|
HC FUNGAL SEROLOGY SURVEY CMPT1
|
Facility
|
IP
|
$41.62
|
|
|
Service Code
|
CPT 86612
|
| Hospital Charge Code |
30200229
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.31 |
| Max. Negotiated Rate |
$37.46 |
| Rate for Payer: Aetna American Axle |
$27.05
|
| Rate for Payer: Aetna Commercial |
$35.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.05
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cofinity Advantage |
$29.13
|
| Rate for Payer: Cofinity Commercial |
$35.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.30
|
| Rate for Payer: Healthscope Commercial |
$37.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.21
|
| Rate for Payer: PHP Commercial |
$35.38
|
| Rate for Payer: Priority Health SBD |
$26.22
|
| Rate for Payer: UMR Bronson Commercial |
$18.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.21
|
|
|
HC FUNGAL SEROLOGY SURVEY CMPT 2
|
Facility
|
IP
|
$41.62
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
30200245
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.31 |
| Max. Negotiated Rate |
$37.46 |
| Rate for Payer: Aetna American Axle |
$27.05
|
| Rate for Payer: Aetna Commercial |
$35.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.05
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cofinity Advantage |
$29.13
|
| Rate for Payer: Cofinity Commercial |
$35.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.30
|
| Rate for Payer: Healthscope Commercial |
$37.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.21
|
| Rate for Payer: PHP Commercial |
$35.38
|
| Rate for Payer: Priority Health SBD |
$26.22
|
| Rate for Payer: UMR Bronson Commercial |
$18.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.21
|
|
|
HC FUNGAL SEROLOGY SURVEY CMPT 2
|
Facility
|
OP
|
$41.62
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
30200245
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$37.46 |
| Rate for Payer: Aetna American Axle |
$27.05
|
| Rate for Payer: Aetna Commercial |
$35.38
|
| Rate for Payer: Aetna Medicare |
$11.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.34
|
| Rate for Payer: BCBS Complete |
$6.30
|
| Rate for Payer: BCBS MAPPO |
$11.47
|
| Rate for Payer: BCBS Trust/PPO |
$13.26
|
| Rate for Payer: BCN Commercial |
$13.26
|
| Rate for Payer: BCN Medicare Advantage |
$11.47
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cofinity Advantage |
$29.13
|
| Rate for Payer: Cofinity Commercial |
$35.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.47
|
| Rate for Payer: Healthscope Commercial |
$37.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.21
|
| Rate for Payer: Mclaren Medicaid |
$11.47
|
| Rate for Payer: Mclaren Medicare |
$11.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.04
|
| Rate for Payer: Meridian Medicaid |
$12.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$12.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.38
|
| Rate for Payer: Nomi Health Commercial |
$17.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.21
|
| Rate for Payer: PACE Medicare |
$10.90
|
| Rate for Payer: PACE SWMI |
$11.47
|
| Rate for Payer: PHP Commercial |
$35.38
|
| Rate for Payer: PHP Medicare Advantage |
$11.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11.47
|
| Rate for Payer: Priority Health Medicare |
$11.47
|
| Rate for Payer: Priority Health SBD |
$26.22
|
| Rate for Payer: Priority Health Tiered Network |
$9.18
|
| Rate for Payer: Railroad Medicare Medicare |
$11.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.21
|
| Rate for Payer: UHC Core |
$17.21
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11.47
|
| Rate for Payer: UHC Exchange |
$17.21
|
| Rate for Payer: UHC Medicaid |
$6.00
|
| Rate for Payer: UHCCP Medicaid |
$6.00
|
| Rate for Payer: UMR Bronson Commercial |
$15.40
|
| Rate for Payer: VA VA |
$11.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.21
|
|
|
HC FUNGAL SEROLOGY SURVEY CMPT 3
|
Facility
|
OP
|
$42.45
|
|
|
Service Code
|
CPT 86698
|
| Hospital Charge Code |
30200287
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.21 |
| Max. Negotiated Rate |
$38.20 |
| Rate for Payer: Aetna American Axle |
$27.59
|
| Rate for Payer: Aetna Commercial |
$36.08
|
| Rate for Payer: Aetna Medicare |
$14.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.24
|
| Rate for Payer: BCBS Complete |
$7.57
|
| Rate for Payer: BCBS MAPPO |
$13.79
|
| Rate for Payer: BCBS Trust/PPO |
$15.94
|
| Rate for Payer: BCN Commercial |
$15.94
|
| Rate for Payer: BCN Medicare Advantage |
$13.79
|
