|
HC DRUG SCREEN COLLECT-OUTSIDE SVC
|
Facility
|
IP
|
$24.48
|
|
|
Service Code
|
CPT 99000
|
| Hospital Charge Code |
98300005
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$10.77 |
| Max. Negotiated Rate |
$22.03 |
| Rate for Payer: Aetna American Axle |
$15.91
|
| Rate for Payer: Aetna Commercial |
$20.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.91
|
| Rate for Payer: Cash Price |
$19.58
|
| Rate for Payer: Cofinity Commercial |
$17.14
|
| Rate for Payer: Cofinity Commercial |
$21.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.58
|
| Rate for Payer: Healthscope Commercial |
$22.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.81
|
| Rate for Payer: PHP Commercial |
$20.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.91
|
| Rate for Payer: Priority Health SBD |
$15.42
|
| Rate for Payer: UMR Bronson Commercial |
$10.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.36
|
|
|
HC DRUG SCREEN QUAL EA PROC
|
Facility
|
OP
|
$48.23
|
|
|
Service Code
|
CPT 80305
|
| Hospital Charge Code |
30100652
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.75 |
| Max. Negotiated Rate |
$43.41 |
| Rate for Payer: Aetna American Axle |
$31.35
|
| Rate for Payer: Aetna Commercial |
$41.00
|
| Rate for Payer: Aetna Medicare |
$13.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.75
|
| Rate for Payer: BCBS Complete |
$7.09
|
| Rate for Payer: BCBS MAPPO |
$12.60
|
| Rate for Payer: BCN Medicare Advantage |
$12.60
|
| Rate for Payer: Cash Price |
$38.58
|
| Rate for Payer: Cash Price |
$38.58
|
| Rate for Payer: Cofinity Commercial |
$41.48
|
| Rate for Payer: Cofinity Commercial |
$33.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$33.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.60
|
| Rate for Payer: Healthscope Commercial |
$43.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.17
|
| Rate for Payer: Mclaren Medicaid |
$6.75
|
| Rate for Payer: Mclaren Medicare |
$12.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.23
|
| Rate for Payer: Meridian Medicaid |
$7.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.00
|
| Rate for Payer: PACE Medicare |
$11.97
|
| Rate for Payer: PACE SWMI |
$12.60
|
| Rate for Payer: PHP Commercial |
$41.00
|
| Rate for Payer: PHP Medicare Advantage |
$12.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.35
|
| Rate for Payer: Priority Health Medicare |
$12.60
|
| Rate for Payer: Priority Health SBD |
$30.38
|
| Rate for Payer: Railroad Medicare Medicare |
$12.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.60
|
| Rate for Payer: UHC Exchange |
$24.08
|
| Rate for Payer: UHC Medicare Advantage |
$12.60
|
| Rate for Payer: UHCCP Medicaid |
$6.75
|
| Rate for Payer: UMR Bronson Commercial |
$17.85
|
| Rate for Payer: VA VA |
$12.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.17
|
|
|
HC DRUG SCREEN QUAL EA PROC
|
Facility
|
IP
|
$48.23
|
|
|
Service Code
|
CPT 80305
|
| Hospital Charge Code |
30100652
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.22 |
| Max. Negotiated Rate |
$43.41 |
| Rate for Payer: Aetna American Axle |
$31.35
|
| Rate for Payer: Aetna Commercial |
$41.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.35
|
| Rate for Payer: Cash Price |
$38.58
|
| Rate for Payer: Cofinity Commercial |
$33.76
|
| Rate for Payer: Cofinity Commercial |
$41.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$33.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.58
|
| Rate for Payer: Healthscope Commercial |
$43.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.00
|
| Rate for Payer: PHP Commercial |
$41.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.35
|
| Rate for Payer: Priority Health SBD |
$30.38
|
| Rate for Payer: UMR Bronson Commercial |
$21.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.17
|
|
|
HC DRUG SCREEN QUANTALCOHOLS
|
Facility
|
IP
|
$76.50
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
30100732
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.66 |
| Max. Negotiated Rate |
$68.85 |
| Rate for Payer: Aetna American Axle |
$49.73
|
| Rate for Payer: Aetna Commercial |
$65.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.73
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cofinity Commercial |
$53.55
|
| Rate for Payer: Cofinity Commercial |
$65.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$53.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.20
|
| Rate for Payer: Healthscope Commercial |
$68.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$53.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.03
|
| Rate for Payer: PHP Commercial |
$65.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.73
|
| Rate for Payer: Priority Health SBD |
$48.20
|
| Rate for Payer: UMR Bronson Commercial |
$33.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.38
|
|
|
HC DRUG SCREEN QUANTALCOHOLS
|
Facility
