|
HC OCT CATHETER
|
Facility
|
OP
|
$2,529.70
|
|
|
Service Code
|
HCPCS C1753
|
| Hospital Charge Code |
27200243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$935.99 |
| Max. Negotiated Rate |
$2,276.73 |
| Rate for Payer: Aetna American Axle |
$1,644.30
|
| Rate for Payer: Aetna Commercial |
$2,150.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,644.30
|
| Rate for Payer: BCBS Complete |
$1,011.88
|
| Rate for Payer: Cash Price |
$2,023.76
|
| Rate for Payer: Cofinity Commercial |
$1,770.79
|
| Rate for Payer: Cofinity Commercial |
$2,175.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,023.76
|
| Rate for Payer: Healthscope Commercial |
$2,276.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,770.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,897.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,150.24
|
| Rate for Payer: PHP Commercial |
$2,150.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,770.79
|
| Rate for Payer: Priority Health SBD |
$1,593.71
|
| Rate for Payer: UMR Bronson Commercial |
$935.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,897.28
|
|
|
HC OCTOPUS SET CARDIOPLEGIA
|
Facility
|
OP
|
$45.00
|
|
| Hospital Charge Code |
27000106
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.65 |
| Max. Negotiated Rate |
$40.50 |
| Rate for Payer: Aetna American Axle |
$29.25
|
| Rate for Payer: Aetna Commercial |
$38.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.25
|
| Rate for Payer: BCBS Complete |
$18.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cofinity Commercial |
$31.50
|
| Rate for Payer: Cofinity Commercial |
$38.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.00
|
| Rate for Payer: Healthscope Commercial |
$40.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.25
|
| Rate for Payer: PHP Commercial |
$38.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.50
|
| Rate for Payer: Priority Health SBD |
$28.35
|
| Rate for Payer: UMR Bronson Commercial |
$16.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.75
|
|
|
HC OCTOPUS SET CARDIOPLEGIA
|
Facility
|
IP
|
$45.00
|
|
| Hospital Charge Code |
27000106
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$19.80 |
| Max. Negotiated Rate |
$40.50 |
| Rate for Payer: Aetna American Axle |
$29.25
|
| Rate for Payer: Aetna Commercial |
$38.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.25
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cofinity Commercial |
$31.50
|
| Rate for Payer: Cofinity Commercial |
$38.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.00
|
| Rate for Payer: Healthscope Commercial |
$40.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.25
|
| Rate for Payer: PHP Commercial |
$38.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.50
|
| Rate for Payer: Priority Health SBD |
$28.35
|
| Rate for Payer: UMR Bronson Commercial |
$19.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.75
|
|
|
HC OCULAR INSTRMNT SCREEN BILAT
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 99174
|
| Hospital Charge Code |
51000105
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$6.22 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna American Axle |
$33.15
|
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.15
|
| Rate for Payer: BCBS Complete |
$20.40
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Cofinity Commercial |
$35.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health SBD |
$32.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.84
|
| Rate for Payer: UHC Exchange |
$6.22
|
| Rate for Payer: UMR Bronson Commercial |
$18.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.25
|
|
|
HC OCULAR INSTRMNT SCREEN BILAT
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 99174
|
| Hospital Charge Code |
51000105
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$22.44 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna American Axle |
$33.15
|
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.15
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$35.70
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health SBD |
$32.13
|
| Rate for Payer: UMR Bronson Commercial |
$22.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.25
|
|
|
HC OLIGOCLONAL BANDS
|
Facility
|
IP
|
$42.04
|
|
|
Service Code
|
CPT 83916
|
| Hospital Charge Code |
30100371
