|
HC PEDS AUTOIMM ENCEPH CNS, CMPT 4
|
Facility
|
IP
|
$263.80
|
|
|
Service Code
|
CPT 86363
|
| Hospital Charge Code |
30200500
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$116.07 |
| Max. Negotiated Rate |
$237.42 |
| Rate for Payer: Aetna American Axle |
$171.47
|
| Rate for Payer: Aetna Commercial |
$224.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.47
|
| Rate for Payer: Cash Price |
$211.04
|
| Rate for Payer: Cofinity Commercial |
$184.66
|
| Rate for Payer: Cofinity Commercial |
$226.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$211.04
|
| Rate for Payer: Healthscope Commercial |
$237.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$184.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$197.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$224.23
|
| Rate for Payer: PHP Commercial |
$224.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.66
|
| Rate for Payer: Priority Health SBD |
$166.19
|
| Rate for Payer: UMR Bronson Commercial |
$116.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$197.85
|
|
|
HC PEDS ECHO COMPLETE
|
Facility
|
OP
|
$1,969.00
|
|
|
Service Code
|
CPT 93306
|
| Hospital Charge Code |
48300005
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$192.86 |
| Max. Negotiated Rate |
$1,772.10 |
| Rate for Payer: Aetna American Axle |
$1,279.85
|
| Rate for Payer: Aetna Commercial |
$1,673.65
|
| Rate for Payer: Aetna Medicare |
$509.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,279.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$612.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$612.96
|
| Rate for Payer: BCBS Complete |
$281.67
|
| Rate for Payer: BCBS MAPPO |
$490.37
|
| Rate for Payer: BCBS Trust/PPO |
$645.12
|
| Rate for Payer: BCN Medicare Advantage |
$490.37
|
| Rate for Payer: Cash Price |
$1,575.20
|
| Rate for Payer: Cash Price |
$1,575.20
|
| Rate for Payer: Cash Price |
$1,575.20
|
| Rate for Payer: Cofinity Commercial |
$1,693.34
|
| Rate for Payer: Cofinity Commercial |
$1,378.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,575.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$490.37
|
| Rate for Payer: Healthscope Commercial |
$1,772.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,378.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,476.75
|
| Rate for Payer: Mclaren Medicaid |
$268.23
|
| Rate for Payer: Mclaren Medicare |
$490.37
|
| Rate for Payer: Meridian Medicaid |
$281.67
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$514.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$563.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,673.65
|
| Rate for Payer: PACE Medicare |
$465.85
|
| Rate for Payer: PACE SWMI |
$490.37
|
| Rate for Payer: PHP Commercial |
$1,673.65
|
| Rate for Payer: PHP Medicare Advantage |
$490.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$268.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,378.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,543.71
|
| Rate for Payer: Priority Health Medicare |
$490.37
|
| Rate for Payer: Priority Health Narrow Network |
$1,234.97
|
| Rate for Payer: Priority Health SBD |
$1,240.47
|
| Rate for Payer: Railroad Medicare Medicare |
$490.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$212.15
|
| Rate for Payer: UHC Core |
$816.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$490.37
|
| Rate for Payer: UHC Exchange |
$192.86
|
| Rate for Payer: UHC Medicare Advantage |
$505.08
|
| Rate for Payer: UMR Bronson Commercial |
$728.53
|
| Rate for Payer: VA VA |
$490.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,476.75
|
|
|
HC PEDS ECHO COMPLETE
|
Facility
|
IP
|
$1,969.00
|
|
|
Service Code
|
CPT 93306
|
| Hospital Charge Code |
48300005
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$866.36 |
| Max. Negotiated Rate |
$1,772.10 |
| Rate for Payer: Aetna American Axle |
$1,279.85
|
| Rate for Payer: Aetna Commercial |
$1,673.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,279.85
|
| Rate for Payer: Cash Price |
$1,575.20
|
| Rate for Payer: Cofinity Commercial |
$1,378.30
|
| Rate for Payer: Cofinity Commercial |
$1,693.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,575.20
|
| Rate for Payer: Healthscope Commercial |
$1,772.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,378.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,476.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,673.65
|
| Rate for Payer: PHP Commercial |
$1,673.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,378.30
|
| Rate for Payer: Priority Health SBD |
$1,240.47
|
| Rate for Payer: UMR Bronson Commercial |
$866.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,476.75
|
|
|
HC PEDS ECHO LIMITED
|
Facility
|
IP
|
$809.36
|
|
|
Service Code
|
CPT 93308
|
| Hospital Charge Code |
48300006
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$356.12 |
| Max. Negotiated Rate |
$728.42 |
| Rate for Payer: Aetna American Axle |
