Commercial |
$59.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.65
|
| Rate for Payer: Healthscope Commercial |
$77.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$59.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.19
|
| Rate for Payer: Mclaren Medicaid |
$19.50
|
| Rate for Payer: Mclaren Medicare |
$35.65
|
| Rate for Payer: Meridian Medicaid |
$20.48
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$37.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$72.75
|
| Rate for Payer: PACE Medicare |
$33.87
|
| Rate for Payer: PACE SWMI |
$35.65
|
| Rate for Payer: PHP Commercial |
$72.75
|
| Rate for Payer: PHP Medicare Advantage |
$35.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$112.22
|
| Rate for Payer: Priority Health Medicare |
$35.65
|
| Rate for Payer: Priority Health Narrow Network |
$89.78
|
| Rate for Payer: Priority Health SBD |
$53.92
|
| Rate for Payer: Railroad Medicare Medicare |
$35.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$81.76
|
| Rate for Payer: UHC Core |
$28.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.65
|
| Rate for Payer: UHC Exchange |
$74.33
|
| Rate for Payer: UHC Medicare Advantage |
$36.72
|
| Rate for Payer: UMR Bronson Commercial |
$31.67
|
| Rate for Payer: VA VA |
$35.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.19
|
|
|
HC NONCONC SLIDES W/INTERP
|
Facility
|
IP
|
$85.59
|
|
|
Service Code
|
CPT 88104
|
| Hospital Charge Code |
31100001
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$37.66 |
| Max. Negotiated Rate |
$77.03 |
| Rate for Payer: Aetna American Axle |
$55.63
|
| Rate for Payer: Aetna Commercial |
$72.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.63
|
| Rate for Payer: Cash Price |
$68.47
|
| Rate for Payer: Cofinity Commercial |
$59.91
|
| Rate for Payer: Cofinity Commercial |
$73.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.47
|
| Rate for Payer: Healthscope Commercial |
$77.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$59.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$72.75
|
| Rate for Payer: PHP Commercial |
$72.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.91
|
| Rate for Payer: Priority Health SBD |
$53.92
|
| Rate for Payer: UMR Bronson Commercial |
$37.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.19
|
|
|
HC NONINVASIVE PROGRAM STIM
|
Facility
|
IP
|
$2,421.31
|
|
|
Service Code
|
CPT 93642
|
| Hospital Charge Code |
48100043
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,065.38 |
| Max. Negotiated Rate |
$2,179.18 |
| Rate for Payer: Aetna American Axle |
$1,573.85
|
| Rate for Payer: Aetna Commercial |
$2,058.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,573.85
|
| Rate for Payer: Cash Price |
$1,937.05
|
| Rate for Payer: Cofinity Commercial |
$1,694.92
|
| Rate for Payer: Cofinity Commercial |
$2,082.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,937.05
|
| Rate for Payer: Healthscope Commercial |
$2,179.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,694.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,815.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,058.11
|
| Rate for Payer: PHP Commercial |
$2,058.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,694.92
|
| Rate for Payer: Priority Health SBD |
$1,525.43
|
| Rate for Payer: UMR Bronson Commercial |
$1,065.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,815.98
|
|
|
HC NONINVASIVE PROGRAM STIM
|
Facility
|
OP
|
$2,421.31
|
|
|
Service Code
|
CPT 93642
|
| Hospital Charge Code |
48100043
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$319.91 |
| Max. Negotiated Rate |
$3,330.26 |
| Rate for Payer: Aetna American Axle |
$1,573.85
|
| Rate for Payer: Aetna Commercial |
$2,058.11
|
| Rate for Payer: Aetna Medicare |
$1,100.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,573.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,322.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,322.35
|
| Rate for Payer: BCBS Complete |
$607.65
|
| Rate for Payer: BCBS MAPPO |
$1,057.88
|
| Rate for Payer: BCBS Trust/PPO |
$413.88
|
| Rate for Payer: BCN Medicare Advantage |
$1,057.88
|
| Rate for Payer: Cash Price |
$1,937.05
|
| Rate for Payer: Cash Price |
$1,937.05
|
| Rate for Payer: Cofinity Commercial |
$2,082.33
|
| Rate for Payer: Cofinity Commercial |
$1,694.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,937.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,057.88
|
| Rate for Payer: Healthscope Commercial |
$2,179.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,694.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,815.98
|
| Rate for Payer: Mclaren Medicaid |
$578.66
|
| Rate for Payer: Mclaren Medicare |
$1,057.88
|
| Rate for Payer: Meridian Medicaid |
$607.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,110.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,216.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,058.11
|
| Rate for Payer: PACE Medicare |
$1,004.99
|
| Rate for Payer: PACE SWMI |
$1,057.88
|
| Rate for Payer: PHP Commercial |
$2,058.11
|
| Rate for Payer: PHP Medicare Advantage |
$1,057.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$578.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,694.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,330.26
|
| Rate for Payer: Priority Health Medicare |
$1,057.88
|
| Rate for Payer: Priority Health Narrow Network |
$2,664.21
|
| Rate for Payer: Priority Health SBD |
$1,525.43
|
| Rate for Payer: Railroad Medicare Medicare |
$1,057.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$351.90
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,057.88
|
| Rate for Payer: UHC Exchange |
$319.91
|
| Rate for Payer: UHC Medicare Advantage |
$1,089.62
|
| Rate for Payer: UMR Bronson Commercial |
$895.88
|
| Rate for Payer: VA VA |
$1,057.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,815.98
|
|