| Rate for Payer: Cash Price |
$33.96
|
| Rate for Payer: Cash Price |
$33.96
|
| Rate for Payer: Cofinity Advantage |
$29.71
|
| Rate for Payer: Cofinity Commercial |
$36.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.79
|
| Rate for Payer: Healthscope Commercial |
$38.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.84
|
| Rate for Payer: Mclaren Medicaid |
$13.79
|
| Rate for Payer: Mclaren Medicare |
$13.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.48
|
| Rate for Payer: Meridian Medicaid |
$14.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$15.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.08
|
| Rate for Payer: Nomi Health Commercial |
$20.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.84
|
| Rate for Payer: PACE Medicare |
$13.10
|
| Rate for Payer: PACE SWMI |
$13.79
|
| Rate for Payer: PHP Commercial |
$36.08
|
| Rate for Payer: PHP Medicare Advantage |
$13.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$13.79
|
| Rate for Payer: Priority Health Medicare |
$13.79
|
| Rate for Payer: Priority Health SBD |
$26.74
|
| Rate for Payer: Priority Health Tiered Network |
$11.03
|
| Rate for Payer: Railroad Medicare Medicare |
$13.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.69
|
| Rate for Payer: UHC Core |
$20.69
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13.79
|
| Rate for Payer: UHC Exchange |
$20.69
|
| Rate for Payer: UHC Medicaid |
$7.21
|
| Rate for Payer: UHCCP Medicaid |
$7.21
|
| Rate for Payer: UMR Bronson Commercial |
$15.71
|
| Rate for Payer: VA VA |
$13.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.84
|
|
|
HC FUNGAL SEROLOGY SURVEY CMPT 3
|
Facility
|
IP
|
$42.45
|
|
|
Service Code
|
CPT 86698
|
| Hospital Charge Code |
30200287
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.68 |
| Max. Negotiated Rate |
$38.20 |
| Rate for Payer: Aetna American Axle |
$27.59
|
| Rate for Payer: Aetna Commercial |
$36.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.59
|
| Rate for Payer: Cash Price |
$33.96
|
| Rate for Payer: Cofinity Advantage |
$29.71
|
| Rate for Payer: Cofinity Commercial |
$36.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.96
|
| Rate for Payer: Healthscope Commercial |
$38.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.84
|
| Rate for Payer: PHP Commercial |
$36.08
|
| Rate for Payer: Priority Health SBD |
$26.74
|
| Rate for Payer: UMR Bronson Commercial |
$18.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.84
|
|
|
HC FUNGITELL ASSAY
|
Facility
|
IP
|
$161.26
|
|
|
Service Code
|
CPT 87449
|
| Hospital Charge Code |
30600148
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$70.95 |
| Max. Negotiated Rate |
$145.13 |
| Rate for Payer: Aetna American Axle |
$104.82
|
| Rate for Payer: Aetna Commercial |
$137.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.82
|
| Rate for Payer: Cash Price |
$129.01
|
| Rate for Payer: Cofinity Advantage |
$112.88
|
| Rate for Payer: Cofinity Commercial |
$138.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.01
|
| Rate for Payer: Healthscope Commercial |
$145.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$112.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$120.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.94
|
| Rate for Payer: PHP Commercial |
$137.07
|
| Rate for Payer: Priority Health SBD |
$101.59
|
| Rate for Payer: UMR Bronson Commercial |
$70.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$120.94
|
|
|
HC FUNGITELL ASSAY
|
Facility
|
OP
|
$161.26
|
|
|
Service Code
|
CPT 87449
|
| Hospital Charge Code |
30600148
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.27 |
| Max. Negotiated Rate |
$145.13 |
| Rate for Payer: Aetna American Axle |
$104.82
|
| Rate for Payer: Aetna Commercial |
$137.07
|
| Rate for Payer: Aetna Medicare |
$12.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.97
|
| Rate for Payer: BCBS Complete |
$6.58
|
| Rate for Payer: BCBS MAPPO |
$11.98
|
| Rate for Payer: BCBS Trust/PPO |
$13.86
|
| Rate for Payer: BCN Commercial |
$13.86
|
| Rate for Payer: BCN Medicare Advantage |
$11.98
|
| Rate for Payer: Cash Price |
$129.01
|
| Rate for Payer: Cash Price |
$129.01
|
| Rate for Payer: Cofinity Advantage |
$112.88
|
| Rate for Payer: Cofinity Commercial |
$138.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.98
|
| Rate for Payer: Healthscope Commercial |
$145.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$112.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$120.94
|
| Rate for Payer: Mclaren Medicaid |
