|
HC HCV GENOTYPE RESOLUTION
|
Facility
|
IP
|
$411.56
|
|
|
Service Code
|
CPT 87902
|
| Hospital Charge Code |
30600262
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$181.09 |
| Max. Negotiated Rate |
$370.40 |
| Rate for Payer: Aetna American Axle |
$267.51
|
| Rate for Payer: Aetna Commercial |
$349.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$267.51
|
| Rate for Payer: Cash Price |
$329.25
|
| Rate for Payer: Cofinity Advantage |
$288.09
|
| Rate for Payer: Cofinity Commercial |
$353.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$329.25
|
| Rate for Payer: Healthscope Commercial |
$370.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$288.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$308.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$349.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$308.67
|
| Rate for Payer: PHP Commercial |
$349.83
|
| Rate for Payer: Priority Health SBD |
$259.28
|
| Rate for Payer: UMR Bronson Commercial |
$181.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$308.67
|
|
|
HC HDL CHOLESTEROL
|
Facility
|
IP
|
$31.83
|
|
|
Service Code
|
CPT 83718
|
| Hospital Charge Code |
30100282
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.01 |
| Max. Negotiated Rate |
$28.65 |
| Rate for Payer: Aetna American Axle |
$20.69
|
| Rate for Payer: Aetna Commercial |
$27.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.69
|
| Rate for Payer: Cash Price |
$25.46
|
| Rate for Payer: Cofinity Advantage |
$22.28
|
| Rate for Payer: Cofinity Commercial |
$27.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.46
|
| Rate for Payer: Healthscope Commercial |
$28.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.87
|
| Rate for Payer: PHP Commercial |
$27.06
|
| Rate for Payer: Priority Health SBD |
$20.05
|
| Rate for Payer: UMR Bronson Commercial |
$14.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.87
|
|
|
HC HDL CHOLESTEROL
|
Facility
|
OP
|
$31.83
|
|
|
Service Code
|
CPT 83718
|
| Hospital Charge Code |
30100282
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.28 |
| Max. Negotiated Rate |
$28.65 |
| Rate for Payer: Aetna American Axle |
$20.69
|
| Rate for Payer: Aetna Commercial |
$27.06
|
| Rate for Payer: Aetna Medicare |
$8.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.24
|
| Rate for Payer: BCBS Complete |
$4.50
|
| Rate for Payer: BCBS MAPPO |
$8.19
|
| Rate for Payer: BCBS Trust/PPO |
$9.46
|
| Rate for Payer: BCN Commercial |
$9.46
|
| Rate for Payer: BCN Medicare Advantage |
$8.19
|
| Rate for Payer: Cash Price |
$25.46
|
| Rate for Payer: Cash Price |
$25.46
|
| Rate for Payer: Cofinity Advantage |
$22.28
|
| Rate for Payer: Cofinity Commercial |
$27.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.19
|
| Rate for Payer: Healthscope Commercial |
$28.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.87
|
| Rate for Payer: Mclaren Medicaid |
$8.19
|
| Rate for Payer: Mclaren Medicare |
$8.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.60
|
| Rate for Payer: Meridian Medicaid |
$8.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$9.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.06
|
| Rate for Payer: Nomi Health Commercial |
$24.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.87
|
| Rate for Payer: PACE Medicare |
$7.78
|
| Rate for Payer: PACE SWMI |
$8.19
|
| Rate for Payer: PHP Commercial |
$27.06
|
| Rate for Payer: PHP Medicare Advantage |
$8.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$8.19
|
| Rate for Payer: Priority Health Medicare |
$8.19
|
| Rate for Payer: Priority Health SBD |
$20.05
|
| Rate for Payer: Priority Health Tiered Network |
$6.55
|
| Rate for Payer: Railroad Medicare Medicare |
$8.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.29
|
| Rate for Payer: UHC Core |
$12.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8.19
|
| Rate for Payer: UHC Exchange |
$12.29
|
| Rate for Payer: UHC Medicaid |
$4.28
|
| Rate for Payer: UHCCP Medicaid |
$4.28
|
| Rate for Payer: UMR Bronson Commercial |
$11.78
|
| Rate for Payer: VA VA |
$8.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.87
|
|
|
HC HDL CHOLESTEROL LMPP
|
Facility
|
OP
|
$21.23
|
|
|
Service Code
|
CPT 83718
|
| Hospital Charge Code |
30100690
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.28 |
| Max. Negotiated Rate |
$24.57 |
| Rate for Payer: Aetna American Axle |
$13.80
|
| Rate for Payer: Aetna Commercial |
$18.05
|
| Rate for Payer: Aetna Medicare |
$8.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.24
|
| Rate for Payer: BCBS Complete |
$4.50
|
| Rate for Payer: BCBS MAPPO |
$8.19
|
| Rate for Payer: BCBS Trust/PPO |
$9.46
|
| Rate for Payer: BCN Commercial |
$9.46
|
| Rate for Payer: BCN Medicare Advantage |
$8.19
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cofinity Advantage |
$14.86
|
| Rate for Payer: Cofinity Commercial |