$526.08
|
| Rate for Payer: Aetna Commercial |
$687.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$526.08
|
| Rate for Payer: Cash Price |
$647.49
|
| Rate for Payer: Cofinity Commercial |
$566.55
|
| Rate for Payer: Cofinity Commercial |
$696.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$647.49
|
| Rate for Payer: Healthscope Commercial |
$728.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$566.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$607.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$687.96
|
| Rate for Payer: PHP Commercial |
$687.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$566.55
|
| Rate for Payer: Priority Health SBD |
$509.90
|
| Rate for Payer: UMR Bronson Commercial |
$356.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$607.02
|
|
|
HC PEDS ECHO LIMITED
|
Facility
|
OP
|
$809.36
|
|
|
Service Code
|
CPT 93308
|
| Hospital Charge Code |
48300006
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$96.92 |
| Max. Negotiated Rate |
$816.00 |
| Rate for Payer: Aetna American Axle |
$526.08
|
| Rate for Payer: Aetna Commercial |
$687.96
|
| Rate for Payer: Aetna Medicare |
$226.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$526.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$272.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$272.26
|
| Rate for Payer: BCBS Complete |
$125.11
|
| Rate for Payer: BCBS MAPPO |
$217.81
|
| Rate for Payer: BCBS Trust/PPO |
$370.30
|
| Rate for Payer: BCN Medicare Advantage |
$217.81
|
| Rate for Payer: Cash Price |
$647.49
|
| Rate for Payer: Cash Price |
$647.49
|
| Rate for Payer: Cash Price |
$647.49
|
| Rate for Payer: Cofinity Commercial |
$566.55
|
| Rate for Payer: Cofinity Commercial |
$696.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$647.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$217.81
|
| Rate for Payer: Healthscope Commercial |
$728.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$566.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$607.02
|
| Rate for Payer: Mclaren Medicaid |
$119.14
|
| Rate for Payer: Mclaren Medicare |
$217.81
|
| Rate for Payer: Meridian Medicaid |
$125.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$228.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$250.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$687.96
|
| Rate for Payer: PACE Medicare |
$206.92
|
| Rate for Payer: PACE SWMI |
$217.81
|
| Rate for Payer: PHP Commercial |
$687.96
|
| Rate for Payer: PHP Medicare Advantage |
$217.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$119.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$566.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$685.66
|
| Rate for Payer: Priority Health Medicare |
$217.81
|
| Rate for Payer: Priority Health Narrow Network |
$548.53
|
| Rate for Payer: Priority Health SBD |
$509.90
|
| Rate for Payer: Railroad Medicare Medicare |
$217.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$106.61
|
| Rate for Payer: UHC Core |
$816.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$217.81
|
| Rate for Payer: UHC Exchange |
$96.92
|
| Rate for Payer: UHC Medicare Advantage |
$224.34
|
| Rate for Payer: UMR Bronson Commercial |
$299.46
|
| Rate for Payer: VA VA |
$217.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$607.02
|
|
|
HC PEDS ECHO W/DEFINITY
|
Facility
|
OP
|
$1,458.97
|
|
|
Service Code
|
HCPCS C8921
|
| Hospital Charge Code |
48000028
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$389.31 |
| Max. Negotiated Rate |
$2,240.48 |
| Rate for Payer: Aetna American Axle |
$948.33
|
| Rate for Payer: Aetna Commercial |
$1,240.12
|
| Rate for Payer: Aetna Medicare |
$740.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$948.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$889.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$889.64
|
| Rate for Payer: BCBS Complete |
$408.81
|
| Rate for Payer: BCBS MAPPO |
$711.71
|
| Rate for Payer: BCBS Trust/PPO |
$888.23
|
| Rate for Payer: BCN Medicare Advantage |
$711.71
|
| Rate for Payer: Cash Price |
$1,167.18
|
| Rate for Payer: Cash Price |
$1,167.18
|
| Rate for Payer: Cash Price |
$1,167.18
|
| Rate for Payer: Cofinity Commercial |
$1,254.71
|
| Rate for Payer: Cofinity Commercial |
$1,021.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,167.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$711.71
|
| Rate for Payer: Healthscope Commercial |
$1,313.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,021.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,094.23
|
| Rate for Payer: Mclaren Medicaid |
$389.31
|
| Rate for Payer: Mclaren Medicare |
$711.71
|
| Rate for Payer: Meridian Medicaid |
$408.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$747.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$818.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,240.12
|
| Rate for Payer: PACE Medicare |
$676.12