|
OP
|
$76.50
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
30100732
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.30 |
| Max. Negotiated Rate |
$68.85 |
| Rate for Payer: Aetna American Axle |
$49.73
|
| Rate for Payer: Aetna Commercial |
$65.03
|
| Rate for Payer: Aetna Medicare |
$38.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.73
|
| Rate for Payer: BCBS Complete |
$30.60
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cofinity Commercial |
$53.55
|
| Rate for Payer: Cofinity Commercial |
$65.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$53.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.20
|
| Rate for Payer: Healthscope Commercial |
$68.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$53.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.03
|
| Rate for Payer: PHP Commercial |
$65.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.73
|
| Rate for Payer: Priority Health SBD |
$48.20
|
| Rate for Payer: UMR Bronson Commercial |
$28.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.38
|
|
|
HC DSDNA AB WITH REFLEX, IGG, S
|
Facility
|
OP
|
$39.51
|
|
|
Service Code
|
CPT 86225
|
| Hospital Charge Code |
30200505
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.36 |
| Max. Negotiated Rate |
$38.68 |
| Rate for Payer: Aetna American Axle |
$25.68
|
| Rate for Payer: Aetna Commercial |
$33.58
|
| Rate for Payer: Aetna Medicare |
$14.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.18
|
| Rate for Payer: BCBS Complete |
$7.73
|
| Rate for Payer: BCBS MAPPO |
$13.74
|
| Rate for Payer: BCN Medicare Advantage |
$13.74
|
| Rate for Payer: Cash Price |
$31.61
|
| Rate for Payer: Cash Price |
$31.61
|
| Rate for Payer: Cofinity Commercial |
$33.98
|
| Rate for Payer: Cofinity Commercial |
$27.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.74
|
| Rate for Payer: Healthscope Commercial |
$35.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.63
|
| Rate for Payer: Mclaren Medicaid |
$7.36
|
| Rate for Payer: Mclaren Medicare |
$13.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.43
|
| Rate for Payer: Meridian Medicaid |
$7.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.58
|
| Rate for Payer: PACE Medicare |
$13.05
|
| Rate for Payer: PACE SWMI |
$13.74
|
| Rate for Payer: PHP Commercial |
$33.58
|
| Rate for Payer: PHP Medicare Advantage |
$13.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.68
|
| Rate for Payer: Priority Health Medicare |
$13.74
|
| Rate for Payer: Priority Health SBD |
$24.89
|
| Rate for Payer: Railroad Medicare Medicare |
$13.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.74
|
| Rate for Payer: UHC Exchange |
$26.26
|
| Rate for Payer: UHC Medicare Advantage |
$13.74
|
| Rate for Payer: UHCCP Medicaid |
$7.36
|
| Rate for Payer: UMR Bronson Commercial |
$14.62
|
| Rate for Payer: VA VA |
$13.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.63
|
|
|
HC DSDNA AB WITH REFLEX, IGG, S
|
Facility
|
IP
|
$39.51
|
|
|
Service Code
|
CPT 86225
|
| Hospital Charge Code |
30200505
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.38 |
| Max. Negotiated Rate |
$35.56 |
| Rate for Payer: Aetna American Axle |
$25.68
|
| Rate for Payer: Aetna Commercial |
$33.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.68
|
| Rate for Payer: Cash Price |
$31.61
|
| Rate for Payer: Cofinity Commercial |
$27.66
|
| Rate for Payer: Cofinity Commercial |
$33.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.61
|
| Rate for Payer: Healthscope Commercial |
$35.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.58
|
| Rate for Payer: PHP Commercial |
$33.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.68
|
| Rate for Payer: Priority Health SBD |
$24.89
|
| Rate for Payer: UMR Bronson Commercial |
$17.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.63
|
|
|
HC DSMA TC 99M PER STUDY
|
Facility
|
IP
|
$388.71
|
|
|
Service Code
|
HCPCS A9551
|
| Hospital Charge Code |
34300004
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$171.03 |
| Max. Negotiated Rate |
$349.84 |
| Rate for Payer: Aetna American Axle |
$252.66
|
| Rate for Payer: Aetna Commercial |
$330.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$252.66
|
| Rate for Payer: Cash Price |
$310.97
|
| Rate for Payer: Cofinity Commercial |
$272.10
|
| Rate for Payer: Cofinity Commercial |
$334.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$272.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.97
|
| Rate for Payer: Healthscope Commercial |
$349.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$272.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$291.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$330.40
|
| Rate for Payer: PHP Commercial |
$330.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$252.66
|
| Rate for Payer: Priority Health SBD |
$244.89
|