$11.98
|
| Rate for Payer: Mclaren Medicare |
$11.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.58
|
| Rate for Payer: Meridian Medicaid |
$12.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.78
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.07
|
| Rate for Payer: Nomi Health Commercial |
$17.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.94
|
| Rate for Payer: PACE Medicare |
$11.38
|
| Rate for Payer: PACE SWMI |
$11.98
|
| Rate for Payer: PHP Commercial |
$137.07
|
| Rate for Payer: PHP Medicare Advantage |
$11.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11.98
|
| Rate for Payer: Priority Health Medicare |
$11.98
|
| Rate for Payer: Priority Health SBD |
$101.59
|
| Rate for Payer: Priority Health Tiered Network |
$9.58
|
| Rate for Payer: Railroad Medicare Medicare |
$11.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.97
|
| Rate for Payer: UHC Core |
$17.97
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11.98
|
| Rate for Payer: UHC Exchange |
$17.97
|
| Rate for Payer: UHC Medicaid |
$6.27
|
| Rate for Payer: UHCCP Medicaid |
$6.27
|
| Rate for Payer: UMR Bronson Commercial |
$59.67
|
| Rate for Payer: VA VA |
$11.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$120.94
|
|
|
HC FUSARIUM PROLIFERATUM IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200085
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.40 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna American Axle |
$16.84
|
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Advantage |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: Priority Health SBD |
$16.32
|
| Rate for Payer: UMR Bronson Commercial |
$11.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.43
|
|
|
HC FUSARIUM PROLIFERATUM IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200085
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna American Axle |
$16.84
|
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| 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 |
$2.87
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$6.04
|
| Rate for Payer: BCN Commercial |
$6.04
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Advantage |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.43
|
| Rate for Payer: Mclaren Medicaid |
$5.22
|
| 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 |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$7.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.22
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$16.32
|
| Rate for Payer: Priority Health Tiered Network |
$4.18
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.83
|
| Rate for Payer: UHC Core |
$7.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.22
|
| Rate for Payer: UHC Exchange |
$7.83
|
| Rate for Payer: UHC Medicaid |
$2.73
|
| Rate for Payer: UHCCP Medicaid |
$2.73
|
| Rate for Payer: UMR Bronson Commercial |
$9.58
|
| Rate for Payer: VA VA |
$5.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.43
|
|
|
HC GABA-B-R AB CBA, SERUM
|
Facility
|
IP
|
$520.20
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200418
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$228.89 |
| Max. Negotiated Rate |
$468.18 |
| Rate for Payer: Aetna American Axle |
$338.13
|
| Rate for Payer: Aetna Commercial |
$442.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$338.13
|
| Rate for Payer: Cash Price |
$416.16
|
| Rate for Payer: Cofinity Advantage |
$364.14
|
| Rate for Payer: Cofinity Commercial |
$447.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$416.16
|
| Rate for Payer: Healthscope Commercial |
$468.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$364.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$390.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$442.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$390.15
|
| Rate for Payer: PHP Commercial |
$442.17
|
| Rate for Payer: Priority Health SBD |
$327.73
|
| Rate for Payer: UMR Bronson Commercial |
$228.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$390.15
|
|
|
HC GABA-B-R AB CBA, SERUM
|
Facility
|
OP
|
$520.20
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200418
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$468.18 |
| Rate for Payer: Aetna American Axle |
$338.13
|
| Rate for Payer: Aetna Commercial |
$442.17
|
| Rate for Payer: Aetna Medicare |
$12.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$338.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: BCBS Complete |
$6.62