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.50 |
| Max. Negotiated Rate |
$37.84 |
| Rate for Payer: Aetna American Axle |
$27.33
|
| Rate for Payer: Aetna Commercial |
$35.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.33
|
| Rate for Payer: Cash Price |
$33.63
|
| Rate for Payer: Cofinity Commercial |
$29.43
|
| Rate for Payer: Cofinity Commercial |
$36.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.63
|
| Rate for Payer: Healthscope Commercial |
$37.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$35.73
|
| Rate for Payer: PHP Commercial |
$35.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.43
|
| Rate for Payer: Priority Health SBD |
$26.49
|
| Rate for Payer: UMR Bronson Commercial |
$18.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.53
|
|
|
HC OLIGOCLONAL BANDS
|
Facility
|
OP
|
$42.04
|
|
|
Service Code
|
CPT 83916
|
| Hospital Charge Code |
30100371
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.98 |
| Max. Negotiated Rate |
$37.84 |
| Rate for Payer: Aetna American Axle |
$27.33
|
| Rate for Payer: Aetna Commercial |
$35.73
|
| Rate for Payer: Aetna Medicare |
$28.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.24
|
| Rate for Payer: BCBS Complete |
$15.73
|
| Rate for Payer: BCBS MAPPO |
$27.39
|
| Rate for Payer: BCBS Trust/PPO |
$24.63
|
| Rate for Payer: BCN Medicare Advantage |
$27.39
|
| Rate for Payer: Cash Price |
$33.63
|
| Rate for Payer: Cash Price |
$33.63
|
| Rate for Payer: Cofinity Commercial |
$36.15
|
| Rate for Payer: Cofinity Commercial |
$29.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.39
|
| Rate for Payer: Healthscope Commercial |
$37.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.53
|
| Rate for Payer: Mclaren Medicaid |
$14.98
|
| Rate for Payer: Mclaren Medicare |
$27.39
|
| Rate for Payer: Meridian Medicaid |
$15.73
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$28.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$35.73
|
| Rate for Payer: PACE Medicare |
$26.02
|
| Rate for Payer: PACE SWMI |
$27.39
|
| Rate for Payer: PHP Commercial |
$35.73
|
| Rate for Payer: PHP Medicare Advantage |
$27.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25.53
|
| Rate for Payer: Priority Health Medicare |
$27.39
|
| Rate for Payer: Priority Health Narrow Network |
$20.42
|
| Rate for Payer: Priority Health SBD |
$26.49
|
| Rate for Payer: Railroad Medicare Medicare |
$27.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.87
|
| Rate for Payer: UHC Core |
$33.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.39
|
| Rate for Payer: UHC Exchange |
$27.39
|
| Rate for Payer: UHC Medicare Advantage |
$28.21
|
| Rate for Payer: UMR Bronson Commercial |
$15.55
|
| Rate for Payer: VA VA |
$27.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.53
|
|
|
HC OLIGOCLONAL BANDS CMPT
|
Facility
|
OP
|
$42.04
|
|
|
Service Code
|
CPT 83916
|
| Hospital Charge Code |
30100551
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.98 |
| Max. Negotiated Rate |
$37.84 |
| Rate for Payer: Aetna American Axle |
$27.33
|
| Rate for Payer: Aetna Commercial |
$35.73
|
| Rate for Payer: Aetna Medicare |
$28.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.24
|
| Rate for Payer: BCBS Complete |
$15.73
|
| Rate for Payer: BCBS MAPPO |
$27.39
|
| Rate for Payer: BCBS Trust/PPO |
$24.63
|
| Rate for Payer: BCN Medicare Advantage |
$27.39
|
| Rate for Payer: Cash Price |
$33.63
|
| Rate for Payer: Cash Price |
$33.63
|
| Rate for Payer: Cofinity Commercial |
$36.15
|
| Rate for Payer: Cofinity Commercial |
$29.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.39
|
| Rate for Payer: Healthscope Commercial |
$37.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.53
|
| Rate for Payer: Mclaren Medicaid |
$14.98
|
| Rate for Payer: Mclaren Medicare |
$27.39
|
| Rate for Payer: Meridian Medicaid |
$15.73
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$28.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$35.73
|
| Rate for Payer: PACE Medicare |
$26.02
|
| Rate for Payer: PACE SWMI |
$27.39
|
| Rate for Payer: PHP Commercial |
$35.73
|
| Rate for Payer: PHP Medicare Advantage |
$27.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25.53
|
| Rate for Payer: Priority Health Medicare |
$27.39
|
| Rate for Payer: Priority Health Narrow Network |
$20.42
|