| Rate for Payer: UMR Bronson Commercial |
$171.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$291.53
|
|
|
HC DSMA TC 99M PER STUDY
|
Facility
|
OP
|
$388.71
|
|
|
Service Code
|
HCPCS A9551
|
| Hospital Charge Code |
34300004
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$143.82 |
| Max. Negotiated Rate |
$349.84 |
| Rate for Payer: Aetna American Axle |
$252.66
|
| Rate for Payer: Aetna Commercial |
$330.40
|
| Rate for Payer: Aetna Medicare |
$194.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$252.66
|
| Rate for Payer: BCBS Complete |
$155.48
|
| Rate for Payer: Cash Price |
$310.97
|
| Rate for Payer: Cofinity Commercial |
$272.10
|
| Rate for Payer: Cofinity Commercial |
$334.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$272.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.97
|
| Rate for Payer: Healthscope Commercial |
$349.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$272.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$291.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$330.40
|
| Rate for Payer: PHP Commercial |
$330.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$252.66
|
| Rate for Payer: Priority Health SBD |
$244.89
|
| Rate for Payer: UMR Bronson Commercial |
$143.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$291.53
|
|
|
HC DTAP HEPB IPV VACCINE INTRAMUSCULAR
|
Facility
|
IP
|
$176.19
|
|
|
Service Code
|
CPT 90723
|
| Hospital Charge Code |
63600137
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$77.52 |
| Max. Negotiated Rate |
$158.57 |
| Rate for Payer: Aetna American Axle |
$114.52
|
| Rate for Payer: Aetna Commercial |
$149.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.52
|
| Rate for Payer: Cash Price |
$140.95
|
| Rate for Payer: Cofinity Commercial |
$123.33
|
| Rate for Payer: Cofinity Commercial |
$151.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$123.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.95
|
| Rate for Payer: Healthscope Commercial |
$158.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$123.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$149.76
|
| Rate for Payer: PHP Commercial |
$149.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.52
|
| Rate for Payer: Priority Health SBD |
$111.00
|
| Rate for Payer: UMR Bronson Commercial |
$77.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.14
|
|
|
HC DTAP HEPB IPV VACCINE INTRAMUSCULAR
|
Facility
|
OP
|
$176.19
|
|
|
Service Code
|
CPT 90723
|
| Hospital Charge Code |
63600137
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$65.19 |
| Max. Negotiated Rate |
$158.57 |
| Rate for Payer: Aetna American Axle |
$114.52
|
| Rate for Payer: Aetna Commercial |
$149.76
|
| Rate for Payer: Aetna Medicare |
$88.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.52
|
| Rate for Payer: BCBS Complete |
$70.48
|
| Rate for Payer: Cash Price |
$140.95
|
| Rate for Payer: Cofinity Commercial |
$123.33
|
| Rate for Payer: Cofinity Commercial |
$151.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$123.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.95
|
| Rate for Payer: Healthscope Commercial |
$158.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$123.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$149.76
|
| Rate for Payer: PHP Commercial |
$149.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.52
|
| Rate for Payer: Priority Health SBD |
$111.00
|
| Rate for Payer: UMR Bronson Commercial |
$65.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.14
|
|
|
HC DTAP-IPV VACCINE 4-6 YEARS IM
|
Facility
|
OP
|
$76.67
|
|
|
Service Code
|
CPT 90696
|
| Hospital Charge Code |
63600120
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.37 |
| Max. Negotiated Rate |
$69.00 |
| Rate for Payer: Aetna American Axle |
$49.84
|
| Rate for Payer: Aetna Commercial |
$65.17
|
| Rate for Payer: Aetna Medicare |
$38.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.84
|
| Rate for Payer: BCBS Complete |
$30.67
|
| Rate for Payer: Cash Price |
$61.34
|
| Rate for Payer: Cofinity Commercial |
$53.67
|
| Rate for Payer: Cofinity Commercial |
$65.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$53.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.34
|
| Rate for Payer: Healthscope Commercial |
$69.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$53.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.17
|
| Rate for Payer: PHP Commercial |
$65.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.84
|
| Rate for Payer: Priority Health SBD |
$48.30
|
| Rate for Payer: UMR Bronson Commercial |
$28.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.50
|
|
|
HC DTAP-IPV VACCINE 4-6 YEARS IM
|
Facility
|
IP
|
$76.67
|
|
|
Service Code
|
CPT 90696
|
| Hospital Charge Code |
63600120
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.73 |
| Max. Negotiated Rate |
$69.00 |