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$10.45
|
| Rate for Payer: BCN Commercial |
$10.45
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$416.16
|
| Rate for Payer: Cash Price |
$416.16
|
| Rate for Payer: Cofinity Advantage |
$364.14
|
| Rate for Payer: Cofinity Commercial |
$447.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$416.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$468.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$364.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$390.15
|
| Rate for Payer: Mclaren Medicaid |
$12.05
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: Meridian Medicaid |
$12.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$442.17
|
| Rate for Payer: Nomi Health Commercial |
$18.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$390.15
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$442.17
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12.05
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health SBD |
$327.73
|
| Rate for Payer: Priority Health Tiered Network |
$9.64
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.08
|
| Rate for Payer: UHC Core |
$18.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.05
|
| Rate for Payer: UHC Exchange |
$18.08
|
| Rate for Payer: UHC Medicaid |
$6.30
|
| Rate for Payer: UHCCP Medicaid |
$6.30
|
| Rate for Payer: UMR Bronson Commercial |
$192.47
|
| Rate for Payer: VA VA |
$12.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$390.15
|
|
|
HC GABA-B-R AB IF TITER ASSAY, S
|
Facility
|
OP
|
$119.65
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
30200419
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$107.69 |
| Rate for Payer: Aetna American Axle |
$77.77
|
| Rate for Payer: Aetna Commercial |
$101.70
|
| Rate for Payer: Aetna Medicare |
$12.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: BCBS Complete |
$6.62
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$10.45
|
| Rate for Payer: BCN Commercial |
$10.45
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$95.72
|
| Rate for Payer: Cash Price |
$95.72
|
| Rate for Payer: Cofinity Advantage |
$83.75
|
| Rate for Payer: Cofinity Commercial |
$102.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$107.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$83.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.74
|
| Rate for Payer: Mclaren Medicaid |
$12.05
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: Meridian Medicaid |
$12.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.70
|
| Rate for Payer: Nomi Health Commercial |
$18.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.74
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$101.70
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12.05
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health SBD |
$75.38
|
| Rate for Payer: Priority Health Tiered Network |
$9.64
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.08
|
| Rate for Payer: UHC Core |
$18.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.05
|
| Rate for Payer: UHC Exchange |
$18.08
|
| Rate for Payer: UHC Medicaid |
$6.30
|
| Rate for Payer: UHCCP Medicaid |
$6.30
|
| Rate for Payer: UMR Bronson Commercial |
$44.27
|
| Rate for Payer: VA VA |
$12.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.74
|
|
|
HC GABA-B-R AB IF TITER ASSAY, S
|
Facility
|
IP
|
$119.65
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
30200419
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$52.65 |
| Max. Negotiated Rate |
$107.69 |
| Rate for Payer: Aetna American Axle |
$77.77
|
| Rate for Payer: Aetna Commercial |
$101.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.77
|
| Rate for Payer: Cash Price |
$95.72
|
| Rate for Payer: Cofinity Advantage |
$83.75
|
| Rate for Payer: Cofinity Commercial |
$102.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.72
|
| Rate for Payer: Healthscope Commercial |
$107.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$83.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.74
|
| Rate for Payer: PHP Commercial |
$101.70
|
| Rate for Payer: Priority Health SBD |
$75.38
|
| Rate for Payer: UMR Bronson Commercial |
$52.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.74
|
|
|
HC GABAPENTIN LEVEL NEURONTIN
|
Facility
|
IP
|
$49.88
|
|
|
Service Code
|
CPT 80171
|
| Hospital Charge Code |
30100160
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.95 |
| Max. Negotiated Rate |
$44.89 |
| Rate for Payer: Aetna American Axle |
$32.42
|