$18.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.19
|
| Rate for Payer: Healthscope Commercial |
$19.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.92
|
| Rate for Payer: Mclaren Medicaid |
$8.19
|
| Rate for Payer: Mclaren Medicare |
$8.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.60
|
| Rate for Payer: Meridian Medicaid |
$8.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$9.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.05
|
| Rate for Payer: Nomi Health Commercial |
$24.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.92
|
| Rate for Payer: PACE Medicare |
$7.78
|
| Rate for Payer: PACE SWMI |
$8.19
|
| Rate for Payer: PHP Commercial |
$18.05
|
| Rate for Payer: PHP Medicare Advantage |
$8.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$8.19
|
| Rate for Payer: Priority Health Medicare |
$8.19
|
| Rate for Payer: Priority Health SBD |
$13.37
|
| Rate for Payer: Priority Health Tiered Network |
$6.55
|
| Rate for Payer: Railroad Medicare Medicare |
$8.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.29
|
| Rate for Payer: UHC Core |
$12.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8.19
|
| Rate for Payer: UHC Exchange |
$12.29
|
| Rate for Payer: UHC Medicaid |
$4.28
|
| Rate for Payer: UHCCP Medicaid |
$4.28
|
| Rate for Payer: UMR Bronson Commercial |
$7.86
|
| Rate for Payer: VA VA |
$8.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.92
|
|
|
HC HDL CHOLESTEROL LMPP
|
Facility
|
IP
|
$21.23
|
|
|
Service Code
|
CPT 83718
|
| Hospital Charge Code |
30100690
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.34 |
| Max. Negotiated Rate |
$19.11 |
| Rate for Payer: Aetna American Axle |
$13.80
|
| Rate for Payer: Aetna Commercial |
$18.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.80
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cofinity Advantage |
$14.86
|
| Rate for Payer: Cofinity Commercial |
$18.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.98
|
| Rate for Payer: Healthscope Commercial |
$19.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.92
|
| Rate for Payer: PHP Commercial |
$18.05
|
| Rate for Payer: Priority Health SBD |
$13.37
|
| Rate for Payer: UMR Bronson Commercial |
$9.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.92
|
|
|
HC HDR 1 CHANNEL
|
Facility
|
OP
|
$2,029.45
|
|
|
Service Code
|
CPT 77770
|
| Hospital Charge Code |
33300055
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$362.95 |
| Max. Negotiated Rate |
$2,244.23 |
| Rate for Payer: Aetna American Axle |
$1,319.14
|
| Rate for Payer: Aetna Commercial |
$1,725.03
|
| Rate for Payer: Aetna Medicare |
$721.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,319.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$867.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$867.46
|
| Rate for Payer: BCBS Complete |
$381.13
|
| Rate for Payer: BCBS MAPPO |
$693.97
|
| Rate for Payer: BCBS Trust/PPO |
$833.42
|
| Rate for Payer: BCN Commercial |
$833.42
|
| Rate for Payer: BCN Medicare Advantage |
$693.97
|
| Rate for Payer: Cash Price |
$1,623.56
|
| Rate for Payer: Cash Price |
$1,623.56
|
| Rate for Payer: Cash Price |
$1,623.56
|
| Rate for Payer: Cofinity Advantage |
$1,420.62
|
| Rate for Payer: Cofinity Commercial |
$1,745.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,623.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$693.97
|
| Rate for Payer: Healthscope Commercial |
$1,826.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,420.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,522.09
|
| Rate for Payer: Mclaren Medicaid |
$693.97
|
| Rate for Payer: Mclaren Medicare |
$693.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$728.67
|
| Rate for Payer: Meridian Medicaid |
$728.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$798.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$763.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,725.03
|
| Rate for Payer: Nomi Health Commercial |
$2,081.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,522.09
|
| Rate for Payer: PACE Medicare |
$659.27
|
| Rate for Payer: PACE SWMI |
$693.97
|
| Rate for Payer: PHP Commercial |
$1,725.03
|
| Rate for Payer: PHP Medicare Advantage |
$693.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$362.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,244.23
|
| Rate for Payer: Priority Health Medicare |
$693.97
|
| Rate for Payer: Priority Health SBD |
$1,278.55
|
| Rate for Payer: Priority Health Tiered Network |
$1,795.38
|
| Rate for Payer: Railroad Medicare Medicare |
$693.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,319.14
|
| Rate for Payer: UHC Core |
$1,057.34
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$693.97
|
| Rate for Payer: UHC Exchange |
$797.57
|
| Rate for Payer: UHC Medicaid |
$362.95
|
| Rate for Payer: UHCCP Medicaid |
$362.95
|
| Rate for Payer: UMR Bronson Commercial |