|
| Rate for Payer: PACE SWMI |
$711.71
|
| Rate for Payer: PHP Commercial |
$1,240.12
|
| Rate for Payer: PHP Medicare Advantage |
$711.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$389.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,021.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,240.48
|
| Rate for Payer: Priority Health Medicare |
$711.71
|
| Rate for Payer: Priority Health Narrow Network |
$1,792.38
|
| Rate for Payer: Priority Health SBD |
$919.15
|
| Rate for Payer: Railroad Medicare Medicare |
$711.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,995.42
|
| Rate for Payer: UHC Core |
$816.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$711.71
|
| Rate for Payer: UHC Exchange |
$1,360.15
|
| Rate for Payer: UHC Medicare Advantage |
$733.06
|
| Rate for Payer: UMR Bronson Commercial |
$539.82
|
| Rate for Payer: VA VA |
$711.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,094.23
|
|
|
HC PEDS ECHO W/DEFINITY
|
Facility
|
IP
|
$1,458.97
|
|
|
Service Code
|
HCPCS C8921
|
| Hospital Charge Code |
48000028
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$641.95 |
| Max. Negotiated Rate |
$1,313.07 |
| Rate for Payer: Aetna American Axle |
$948.33
|
| Rate for Payer: Aetna Commercial |
$1,240.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$948.33
|
| Rate for Payer: Cash Price |
$1,167.18
|
| Rate for Payer: Cofinity Commercial |
$1,021.28
|
| Rate for Payer: Cofinity Commercial |
$1,254.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,167.18
|
| Rate for Payer: Healthscope Commercial |
$1,313.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,021.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,094.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,240.12
|
| Rate for Payer: PHP Commercial |
$1,240.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,021.28
|
| Rate for Payer: Priority Health SBD |
$919.15
|
| Rate for Payer: UMR Bronson Commercial |
$641.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,094.23
|
|
|
HC PEDS OBS OVERFLOW PER HR
|
Facility
|
IP
|
$153.31
|
|
| Hospital Charge Code |
76900003
|
|
Hospital Revenue Code
|
769
|
| Min. Negotiated Rate |
$67.46 |
| Max. Negotiated Rate |
$137.98 |
| Rate for Payer: Aetna American Axle |
$99.65
|
| Rate for Payer: Aetna Commercial |
$130.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.65
|
| Rate for Payer: Cash Price |
$122.65
|
| Rate for Payer: Cofinity Commercial |
$107.32
|
| Rate for Payer: Cofinity Commercial |
$131.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.65
|
| Rate for Payer: Healthscope Commercial |
$137.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$107.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$130.31
|
| Rate for Payer: PHP Commercial |
$130.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.32
|
| Rate for Payer: Priority Health SBD |
$96.59
|
| Rate for Payer: UMR Bronson Commercial |
$67.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.98
|
|
|
HC PEDS OBS OVERFLOW PER HR
|
Facility
|
OP
|
$153.31
|
|
| Hospital Charge Code |
76900003
|
|
Hospital Revenue Code
|
769
|
| Min. Negotiated Rate |
$56.72 |
| Max. Negotiated Rate |
$137.98 |
| Rate for Payer: Aetna American Axle |
$99.65
|
| Rate for Payer: Aetna Commercial |
$130.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.65
|
| Rate for Payer: BCBS Complete |
$61.32
|
| Rate for Payer: Cash Price |
$122.65
|
| Rate for Payer: Cofinity Commercial |
$107.32
|
| Rate for Payer: Cofinity Commercial |
$131.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.65
|
| Rate for Payer: Healthscope Commercial |
$137.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$107.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$130.31
|
| Rate for Payer: PHP Commercial |
$130.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.32
|
| Rate for Payer: Priority Health SBD |
$96.59
|
| Rate for Payer: UMR Bronson Commercial |
$56.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.98
|
|
|
HC PEDS VENT INIT DAY
|
Facility
|
OP
|
$1,491.66
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
41000035
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$88.41 |
| Max. Negotiated Rate |
$1,753.55 |
| Rate for Payer: Aetna American Axle |
$969.58
|
| Rate for Payer: Aetna Commercial |
$1,267.91
|
| Rate for Payer: Aetna Medicare |
$579.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$969.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$696.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$696.29
|
| Rate for Payer: BCBS Complete |
$319.96
|
| Rate for Payer: BCBS MAPPO |
$557.03
|
| Rate for Payer: BCBS Trust/PPO |
$90.49
|
| Rate for Payer: BCN Medicare Advantage |
$557.03
|
| Rate for Payer: Cash Price |
$1,193.33
|
| Rate for Payer: Cash Price |
$1,193.33
|
| Rate for Payer: Cash Price |
$1,193.33
|
| Rate for Payer: Cofinity Commercial |
$1,282.83
|
| Rate for Payer: Cofinity Commercial |