| Rate for Payer: Priority Health SBD |
$26.49
|
| Rate for Payer: Railroad Medicare Medicare |
$27.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.87
|
| Rate for Payer: UHC Core |
$33.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.39
|
| Rate for Payer: UHC Exchange |
$27.39
|
| Rate for Payer: UHC Medicare Advantage |
$28.21
|
| Rate for Payer: UMR Bronson Commercial |
$15.55
|
| Rate for Payer: VA VA |
$27.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.53
|
|
|
HC OLIGOCLONAL BANDS CMPT
|
Facility
|
IP
|
$42.04
|
|
|
Service Code
|
CPT 83916
|
| Hospital Charge Code |
30100551
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.50 |
| Max. Negotiated Rate |
$37.84 |
| Rate for Payer: Aetna American Axle |
$27.33
|
| Rate for Payer: Aetna Commercial |
$35.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.33
|
| Rate for Payer: Cash Price |
$33.63
|
| Rate for Payer: Cofinity Commercial |
$29.43
|
| Rate for Payer: Cofinity Commercial |
$36.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.63
|
| Rate for Payer: Healthscope Commercial |
$37.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$35.73
|
| Rate for Payer: PHP Commercial |
$35.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.43
|
| Rate for Payer: Priority Health SBD |
$26.49
|
| Rate for Payer: UMR Bronson Commercial |
$18.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.53
|
|
|
HC OMMAYA
|
Facility
|
IP
|
$377.19
|
|
|
Service Code
|
CPT 96542
|
| Hospital Charge Code |
33500005
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$165.96 |
| Max. Negotiated Rate |
$339.47 |
| Rate for Payer: Aetna American Axle |
$245.17
|
| Rate for Payer: Aetna Commercial |
$320.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$245.17
|
| Rate for Payer: Cash Price |
$301.75
|
| Rate for Payer: Cofinity Commercial |
$264.03
|
| Rate for Payer: Cofinity Commercial |
$324.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$301.75
|
| Rate for Payer: Healthscope Commercial |
$339.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$264.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$282.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$320.61
|
| Rate for Payer: PHP Commercial |
$320.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$264.03
|
| Rate for Payer: Priority Health SBD |
$237.63
|
| Rate for Payer: UMR Bronson Commercial |
$165.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$282.89
|
|
|
HC OMMAYA
|
Facility
|
OP
|
$377.19
|
|
|
Service Code
|
CPT 96542
|
| Hospital Charge Code |
33500005
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$40.93 |
| Max. Negotiated Rate |
$947.66 |
| Rate for Payer: Aetna American Axle |
$245.17
|
| Rate for Payer: Aetna Commercial |
$320.61
|
| Rate for Payer: Aetna Medicare |
$313.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$245.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$376.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$376.29
|
| Rate for Payer: BCBS Complete |
$172.91
|
| Rate for Payer: BCBS MAPPO |
$301.03
|
| Rate for Payer: BCBS Trust/PPO |
$693.45
|
| Rate for Payer: BCN Medicare Advantage |
$301.03
|
| Rate for Payer: Cash Price |
$301.75
|
| Rate for Payer: Cash Price |
$301.75
|
| Rate for Payer: Cofinity Commercial |
$324.38
|
| Rate for Payer: Cofinity Commercial |
$264.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$301.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$301.03
|
| Rate for Payer: Healthscope Commercial |
$339.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$264.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$282.89
|
| Rate for Payer: Mclaren Medicaid |
$164.66
|
| Rate for Payer: Mclaren Medicare |
$301.03
|
| Rate for Payer: Meridian Medicaid |
$172.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$316.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$346.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$320.61
|
| Rate for Payer: PACE Medicare |
$285.98
|
| Rate for Payer: PACE SWMI |
$301.03
|
| Rate for Payer: PHP Commercial |
$320.61
|
| Rate for Payer: PHP Medicare Advantage |
$301.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$164.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$264.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$947.66
|
| Rate for Payer: Priority Health Medicare |
$301.03
|