| Rate for Payer: Aetna American Axle |
$49.84
|
| Rate for Payer: Aetna Commercial |
$65.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.84
|
| Rate for Payer: Cash Price |
$61.34
|
| Rate for Payer: Cofinity Commercial |
$53.67
|
| Rate for Payer: Cofinity Commercial |
$65.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$53.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.34
|
| Rate for Payer: Healthscope Commercial |
$69.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$53.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.17
|
| Rate for Payer: PHP Commercial |
$65.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.84
|
| Rate for Payer: Priority Health SBD |
$48.30
|
| Rate for Payer: UMR Bronson Commercial |
$33.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.50
|
|
|
HC DTAP-IVP-HIB-HEPB INTRAMUSCULAR
|
Facility
|
OP
|
$166.46
|
|
|
Service Code
|
CPT 90697
|
| Hospital Charge Code |
63600207
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$61.59 |
| Max. Negotiated Rate |
$149.81 |
| Rate for Payer: Aetna American Axle |
$108.20
|
| Rate for Payer: Aetna Commercial |
$141.49
|
| Rate for Payer: Aetna Medicare |
$83.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.20
|
| Rate for Payer: BCBS Complete |
$66.58
|
| Rate for Payer: Cash Price |
$133.17
|
| Rate for Payer: Cofinity Commercial |
$116.52
|
| Rate for Payer: Cofinity Commercial |
$143.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$116.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.17
|
| Rate for Payer: Healthscope Commercial |
$149.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$116.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$124.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.49
|
| Rate for Payer: PHP Commercial |
$141.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.20
|
| Rate for Payer: Priority Health SBD |
$104.87
|
| Rate for Payer: UMR Bronson Commercial |
$61.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$124.84
|
|
|
HC DTAP-IVP-HIB-HEPB INTRAMUSCULAR
|
Facility
|
IP
|
$166.46
|
|
|
Service Code
|
CPT 90697
|
| Hospital Charge Code |
63600207
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$73.24 |
| Max. Negotiated Rate |
$149.81 |
| Rate for Payer: Aetna American Axle |
$108.20
|
| Rate for Payer: Aetna Commercial |
$141.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.20
|
| Rate for Payer: Cash Price |
$133.17
|
| Rate for Payer: Cofinity Commercial |
$116.52
|
| Rate for Payer: Cofinity Commercial |
$143.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$116.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.17
|
| Rate for Payer: Healthscope Commercial |
$149.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$116.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$124.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.49
|
| Rate for Payer: PHP Commercial |
$141.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.20
|
| Rate for Payer: Priority Health SBD |
$104.87
|
| Rate for Payer: UMR Bronson Commercial |
$73.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$124.84
|
|
|
HC DTPA PER STUDY
|
Facility
|
IP
|
$170.17
|
|
|
Service Code
|
HCPCS A9539
|
| Hospital Charge Code |
34300005
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$74.87 |
| Max. Negotiated Rate |
$153.15 |
| Rate for Payer: Aetna American Axle |
$110.61
|
| Rate for Payer: Aetna Commercial |
$144.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$110.61
|
| Rate for Payer: Cash Price |
$136.14
|
| Rate for Payer: Cofinity Commercial |
$119.12
|
| Rate for Payer: Cofinity Commercial |
$146.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$119.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$136.14
|
| Rate for Payer: Healthscope Commercial |
$153.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$119.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$127.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$144.64
|
| Rate for Payer: PHP Commercial |
$144.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.61
|
| Rate for Payer: Priority Health SBD |
$107.21
|
| Rate for Payer: UMR Bronson Commercial |
$74.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$127.63
|
|
|
HC DTPA PER STUDY
|
Facility
|
OP
|
$170.17
|
|
|
Service Code
|
HCPCS A9539
|
| Hospital Charge Code |
34300005
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$62.96 |
| Max. Negotiated Rate |
$153.15 |
| Rate for Payer: Aetna American Axle |
$110.61
|
| Rate for Payer: Aetna Commercial |
$144.64
|
| Rate for Payer: Aetna Medicare |
$85.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$110.61
|
| Rate for Payer: BCBS Complete |
$68.07
|
| Rate for Payer: Cash Price |
$136.14
|
| Rate for Payer: Cofinity Commercial |
$119.12
|
| Rate for Payer: Cofinity Commercial |