| Rate for Payer: Aetna Commercial |
$42.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.42
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cofinity Advantage |
$34.92
|
| Rate for Payer: Cofinity Commercial |
$42.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.90
|
| Rate for Payer: Healthscope Commercial |
$44.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.41
|
| Rate for Payer: PHP Commercial |
$42.40
|
| Rate for Payer: Priority Health SBD |
$31.42
|
| Rate for Payer: UMR Bronson Commercial |
$21.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.41
|
|
|
HC GABAPENTIN LEVEL NEURONTIN
|
Facility
|
OP
|
$49.88
|
|
|
Service Code
|
CPT 80171
|
| Hospital Charge Code |
30100160
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.33 |
| Max. Negotiated Rate |
$44.89 |
| Rate for Payer: Aetna American Axle |
$32.42
|
| Rate for Payer: Aetna Commercial |
$42.40
|
| Rate for Payer: Aetna Medicare |
$22.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.09
|
| Rate for Payer: BCBS Complete |
$11.90
|
| Rate for Payer: BCBS MAPPO |
$21.67
|
| Rate for Payer: BCBS Trust/PPO |
$25.05
|
| Rate for Payer: BCN Commercial |
$25.05
|
| Rate for Payer: BCN Medicare Advantage |
$21.67
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cofinity Advantage |
$34.92
|
| Rate for Payer: Cofinity Commercial |
$42.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.67
|
| Rate for Payer: Healthscope Commercial |
$44.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.41
|
| Rate for Payer: Mclaren Medicaid |
$21.67
|
| Rate for Payer: Mclaren Medicare |
$21.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.75
|
| Rate for Payer: Meridian Medicaid |
$22.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$23.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.40
|
| Rate for Payer: Nomi Health Commercial |
$32.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.41
|
| Rate for Payer: PACE Medicare |
$20.59
|
| Rate for Payer: PACE SWMI |
$21.67
|
| Rate for Payer: PHP Commercial |
$42.40
|
| Rate for Payer: PHP Medicare Advantage |
$21.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$21.67
|
| Rate for Payer: Priority Health Medicare |
$21.67
|
| Rate for Payer: Priority Health SBD |
$31.42
|
| Rate for Payer: Priority Health Tiered Network |
$17.34
|
| Rate for Payer: Railroad Medicare Medicare |
$21.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.51
|
| Rate for Payer: UHC Core |
$32.51
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$21.67
|
| Rate for Payer: UHC Exchange |
$32.51
|
| Rate for Payer: UHC Medicaid |
$11.33
|
| Rate for Payer: UHCCP Medicaid |
$11.33
|
| Rate for Payer: UMR Bronson Commercial |
$18.46
|
| Rate for Payer: VA VA |
$21.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.41
|
|
|
HC GADOBUTROL INJ 0.1 ML
|
Facility
|
OP
|
$2.20
|
|
|
Service Code
|
HCPCS A9585
|
| Hospital Charge Code |
25500003
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$0.81 |
| Max. Negotiated Rate |
$1.98 |
| Rate for Payer: Aetna American Axle |
$1.43
|
| Rate for Payer: Aetna Commercial |
$1.87
|
| Rate for Payer: Aetna Medicare |
$1.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.43
|
| Rate for Payer: BCBS Complete |
$0.88
|
| Rate for Payer: BCBS Trust/PPO |
$0.89
|
| Rate for Payer: BCN Commercial |
$0.89
|
| Rate for Payer: Cash Price |
$1.76
|
| Rate for Payer: Cash Price |
$1.76
|
| Rate for Payer: Cofinity Advantage |
$1.54
|
| Rate for Payer: Cofinity Commercial |
$1.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.76
|
| Rate for Payer: Healthscope Commercial |
$1.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.65
|
| Rate for Payer: PHP Commercial |
$1.87
|
| Rate for Payer: Priority Health SBD |
$1.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.43
|
| Rate for Payer: UHC Core |
$1.15
|
| Rate for Payer: UHC Exchange |
$0.86
|
| Rate for Payer: UMR Bronson Commercial |
$0.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.65
|
|
|
HC GADOBUTROL INJ 0.1 ML
|
Facility
|
IP
|
$2.20
|
|
|
Service Code
|
HCPCS A9585
|
| Hospital Charge Code |
25500003
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$0.97 |
| Max. Negotiated Rate |
$1.98 |
| Rate for Payer: Aetna American Axle |
$1.43
|
| Rate for Payer: Aetna Commercial |
$1.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.43
|
| Rate for Payer: Cash Price |
$1.76
|
| Rate for Payer: Cofinity Advantage |
$1.54
|
| Rate for Payer: Cofinity Commercial |
$1.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.76