| Rate for Payer: Priority Health Narrow Network |
$758.13
|
| Rate for Payer: Priority Health SBD |
$237.63
|
| Rate for Payer: Railroad Medicare Medicare |
$301.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.02
|
| Rate for Payer: UHC Core |
$284.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$301.03
|
| Rate for Payer: UHC Exchange |
$40.93
|
| Rate for Payer: UHC Medicare Advantage |
$310.06
|
| Rate for Payer: UMR Bronson Commercial |
$139.56
|
| Rate for Payer: VA VA |
$301.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$282.89
|
|
|
HC OMNIPAQUE 300 PER ML
|
Facility
|
IP
|
$1.77
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
63600017
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$1.59 |
| Rate for Payer: Aetna American Axle |
$1.15
|
| Rate for Payer: Aetna Commercial |
$1.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.15
|
| Rate for Payer: Cash Price |
$1.42
|
| Rate for Payer: Cofinity Commercial |
$1.24
|
| Rate for Payer: Cofinity Commercial |
$1.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.42
|
| Rate for Payer: Healthscope Commercial |
$1.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.50
|
| Rate for Payer: PHP Commercial |
$1.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.24
|
| Rate for Payer: Priority Health SBD |
$1.12
|
| Rate for Payer: UMR Bronson Commercial |
$0.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.33
|
|
|
HC OMNIPAQUE 300 PER ML
|
Facility
|
OP
|
$1.77
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
63600017
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$1.59 |
| Rate for Payer: Aetna American Axle |
$1.15
|
| Rate for Payer: Aetna Commercial |
$1.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.15
|
| Rate for Payer: BCBS Complete |
$0.71
|
| Rate for Payer: BCBS Trust/PPO |
$0.14
|
| Rate for Payer: Cash Price |
$1.42
|
| Rate for Payer: Cash Price |
$1.42
|
| Rate for Payer: Cofinity Commercial |
$1.24
|
| Rate for Payer: Cofinity Commercial |
$1.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.42
|
| Rate for Payer: Healthscope Commercial |
$1.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.50
|
| Rate for Payer: PHP Commercial |
$1.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.24
|
| Rate for Payer: Priority Health SBD |
$1.12
|
| Rate for Payer: UMR Bronson Commercial |
$0.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.33
|
|
|
HC OPEN HEART PLATELET MAPPING
|
Facility
|
IP
|
$925.49
|
|
| Hospital Charge Code |
27000388
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$407.22 |
| Max. Negotiated Rate |
$832.94 |
| Rate for Payer: Aetna American Axle |
$601.57
|
| Rate for Payer: Aetna Commercial |
$786.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$601.57
|
| Rate for Payer: Cash Price |
$740.39
|
| Rate for Payer: Cofinity Commercial |
$647.84
|
| Rate for Payer: Cofinity Commercial |
$795.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$740.39
|
| Rate for Payer: Healthscope Commercial |
$832.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$647.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$694.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$786.67
|
| Rate for Payer: PHP Commercial |
$786.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$647.84
|
| Rate for Payer: Priority Health SBD |
$583.06
|
| Rate for Payer: UMR Bronson Commercial |
$407.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$694.12
|
|
|
HC OPEN HEART PLATELET MAPPING
|
Facility
|
OP
|
$925.49
|
|
| Hospital Charge Code |
27000388
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$342.43 |
| Max. Negotiated Rate |
$832.94 |
| Rate for Payer: Aetna American Axle |
$601.57
|
| Rate for Payer: Aetna Commercial |
$786.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$601.57
|
| Rate for Payer: BCBS Complete |
$370.20
|
| Rate for Payer: Cash Price |
$740.39
|
| Rate for Payer: Cofinity Commercial |
$647.84
|
| Rate for Payer: Cofinity Commercial |
$795.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$740.39
|
| Rate for Payer: Healthscope Commercial |
$832.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$647.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$694.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$786.67
|
| Rate for Payer: PHP Commercial |