$1,044.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,193.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$557.03
|
| Rate for Payer: Healthscope Commercial |
$1,342.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,044.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,118.74
|
| Rate for Payer: Mclaren Medicaid |
$304.70
|
| Rate for Payer: Mclaren Medicare |
$557.03
|
| Rate for Payer: Meridian Medicaid |
$319.96
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$584.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$640.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,267.91
|
| Rate for Payer: PACE Medicare |
$529.18
|
| Rate for Payer: PACE SWMI |
$557.03
|
| Rate for Payer: PHP Commercial |
$1,267.91
|
| Rate for Payer: PHP Medicare Advantage |
$557.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$304.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,044.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,753.55
|
| Rate for Payer: Priority Health Medicare |
$557.03
|
| Rate for Payer: Priority Health Narrow Network |
$1,402.84
|
| Rate for Payer: Priority Health SBD |
$939.75
|
| Rate for Payer: Railroad Medicare Medicare |
$557.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$97.25
|
| Rate for Payer: UHC Core |
$294.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$557.03
|
| Rate for Payer: UHC Exchange |
$88.41
|
| Rate for Payer: UHC Medicare Advantage |
$573.74
|
| Rate for Payer: UMR Bronson Commercial |
$551.91
|
| Rate for Payer: VA VA |
$557.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,118.74
|
|
|
HC PEDS VENT INIT DAY
|
Facility
|
IP
|
$1,491.66
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
41000035
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$656.33 |
| Max. Negotiated Rate |
$1,342.49 |
| Rate for Payer: Aetna American Axle |
$969.58
|
| Rate for Payer: Aetna Commercial |
$1,267.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$969.58
|
| Rate for Payer: Cash Price |
$1,193.33
|
| Rate for Payer: Cofinity Commercial |
$1,044.16
|
| Rate for Payer: Cofinity Commercial |
$1,282.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,193.33
|
| Rate for Payer: Healthscope Commercial |
$1,342.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,044.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,118.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,267.91
|
| Rate for Payer: PHP Commercial |
$1,267.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,044.16
|
| Rate for Payer: Priority Health SBD |
$939.75
|
| Rate for Payer: UMR Bronson Commercial |
$656.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,118.74
|
|
|
HC PEDS VENT SUB DAY
|
Facility
|
IP
|
$1,289.42
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
41000036
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$567.34 |
| Max. Negotiated Rate |
$1,160.48 |
| Rate for Payer: Aetna American Axle |
$838.12
|
| Rate for Payer: Aetna Commercial |
$1,096.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$838.12
|
| Rate for Payer: Cash Price |
$1,031.54
|
| Rate for Payer: Cofinity Commercial |
$1,108.90
|
| Rate for Payer: Cofinity Commercial |
$902.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,031.54
|
| Rate for Payer: Healthscope Commercial |
$1,160.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$902.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$967.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,096.01
|
| Rate for Payer: PHP Commercial |
$1,096.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$902.59
|
| Rate for Payer: Priority Health SBD |
$812.33
|
| Rate for Payer: UMR Bronson Commercial |
$567.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$967.06
|
|
|
HC PEDS VENT SUB DAY
|
Facility
|
OP
|
$1,289.42
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
41000036
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$62.21 |
| Max. Negotiated Rate |
$1,753.55 |
| Rate for Payer: Aetna American Axle |
$838.12
|
| Rate for Payer: Aetna Commercial |
$1,096.01
|
| Rate for Payer: Aetna Medicare |
$579.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$838.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$696.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$696.29
|
| Rate for Payer: BCBS Complete |
$319.96
|
| Rate for Payer: BCBS MAPPO |
$557.03
|
| Rate for Payer: BCBS Trust/PPO |
$68.70
|
| Rate for Payer: BCN Medicare Advantage |
$557.03
|
| Rate for Payer: Cash Price |
$1,031.54
|
| Rate for Payer: Cash Price |
$1,031.54
|
| Rate for Payer: Cash Price |
$1,031.54
|
| Rate for Payer: Cofinity Commercial |
$902.59
|
| Rate for Payer: Cofinity Commercial |
$1,108.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,031.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$557.03
|
| Rate for Payer: Healthscope Commercial |
$1,160.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$902.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$967.06