|
| Rate for Payer: Healthscope Commercial |
$1.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.65
|
| Rate for Payer: PHP Commercial |
$1.87
|
| Rate for Payer: Priority Health SBD |
$1.39
|
| Rate for Payer: UMR Bronson Commercial |
$0.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.65
|
|
|
HC GADOLINIUM PER ML
|
Facility
|
OP
|
$66.59
|
|
|
Service Code
|
HCPCS A9579
|
| Hospital Charge Code |
63600015
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.31 |
| Max. Negotiated Rate |
$59.93 |
| Rate for Payer: Aetna American Axle |
$43.28
|
| Rate for Payer: Aetna Commercial |
$56.60
|
| Rate for Payer: Aetna Medicare |
$33.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.28
|
| Rate for Payer: BCBS Complete |
$26.64
|
| Rate for Payer: BCBS Trust/PPO |
$2.31
|
| Rate for Payer: BCN Commercial |
$2.31
|
| Rate for Payer: Cash Price |
$53.27
|
| Rate for Payer: Cash Price |
$53.27
|
| Rate for Payer: Cofinity Advantage |
$46.61
|
| Rate for Payer: Cofinity Commercial |
$57.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.27
|
| Rate for Payer: Healthscope Commercial |
$59.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.94
|
| Rate for Payer: PHP Commercial |
$56.60
|
| Rate for Payer: Priority Health SBD |
$41.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.41
|
| Rate for Payer: UHC Core |
$2.41
|
| Rate for Payer: UHC Exchange |
$2.41
|
| Rate for Payer: UMR Bronson Commercial |
$24.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.94
|
|
|
HC GADOLINIUM PER ML
|
Facility
|
IP
|
$66.59
|
|
|
Service Code
|
HCPCS A9579
|
| Hospital Charge Code |
63600015
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.30 |
| Max. Negotiated Rate |
$59.93 |
| Rate for Payer: Aetna American Axle |
$43.28
|
| Rate for Payer: Aetna Commercial |
$56.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.28
|
| Rate for Payer: Cash Price |
$53.27
|
| Rate for Payer: Cofinity Advantage |
$46.61
|
| Rate for Payer: Cofinity Commercial |
$57.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.27
|
| Rate for Payer: Healthscope Commercial |
$59.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.94
|
| Rate for Payer: PHP Commercial |
$56.60
|
| Rate for Payer: Priority Health SBD |
$41.95
|
| Rate for Payer: UMR Bronson Commercial |
$29.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.94
|
|
|
HC GAIT TRAINING EA 15 MIN
|
Facility
|
IP
|
$95.51
|
|
|
Service Code
|
CPT 97116
|
| Hospital Charge Code |
42000023
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$42.02 |
| Max. Negotiated Rate |
$85.96 |
| Rate for Payer: Aetna American Axle |
$62.08
|
| Rate for Payer: Aetna Commercial |
$81.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.08
|
| Rate for Payer: Cash Price |
$76.41
|
| Rate for Payer: Cofinity Advantage |
$66.86
|
| Rate for Payer: Cofinity Commercial |
$82.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.41
|
| Rate for Payer: Healthscope Commercial |
$85.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.63
|
| Rate for Payer: PHP Commercial |
$81.18
|
| Rate for Payer: Priority Health SBD |
$60.17
|
| Rate for Payer: UMR Bronson Commercial |
$42.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.63
|
|
|
HC GAIT TRAINING EA 15 MIN
|
Facility
|
OP
|
$95.51
|
|
|
Service Code
|
CPT 97116
|
| Hospital Charge Code |
42000023
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna American Axle |
$62.08
|
| Rate for Payer: Aetna Commercial |
$81.18
|
| Rate for Payer: Aetna Medicare |
$47.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.08
|
| Rate for Payer: BCBS Complete |
$38.20
|
| Rate for Payer: BCBS Trust/PPO |
$26.91
|
| Rate for Payer: BCN Commercial |
$26.91
|
| Rate for Payer: Cash Price |
$76.41
|
| Rate for Payer: Cash Price |
$76.41
|
| Rate for Payer: Cash Price |
$76.41
|
| Rate for Payer: Cofinity Advantage |
$66.86
|
| Rate for Payer: Cofinity Commercial |
$82.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.41
|
| Rate for Payer: Healthscope Commercial |
$85.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$76.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.18
|
| Rate for Payer: Nomi Health Commercial |
$135.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.63
|
| Rate for Payer: PHP Commercial |
$81.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$25.00
|
| Rate for Payer: Priority Health SBD |
$60.17
|
| Rate for Payer: Priority Health Tiered Network |
$20.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.08
|