$786.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$647.84
|
| Rate for Payer: Priority Health SBD |
$583.06
|
| Rate for Payer: UMR Bronson Commercial |
$342.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$694.12
|
|
|
HC OPEN HEART TEG
|
Facility
|
OP
|
$541.54
|
|
| Hospital Charge Code |
27000199
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$200.37 |
| Max. Negotiated Rate |
$487.39 |
| Rate for Payer: Aetna American Axle |
$352.00
|
| Rate for Payer: Aetna Commercial |
$460.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$352.00
|
| Rate for Payer: BCBS Complete |
$216.62
|
| Rate for Payer: Cash Price |
$433.23
|
| Rate for Payer: Cofinity Commercial |
$379.08
|
| Rate for Payer: Cofinity Commercial |
$465.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$433.23
|
| Rate for Payer: Healthscope Commercial |
$487.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$379.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$406.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$460.31
|
| Rate for Payer: PHP Commercial |
$460.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$379.08
|
| Rate for Payer: Priority Health SBD |
$341.17
|
| Rate for Payer: UMR Bronson Commercial |
$200.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$406.16
|
|
|
HC OPEN HEART TEG
|
Facility
|
IP
|
$541.54
|
|
| Hospital Charge Code |
27000199
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$238.28 |
| Max. Negotiated Rate |
$487.39 |
| Rate for Payer: Aetna American Axle |
$352.00
|
| Rate for Payer: Aetna Commercial |
$460.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$352.00
|
| Rate for Payer: Cash Price |
$433.23
|
| Rate for Payer: Cofinity Commercial |
$379.08
|
| Rate for Payer: Cofinity Commercial |
$465.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$433.23
|
| Rate for Payer: Healthscope Commercial |
$487.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$379.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$406.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$460.31
|
| Rate for Payer: PHP Commercial |
$460.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$379.08
|
| Rate for Payer: Priority Health SBD |
$341.17
|
| Rate for Payer: UMR Bronson Commercial |
$238.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$406.16
|
|
|
HC OP FALSE LABOR 1ST HOUR
|
Facility
|
IP
|
$342.38
|
|
|
Service Code
|
HCPCS S4005
|
| Hospital Charge Code |
72900001
|
|
Hospital Revenue Code
|
729
|
| Min. Negotiated Rate |
$150.65 |
| Max. Negotiated Rate |
$308.14 |
| Rate for Payer: Aetna American Axle |
$222.55
|
| Rate for Payer: Aetna Commercial |
$291.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$222.55
|
| Rate for Payer: Cash Price |
$273.90
|
| Rate for Payer: Cofinity Commercial |
$239.67
|
| Rate for Payer: Cofinity Commercial |
$294.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$273.90
|
| Rate for Payer: Healthscope Commercial |
$308.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$239.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$256.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$291.02
|
| Rate for Payer: PHP Commercial |
$291.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$239.67
|
| Rate for Payer: Priority Health SBD |
$215.70
|
| Rate for Payer: UMR Bronson Commercial |
$150.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$256.78
|
|
|
HC OP FALSE LABOR 1ST HOUR
|
Facility
|
OP
|
$342.38
|
|
|
Service Code
|
HCPCS S4005
|
| Hospital Charge Code |
72900001
|
|
Hospital Revenue Code
|
729
|
| Min. Negotiated Rate |
$126.68 |
| Max. Negotiated Rate |
$2,286.00 |
| Rate for Payer: Aetna American Axle |
$222.55
|
| Rate for Payer: Aetna Commercial |
$291.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$222.55
|
| Rate for Payer: BCBS Complete |
$136.95
|
| Rate for Payer: Cash Price |
$273.90
|
| Rate for Payer: Cash Price |
$273.90
|
| Rate for Payer: Cofinity Commercial |
$294.45
|
| Rate for Payer: Cofinity Commercial |
$239.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$273.90
|
| Rate for Payer: Healthscope Commercial |
$308.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$239.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$256.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$291.02
|
| Rate for Payer: PHP Commercial |
$291.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$239.67