|
| Rate for Payer: Mclaren Medicaid |
$304.70
|
| Rate for Payer: Mclaren Medicare |
$557.03
|
| Rate for Payer: Meridian Medicaid |
$319.96
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$584.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$640.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,096.01
|
| Rate for Payer: PACE Medicare |
$529.18
|
| Rate for Payer: PACE SWMI |
$557.03
|
| Rate for Payer: PHP Commercial |
$1,096.01
|
| Rate for Payer: PHP Medicare Advantage |
$557.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$304.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$902.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,753.55
|
| Rate for Payer: Priority Health Medicare |
$557.03
|
| Rate for Payer: Priority Health Narrow Network |
$1,402.84
|
| Rate for Payer: Priority Health SBD |
$812.33
|
| Rate for Payer: Railroad Medicare Medicare |
$557.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.43
|
| Rate for Payer: UHC Core |
$294.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$557.03
|
| Rate for Payer: UHC Exchange |
$62.21
|
| Rate for Payer: UHC Medicare Advantage |
$573.74
|
| Rate for Payer: UMR Bronson Commercial |
$477.09
|
| Rate for Payer: VA VA |
$557.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$967.06
|
|
|
HC PEG TUBE INSERTION/TRAY
|
Facility
|
IP
|
$1,187.11
|
|
| Hospital Charge Code |
36000079
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$522.33 |
| Max. Negotiated Rate |
$1,068.40 |
| Rate for Payer: Aetna American Axle |
$771.62
|
| Rate for Payer: Aetna Commercial |
$1,009.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$771.62
|
| Rate for Payer: Cash Price |
$949.69
|
| Rate for Payer: Cofinity Commercial |
$1,020.91
|
| Rate for Payer: Cofinity Commercial |
$830.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$949.69
|
| Rate for Payer: Healthscope Commercial |
$1,068.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$830.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$890.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,009.04
|
| Rate for Payer: PHP Commercial |
$1,009.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$830.98
|
| Rate for Payer: Priority Health SBD |
$747.88
|
| Rate for Payer: UMR Bronson Commercial |
$522.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$890.33
|
|
|
HC PEG TUBE INSERTION/TRAY
|
Facility
|
OP
|
$1,187.11
|
|
| Hospital Charge Code |
36000079
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$439.23 |
| Max. Negotiated Rate |
$1,068.40 |
| Rate for Payer: Aetna American Axle |
$771.62
|
| Rate for Payer: Aetna Commercial |
$1,009.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$771.62
|
| Rate for Payer: BCBS Complete |
$474.84
|
| Rate for Payer: Cash Price |
$949.69
|
| Rate for Payer: Cofinity Commercial |
$1,020.91
|
| Rate for Payer: Cofinity Commercial |
$830.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$949.69
|
| Rate for Payer: Healthscope Commercial |
$1,068.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$830.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$890.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,009.04
|
| Rate for Payer: PHP Commercial |
$1,009.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$830.98
|
| Rate for Payer: Priority Health SBD |
$747.88
|
| Rate for Payer: UMR Bronson Commercial |
$439.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$890.33
|
|
|
HC PEJ FDG TUBE INSERTION/REPLACE
|
Facility
|
OP
|
$1,495.13
|
|
| Hospital Charge Code |
36000059
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$553.20 |
| Max. Negotiated Rate |
$1,345.62 |
| Rate for Payer: Aetna American Axle |
$971.83
|
| Rate for Payer: Aetna Commercial |
$1,270.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$971.83
|
| Rate for Payer: BCBS Complete |
$598.05
|
| Rate for Payer: Cash Price |
$1,196.10
|
| Rate for Payer: Cofinity Commercial |
$1,046.59
|
| Rate for Payer: Cofinity Commercial |
$1,285.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,196.10
|
| Rate for Payer: Healthscope Commercial |
$1,345.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,046.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,121.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,270.86
|
| Rate for Payer: PHP Commercial |
$1,270.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,046.59
|
| Rate for Payer: Priority Health SBD |
$941.93
|
| Rate for Payer: UMR Bronson Commercial |
$553.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,121.35
|
|
|
HC PEJ FDG TUBE INSERTION/REPLACE
|
Facility
|
IP
|
$1,495.13
|
|
| Hospital Charge Code |
36000059
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$657.86 |
| Max. Negotiated Rate |
$1,345.62 |
| Rate for Payer: Aetna American Axle |
$971.83
|
| Rate for Payer: Aetna Commercial |
$1,270.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$971.83