| Rate for Payer: UHC Core |
$49.76
|
| Rate for Payer: UHC Exchange |
$37.54
|
| Rate for Payer: UMR Bronson Commercial |
$35.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.63
|
|
|
HC GALIUM 67 PER MCI
|
Facility
|
OP
|
$144.76
|
|
|
Service Code
|
HCPCS A9556
|
| Hospital Charge Code |
34300007
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$37.47 |
| Max. Negotiated Rate |
$130.28 |
| Rate for Payer: Aetna American Axle |
$94.09
|
| Rate for Payer: Aetna Commercial |
$123.05
|
| Rate for Payer: Aetna Medicare |
$72.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.09
|
| Rate for Payer: BCBS Complete |
$57.90
|
| Rate for Payer: BCBS Trust/PPO |
$103.91
|
| Rate for Payer: BCN Commercial |
$103.91
|
| Rate for Payer: Cash Price |
$115.81
|
| Rate for Payer: Cash Price |
$115.81
|
| Rate for Payer: Cofinity Advantage |
$101.33
|
| Rate for Payer: Cofinity Commercial |
$124.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.81
|
| Rate for Payer: Healthscope Commercial |
$130.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$101.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$115.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$108.57
|
| Rate for Payer: PHP Commercial |
$123.05
|
| Rate for Payer: Priority Health SBD |
$91.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.47
|
| Rate for Payer: UHC Core |
$37.47
|
| Rate for Payer: UHC Exchange |
$37.47
|
| Rate for Payer: UMR Bronson Commercial |
$53.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.57
|
|
|
HC GALIUM 67 PER MCI
|
Facility
|
IP
|
$144.76
|
|
|
Service Code
|
HCPCS A9556
|
| Hospital Charge Code |
34300007
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$63.69 |
| Max. Negotiated Rate |
$130.28 |
| Rate for Payer: Aetna American Axle |
$94.09
|
| Rate for Payer: Aetna Commercial |
$123.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.09
|
| Rate for Payer: Cash Price |
$115.81
|
| Rate for Payer: Cofinity Advantage |
$101.33
|
| Rate for Payer: Cofinity Commercial |
$124.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.81
|
| Rate for Payer: Healthscope Commercial |
$130.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$101.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$108.57
|
| Rate for Payer: PHP Commercial |
$123.05
|
| Rate for Payer: Priority Health SBD |
$91.20
|
| Rate for Payer: UMR Bronson Commercial |
$63.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.57
|
|
|
HC GARAMYCIN GENTAMICIN INJ UP TO 80 MG
|
Facility
|
OP
|
$4.24
|
|
|
Service Code
|
HCPCS J1580
|
| Hospital Charge Code |
63600139
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.57 |
| Max. Negotiated Rate |
$7.00 |
| Rate for Payer: Aetna American Axle |
$2.76
|
| Rate for Payer: Aetna Commercial |
$3.60
|
| Rate for Payer: Aetna Medicare |
$2.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.76
|
| Rate for Payer: BCBS Complete |
$1.70
|
| Rate for Payer: BCBS Trust/PPO |
$7.00
|
| Rate for Payer: BCN Commercial |
$7.00
|
| Rate for Payer: Cash Price |
$3.39
|
| Rate for Payer: Cash Price |
$3.39
|
| Rate for Payer: Cofinity Advantage |
$2.97
|
| Rate for Payer: Cofinity Commercial |
$3.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.39
|
| Rate for Payer: Healthscope Commercial |
$3.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.18
|
| Rate for Payer: PHP Commercial |
$3.60
|
| Rate for Payer: Priority Health SBD |
$2.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.58
|
| Rate for Payer: UHC Core |
$3.58
|
| Rate for Payer: UHC Exchange |
$3.58
|
| Rate for Payer: UMR Bronson Commercial |
$1.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.18
|
|
|
HC GARAMYCIN GENTAMICIN INJ UP TO 80 MG
|
Facility
|
IP
|
$4.24
|
|
|
Service Code
|
HCPCS J1580
|
| Hospital Charge Code |
63600139
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.87 |
| Max. Negotiated Rate |
$3.82 |
| Rate for Payer: Aetna American Axle |
$2.76
|
| Rate for Payer: Aetna Commercial |
$3.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.76
|
| Rate for Payer: Cash Price |
$3.39
|
| Rate for Payer: Cofinity Advantage |
$2.97
|
| Rate for Payer: Cofinity Commercial |
$3.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.39
|
| Rate for Payer: Healthscope Commercial |
$3.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.18
|
| Rate for Payer: PHP Commercial |
$3.60
|
| Rate for Payer: Priority Health SBD |
$2.67
|
| Rate for Payer: UMR Bronson Commercial |
$1.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.18
|
|