|
| Rate for Payer: Priority Health SBD |
$215.70
|
| Rate for Payer: UHC Core |
$2,286.00
|
| Rate for Payer: UMR Bronson Commercial |
$126.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$256.78
|
|
|
HC OP FALSE LABOR SUB HOURS
|
Facility
|
OP
|
$189.47
|
|
|
Service Code
|
HCPCS S4005
|
| Hospital Charge Code |
72900002
|
|
Hospital Revenue Code
|
729
|
| Min. Negotiated Rate |
$70.10 |
| Max. Negotiated Rate |
$2,286.00 |
| Rate for Payer: Aetna American Axle |
$123.16
|
| Rate for Payer: Aetna Commercial |
$161.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.16
|
| Rate for Payer: BCBS Complete |
$75.79
|
| Rate for Payer: Cash Price |
$151.58
|
| Rate for Payer: Cash Price |
$151.58
|
| Rate for Payer: Cofinity Commercial |
$162.94
|
| Rate for Payer: Cofinity Commercial |
$132.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.58
|
| Rate for Payer: Healthscope Commercial |
$170.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$132.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$142.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$161.05
|
| Rate for Payer: PHP Commercial |
$161.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.63
|
| Rate for Payer: Priority Health SBD |
$119.37
|
| Rate for Payer: UHC Core |
$2,286.00
|
| Rate for Payer: UMR Bronson Commercial |
$70.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$142.10
|
|
|
HC OP FALSE LABOR SUB HOURS
|
Facility
|
IP
|
$189.47
|
|
|
Service Code
|
HCPCS S4005
|
| Hospital Charge Code |
72900002
|
|
Hospital Revenue Code
|
729
|
| Min. Negotiated Rate |
$83.37 |
| Max. Negotiated Rate |
$170.52 |
| Rate for Payer: Aetna American Axle |
$123.16
|
| Rate for Payer: Aetna Commercial |
$161.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.16
|
| Rate for Payer: Cash Price |
$151.58
|
| Rate for Payer: Cofinity Commercial |
$132.63
|
| Rate for Payer: Cofinity Commercial |
$162.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.58
|
| Rate for Payer: Healthscope Commercial |
$170.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$132.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$142.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$161.05
|
| Rate for Payer: PHP Commercial |
$161.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.63
|
| Rate for Payer: Priority Health SBD |
$119.37
|
| Rate for Payer: UMR Bronson Commercial |
$83.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$142.10
|
|
|
HC OP HEMODIALYSIS
|
Facility
|
IP
|
$969.00
|
|
|
Service Code
|
HCPCS G0257
|
| Hospital Charge Code |
88100001
|
|
Hospital Revenue Code
|
820
|
| Min. Negotiated Rate |
$426.36 |
| Max. Negotiated Rate |
$872.10 |
| Rate for Payer: Aetna American Axle |
$629.85
|
| Rate for Payer: Aetna Commercial |
$823.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$629.85
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cofinity Commercial |
$678.30
|
| Rate for Payer: Cofinity Commercial |
$833.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$775.20
|
| Rate for Payer: Healthscope Commercial |
$872.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$678.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$726.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$823.65
|
| Rate for Payer: PHP Commercial |
$823.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$678.30
|
| Rate for Payer: Priority Health SBD |
$610.47
|
| Rate for Payer: UMR Bronson Commercial |
$426.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$726.75
|
|
|
HC OP HEMODIALYSIS
|
Facility
|
OP
|
$969.00
|
|
|
Service Code
|
HCPCS G0257
|
| Hospital Charge Code |
88100001
|
|
Hospital Revenue Code
|
820
|
| Min. Negotiated Rate |
$339.77 |
| Max. Negotiated Rate |
$1,955.39 |
| Rate for Payer: Aetna American Axle |
$629.85
|
| Rate for Payer: Aetna Commercial |
$823.65
|
| Rate for Payer: Aetna Medicare |
$646.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$629.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$776.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$776.44
|
| Rate for Payer: BCBS Complete |
$356.79
|
| Rate for Payer: BCBS MAPPO |
$621.15
|
| Rate for Payer: BCN Medicare Advantage |
$621.15
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cofinity Commercial |
$678.30
|
| Rate for Payer: Cofinity Commercial |