|
| Rate for Payer: Cash Price |
$1,196.10
|
| Rate for Payer: Cofinity Commercial |
$1,046.59
|
| Rate for Payer: Cofinity Commercial |
$1,285.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,196.10
|
| Rate for Payer: Healthscope Commercial |
$1,345.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,046.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,121.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,270.86
|
| Rate for Payer: PHP Commercial |
$1,270.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,046.59
|
| Rate for Payer: Priority Health SBD |
$941.93
|
| Rate for Payer: UMR Bronson Commercial |
$657.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,121.35
|
|
|
HC PELVIC EXAMINATION
|
Facility
|
OP
|
$20.28
|
|
|
Service Code
|
CPT 99459
|
| Hospital Charge Code |
51000129
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$24.50 |
| Rate for Payer: Aetna American Axle |
$13.18
|
| Rate for Payer: Aetna Commercial |
$17.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.18
|
| Rate for Payer: BCBS Complete |
$8.11
|
| Rate for Payer: Cash Price |
$16.22
|
| Rate for Payer: Cash Price |
$16.22
|
| Rate for Payer: Cofinity Commercial |
$17.44
|
| Rate for Payer: Cofinity Commercial |
$14.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.22
|
| Rate for Payer: Healthscope Commercial |
$18.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.24
|
| Rate for Payer: PHP Commercial |
$17.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.20
|
| Rate for Payer: Priority Health SBD |
$12.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.50
|
| Rate for Payer: UHC Exchange |
$22.27
|
| Rate for Payer: UMR Bronson Commercial |
$7.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.21
|
|
|
HC PELVIC EXAMINATION
|
Facility
|
IP
|
$20.28
|
|
|
Service Code
|
CPT 99459
|
| Hospital Charge Code |
51000129
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$8.92 |
| Max. Negotiated Rate |
$18.25 |
| Rate for Payer: Aetna American Axle |
$13.18
|
| Rate for Payer: Aetna Commercial |
$17.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.18
|
| Rate for Payer: Cash Price |
$16.22
|
| Rate for Payer: Cofinity Commercial |
$14.20
|
| Rate for Payer: Cofinity Commercial |
$17.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.22
|
| Rate for Payer: Healthscope Commercial |
$18.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.24
|
| Rate for Payer: PHP Commercial |
$17.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.20
|
| Rate for Payer: Priority Health SBD |
$12.78
|
| Rate for Payer: UMR Bronson Commercial |
$8.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.21
|
|
|
HC PENICILLIUM IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200055
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.95 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna American Axle |
$16.18
|
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.18
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Cofinity Commercial |
$17.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health SBD |
$15.68
|
| Rate for Payer: UMR Bronson Commercial |
$10.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.67
|
|
|
HC PENICILLIUM IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200055
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna American Axle |
$16.18
|
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: BCBS Complete |
$3.00
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$4.70
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$17.42
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.67
|
| Rate for Payer: Mclaren Medicaid |
$2.86
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Medicaid |
$3.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7.16
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$5.73
|
| Rate for Payer: Priority Health SBD |
$15.68
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.26
|
| Rate for Payer: UHC Core |
$8.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$5.22
|
| Rate for Payer: UHC Medicare Advantage |
$5.38
|
| Rate for Payer: UMR Bronson Commercial |
$9.21
|
| Rate for Payer: VA VA |
$5.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.67
|
|
|
HC PENTAMIDINE THERAPY
|
Facility
|
IP
|
$1,013.28
|
|
|
Service Code
|
CPT 94642
|
| Hospital Charge Code |
41000005
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$445.84 |
| Max. Negotiated Rate |
$911.95 |
| Rate for Payer: Aetna American Axle |
$658.63
|
| Rate for Payer: Aetna Commercial |
$861.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$658.63
|
| Rate for Payer: Cash Price |
$810.62
|
| Rate for Payer: Cofinity Commercial |
$709.30
|
| Rate for Payer: Cofinity Commercial |
$871.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$810.62
|
| Rate for Payer: Healthscope Commercial |