$146.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$119.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$136.14
|
| Rate for Payer: Healthscope Commercial |
$153.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$119.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$127.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$144.64
|
| Rate for Payer: PHP Commercial |
$144.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.61
|
| Rate for Payer: Priority Health SBD |
$107.21
|
| Rate for Payer: UMR Bronson Commercial |
$62.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$127.63
|
|
|
HC DUAL LEAD INSERTION
|
Facility
|
OP
|
$12,710.35
|
|
|
Service Code
|
CPT 33217
|
| Hospital Charge Code |
36100066
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,326.27 |
| Max. Negotiated Rate |
$22,720.18 |
| Rate for Payer: Aetna American Axle |
$8,261.73
|
| Rate for Payer: Aetna Commercial |
$10,803.80
|
| Rate for Payer: Aetna Medicare |
$8,394.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,261.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,089.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,089.25
|
| Rate for Payer: BCBS Complete |
$4,542.58
|
| Rate for Payer: BCBS MAPPO |
$8,071.40
|
| Rate for Payer: BCN Medicare Advantage |
$8,071.40
|
| Rate for Payer: Cash Price |
$10,168.28
|
| Rate for Payer: Cash Price |
$10,168.28
|
| Rate for Payer: Cofinity Commercial |
$8,897.25
|
| Rate for Payer: Cofinity Commercial |
$10,930.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$8,897.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,168.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,071.40
|
| Rate for Payer: Healthscope Commercial |
$11,439.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8,897.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,532.76
|
| Rate for Payer: Mclaren Medicaid |
$4,326.27
|
| Rate for Payer: Mclaren Medicare |
$8,071.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,474.97
|
| Rate for Payer: Meridian Medicaid |
$4,542.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,282.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,803.80
|
| Rate for Payer: PACE Medicare |
$7,667.83
|
| Rate for Payer: PACE SWMI |
$8,071.40
|
| Rate for Payer: PHP Commercial |
$10,803.80
|
| Rate for Payer: PHP Medicare Advantage |
$8,071.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,326.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,261.73
|
| Rate for Payer: Priority Health Medicare |
$8,071.40
|
| Rate for Payer: Priority Health SBD |
$8,007.52
|
| Rate for Payer: Railroad Medicare Medicare |
$8,071.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22,720.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$8,071.40
|
| Rate for Payer: UHC Exchange |
$15,425.25
|
| Rate for Payer: UHC Medicare Advantage |
$8,071.40
|
| Rate for Payer: UHCCP Medicaid |
$4,326.27
|
| Rate for Payer: UMR Bronson Commercial |
$4,702.83
|
| Rate for Payer: VA VA |
$8,071.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,532.76
|
|
|
HC DUAL LEAD INSERTION
|
Facility
|
IP
|
$12,710.35
|
|
|
Service Code
|
CPT 33217
|
| Hospital Charge Code |
36100066
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,592.55 |
| Max. Negotiated Rate |
$11,439.32 |
| Rate for Payer: Aetna American Axle |
$8,261.73
|
| Rate for Payer: Aetna Commercial |
$10,803.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,261.73
|
| Rate for Payer: Cash Price |
$10,168.28
|
| Rate for Payer: Cofinity Commercial |
$10,930.90
|
| Rate for Payer: Cofinity Commercial |
$8,897.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$8,897.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,168.28
|
| Rate for Payer: Healthscope Commercial |
$11,439.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8,897.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,532.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,803.80
|
| Rate for Payer: PHP Commercial |
$10,803.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,261.73
|
| Rate for Payer: Priority Health SBD |
$8,007.52
|
| Rate for Payer: UMR Bronson Commercial |
$5,592.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,532.76
|
|
|
HC DUCK FEATHERS IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200083
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.17 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna American Axle |
$16.50
|
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health SBD |
$16.00
|
| Rate for Payer: UMR Bronson Commercial |
$11.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.04
|
|
|
HC DUCK FEATHERS IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200083
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna American Axle |
$16.50
|
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.04
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$16.00
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$9.98