$833.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$775.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$621.15
|
| Rate for Payer: Healthscope Commercial |
$872.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$678.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$726.75
|
| Rate for Payer: Mclaren Medicaid |
$339.77
|
| Rate for Payer: Mclaren Medicare |
$621.15
|
| Rate for Payer: Meridian Medicaid |
$356.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$652.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$714.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$823.65
|
| Rate for Payer: PACE Medicare |
$590.09
|
| Rate for Payer: PACE SWMI |
$621.15
|
| Rate for Payer: PHP Commercial |
$823.65
|
| Rate for Payer: PHP Medicare Advantage |
$621.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$339.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$678.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,955.39
|
| Rate for Payer: Priority Health Medicare |
$621.15
|
| Rate for Payer: Priority Health Narrow Network |
$1,564.31
|
| Rate for Payer: Priority Health SBD |
$610.47
|
| Rate for Payer: Railroad Medicare Medicare |
$621.15
|
| Rate for Payer: UHC Core |
$491.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$621.15
|
| Rate for Payer: UHC Medicare Advantage |
$639.78
|
| Rate for Payer: UMR Bronson Commercial |
$358.53
|
| Rate for Payer: VA VA |
$621.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$726.75
|
|
|
HC OPIATE URIN
|
Facility
|
IP
|
$95.40
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000129
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$41.98 |
| Max. Negotiated Rate |
$85.86 |
| Rate for Payer: Aetna American Axle |
$62.01
|
| Rate for Payer: Aetna Commercial |
$81.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.01
|
| Rate for Payer: Cash Price |
$76.32
|
| Rate for Payer: Cofinity Commercial |
$66.78
|
| Rate for Payer: Cofinity Commercial |
$82.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.32
|
| Rate for Payer: Healthscope Commercial |
$85.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$81.09
|
| Rate for Payer: PHP Commercial |
$81.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.78
|
| Rate for Payer: Priority Health SBD |
$60.10
|
| Rate for Payer: UMR Bronson Commercial |
$41.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.55
|
|
|
HC OPIATE URIN
|
Facility
|
OP
|
$95.40
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000129
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.99 |
| Max. Negotiated Rate |
$95.77 |
| Rate for Payer: Aetna American Axle |
$62.01
|
| Rate for Payer: Aetna Commercial |
$81.09
|
| Rate for Payer: Aetna Medicare |
$64.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.68
|
| Rate for Payer: BCBS Complete |
$35.69
|
| Rate for Payer: BCBS MAPPO |
$62.14
|
| Rate for Payer: BCBS Trust/PPO |
$55.89
|
| Rate for Payer: BCN Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$76.32
|
| Rate for Payer: Cash Price |
$76.32
|
| Rate for Payer: Cofinity Commercial |
$66.78
|
| Rate for Payer: Cofinity Commercial |
$82.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Healthscope Commercial |
$85.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.55
|
| Rate for Payer: Mclaren Medicaid |
$33.99
|
| Rate for Payer: Mclaren Medicare |
$62.14
|
| Rate for Payer: Meridian Medicaid |
$35.69
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$65.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$81.09
|
| Rate for Payer: PACE Medicare |
$59.03
|
| Rate for Payer: PACE SWMI |
$62.14
|
| Rate for Payer: PHP Commercial |
$81.09
|
| Rate for Payer: PHP Medicare Advantage |
$62.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$48.58
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: Priority Health Narrow Network |
$38.86
|
| Rate for Payer: Priority Health SBD |
$60.10
|
| Rate for Payer: Railroad Medicare Medicare |
$62.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.57
|
| Rate for Payer: UHC Core |
$95.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.14
|
| Rate for Payer: UHC Exchange |
$62.14
|
| Rate for Payer: UHC Medicare Advantage |
$64.00
|
| Rate for Payer: UMR Bronson Commercial |
$35.30
|
| Rate for Payer: VA VA |
$62.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.55
|
|