$911.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$709.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$759.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$861.29
|
| Rate for Payer: PHP Commercial |
$861.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$709.30
|
| Rate for Payer: Priority Health SBD |
$638.37
|
| Rate for Payer: UMR Bronson Commercial |
$445.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$759.96
|
|
|
HC PENTAMIDINE THERAPY
|
Facility
|
OP
|
$1,013.28
|
|
|
Service Code
|
CPT 94642
|
| Hospital Charge Code |
41000005
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$103.71 |
| Max. Negotiated Rate |
$911.95 |
| Rate for Payer: Aetna American Axle |
$658.63
|
| Rate for Payer: Aetna Commercial |
$861.29
|
| Rate for Payer: Aetna Medicare |
$197.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$658.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$236.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$236.99
|
| Rate for Payer: BCBS Complete |
$108.90
|
| Rate for Payer: BCBS MAPPO |
$189.59
|
| Rate for Payer: BCBS Trust/PPO |
$607.38
|
| Rate for Payer: BCN Medicare Advantage |
$189.59
|
| Rate for Payer: Cash Price |
$810.62
|
| Rate for Payer: Cash Price |
$810.62
|
| Rate for Payer: Cash Price |
$810.62
|
| Rate for Payer: Cofinity Commercial |
$871.42
|
| Rate for Payer: Cofinity Commercial |
$709.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$810.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$189.59
|
| Rate for Payer: Healthscope Commercial |
$911.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$709.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$759.96
|
| Rate for Payer: Mclaren Medicaid |
$103.71
|
| Rate for Payer: Mclaren Medicare |
$189.59
|
| Rate for Payer: Meridian Medicaid |
$108.90
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$199.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$218.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$861.29
|
| Rate for Payer: PACE Medicare |
$180.11
|
| Rate for Payer: PACE SWMI |
$189.59
|
| Rate for Payer: PHP Commercial |
$861.29
|
| Rate for Payer: PHP Medicare Advantage |
$189.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$709.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$596.84
|
| Rate for Payer: Priority Health Medicare |
$189.59
|
| Rate for Payer: Priority Health Narrow Network |
$477.47
|
| Rate for Payer: Priority Health SBD |
$638.37
|
| Rate for Payer: Railroad Medicare Medicare |
$189.59
|
| Rate for Payer: UHC Core |
$294.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$189.59
|
| Rate for Payer: UHC Medicare Advantage |
$195.28
|
| Rate for Payer: UMR Bronson Commercial |
$374.91
|
| Rate for Payer: VA VA |
$189.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$759.96
|
|
|
HC PENTOBARBITOL NEMBUTAL LVL
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
CPT 80345
|
| Hospital Charge Code |
30100572
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.70 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Aetna American Axle |
$113.75
|
| Rate for Payer: Aetna Commercial |
$148.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.75
|
| Rate for Payer: BCBS Complete |
$70.00
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cofinity Commercial |
$122.50
|
| Rate for Payer: Cofinity Commercial |
$150.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.00
|
| Rate for Payer: Healthscope Commercial |
$157.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$122.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$131.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$148.75
|
| Rate for Payer: PHP Commercial |
$148.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.50
|
| Rate for Payer: Priority Health SBD |
$110.25
|
| Rate for Payer: UHC Core |
$18.70
|
| Rate for Payer: UMR Bronson Commercial |
$64.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$131.25
|
|
|
HC PENTOBARBITOL NEMBUTAL LVL
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
CPT 80345
|
| Hospital Charge Code |
30100572
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$77.00 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Aetna American Axle |
$113.75
|
| Rate for Payer: Aetna Commercial |
$148.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.75
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cofinity Commercial |
$122.50
|
| Rate for Payer: Cofinity Commercial |
$150.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.00
|
| Rate for Payer: Healthscope Commercial |
$157.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$122.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$131.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$148.75
|
| Rate for Payer: PHP Commercial |
$148.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.50
|
| Rate for Payer: Priority Health SBD |
$110.25
|
| Rate for Payer: UMR Bronson Commercial |
$77.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$131.25
|
|