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.80
|
| Rate for Payer: UMR Bronson Commercial |
$9.39
|
| Rate for Payer: VA VA |
$5.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.04
|
|
|
HC DUODENOSCOPY/COLONOSCOPY
|
Facility
|
IP
|
$4,399.77
|
|
| Hospital Charge Code |
36000033
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,935.90 |
| Max. Negotiated Rate |
$3,959.79 |
| Rate for Payer: Aetna American Axle |
$2,859.85
|
| Rate for Payer: Aetna Commercial |
$3,739.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,859.85
|
| Rate for Payer: Cash Price |
$3,519.82
|
| Rate for Payer: Cofinity Commercial |
$3,079.84
|
| Rate for Payer: Cofinity Commercial |
$3,783.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,079.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,519.82
|
| Rate for Payer: Healthscope Commercial |
$3,959.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,079.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,299.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,739.80
|
| Rate for Payer: PHP Commercial |
$3,739.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,859.85
|
| Rate for Payer: Priority Health SBD |
$2,771.86
|
| Rate for Payer: UMR Bronson Commercial |
$1,935.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,299.83
|
|
|
HC DUODENOSCOPY/COLONOSCOPY
|
Facility
|
OP
|
$4,399.77
|
|
| Hospital Charge Code |
36000033
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,627.91 |
| Max. Negotiated Rate |
$3,959.79 |
| Rate for Payer: Aetna American Axle |
$2,859.85
|
| Rate for Payer: Aetna Commercial |
$3,739.80
|
| Rate for Payer: Aetna Medicare |
$2,199.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,859.85
|
| Rate for Payer: BCBS Complete |
$1,759.91
|
| Rate for Payer: Cash Price |
$3,519.82
|
| Rate for Payer: Cofinity Commercial |
$3,079.84
|
| Rate for Payer: Cofinity Commercial |
$3,783.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,079.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,519.82
|
| Rate for Payer: Healthscope Commercial |
$3,959.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,079.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,299.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,739.80
|
| Rate for Payer: PHP Commercial |
$3,739.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,859.85
|
| Rate for Payer: Priority Health SBD |
$2,771.86
|
| Rate for Payer: UMR Bronson Commercial |
$1,627.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,299.83
|
|
|
HC DUODENOSCOPY (EGD)
|
Facility
|
OP
|
$2,193.58
|
|
| Hospital Charge Code |
36000029
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$811.62 |
| Max. Negotiated Rate |
$1,974.22 |
| Rate for Payer: Aetna American Axle |
$1,425.83
|
| Rate for Payer: Aetna Commercial |
$1,864.54
|
| Rate for Payer: Aetna Medicare |
$1,096.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,425.83
|
| Rate for Payer: BCBS Complete |
$877.43
|
| Rate for Payer: Cash Price |
$1,754.86
|
| Rate for Payer: Cofinity Commercial |
$1,535.51
|
| Rate for Payer: Cofinity Commercial |
$1,886.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,535.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,754.86
|
| Rate for Payer: Healthscope Commercial |
$1,974.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,535.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,645.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,864.54
|
| Rate for Payer: PHP Commercial |
$1,864.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,425.83
|
| Rate for Payer: Priority Health SBD |
$1,381.96
|
| Rate for Payer: UMR Bronson Commercial |
$811.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,645.18
|
|
|
HC DUODENOSCOPY (EGD)
|
Facility
|
IP
|
$2,193.58
|
|
| Hospital Charge Code |
36000029
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$965.18 |
| Max. Negotiated Rate |
$1,974.22 |
| Rate for Payer: Aetna American Axle |
$1,425.83
|
| Rate for Payer: Aetna Commercial |
$1,864.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,425.83
|
| Rate for Payer: Cash Price |
$1,754.86
|
| Rate for Payer: Cofinity Commercial |
$1,535.51
|
| Rate for Payer: Cofinity Commercial |
$1,886.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,535.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,754.86
|
| Rate for Payer: Healthscope Commercial |
$1,974.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,535.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,645.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,864.54
|
| Rate for Payer: PHP Commercial |
$1,864.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,425.83
|
| Rate for Payer: Priority Health SBD |
$1,381.96
|
| Rate for Payer: UMR Bronson Commercial |
$965.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,645.18
|
|