$750.90
|
| Rate for Payer: VA VA |
$693.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,522.09
|
|
|
HC HDR 1 CHANNEL
|
Facility
|
IP
|
$2,029.45
|
|
|
Service Code
|
CPT 77770
|
| Hospital Charge Code |
33300055
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$892.96 |
| Max. Negotiated Rate |
$1,826.51 |
| Rate for Payer: Aetna American Axle |
$1,319.14
|
| Rate for Payer: Aetna Commercial |
$1,725.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,319.14
|
| Rate for Payer: Cash Price |
$1,623.56
|
| Rate for Payer: Cofinity Advantage |
$1,420.62
|
| Rate for Payer: Cofinity Commercial |
$1,745.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,623.56
|
| Rate for Payer: Healthscope Commercial |
$1,826.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,420.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,522.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,725.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,522.09
|
| Rate for Payer: PHP Commercial |
$1,725.03
|
| Rate for Payer: Priority Health SBD |
$1,278.55
|
| Rate for Payer: UMR Bronson Commercial |
$892.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,522.09
|
|
|
HC HDR 2-12 CHANNELS
|
Facility
|
IP
|
$2,254.25
|
|
|
Service Code
|
CPT 77771
|
| Hospital Charge Code |
33300056
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$991.87 |
| Max. Negotiated Rate |
$2,028.83 |
| Rate for Payer: Aetna American Axle |
$1,465.26
|
| Rate for Payer: Aetna Commercial |
$1,916.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,465.26
|
| Rate for Payer: Cash Price |
$1,803.40
|
| Rate for Payer: Cofinity Advantage |
$1,577.97
|
| Rate for Payer: Cofinity Commercial |
$1,938.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,803.40
|
| Rate for Payer: Healthscope Commercial |
$2,028.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,577.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,690.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,916.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,690.69
|
| Rate for Payer: PHP Commercial |
$1,916.11
|
| Rate for Payer: Priority Health SBD |
$1,420.18
|
| Rate for Payer: UMR Bronson Commercial |
$991.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,690.69
|
|
|
HC HDR 2-12 CHANNELS
|
Facility
|
OP
|
$2,254.25
|
|
|
Service Code
|
CPT 77771
|
| Hospital Charge Code |
33300056
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$362.95 |
| Max. Negotiated Rate |
$2,244.23 |
| Rate for Payer: Aetna American Axle |
$1,465.26
|
| Rate for Payer: Aetna Commercial |
$1,916.11
|
| Rate for Payer: Aetna Medicare |
$721.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,465.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$867.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$867.46
|
| Rate for Payer: BCBS Complete |
$381.13
|
| Rate for Payer: BCBS MAPPO |
$693.97
|
| Rate for Payer: BCBS Trust/PPO |
$833.42
|
| Rate for Payer: BCN Commercial |
$833.42
|
| Rate for Payer: BCN Medicare Advantage |
$693.97
|
| Rate for Payer: Cash Price |
$1,803.40
|
| Rate for Payer: Cash Price |
$1,803.40
|
| Rate for Payer: Cash Price |
$1,803.40
|
| Rate for Payer: Cofinity Advantage |
$1,577.97
|
| Rate for Payer: Cofinity Commercial |
$1,938.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,803.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$693.97
|
| Rate for Payer: Healthscope Commercial |
$2,028.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,577.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,690.69
|
| Rate for Payer: Mclaren Medicaid |
$693.97
|
| Rate for Payer: Mclaren Medicare |
$693.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$728.67
|
| Rate for Payer: Meridian Medicaid |
$728.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$798.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$763.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,916.11
|
| Rate for Payer: Nomi Health Commercial |
$2,081.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,690.69
|
| Rate for Payer: PACE Medicare |
$659.27
|
| Rate for Payer: PACE SWMI |
$693.97
|
| Rate for Payer: PHP Commercial |
$1,916.11
|
| Rate for Payer: PHP Medicare Advantage |
$693.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$362.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,244.23
|
| Rate for Payer: Priority Health Medicare |
$693.97
|
| Rate for Payer: Priority Health SBD |
$1,420.18
|
| Rate for Payer: Priority Health Tiered Network |
$1,795.38
|
| Rate for Payer: Railroad Medicare Medicare |
$693.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,465.26
|
| Rate for Payer: UHC Core |
$1,174.46
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$693.97
|
| Rate for Payer: UHC Exchange |
$885.92
|
| Rate for Payer: UHC Medicaid |
$362.95
|
| Rate for Payer: UHCCP Medicaid |
$362.95
|
| Rate for Payer: UMR Bronson Commercial |
$834.07
|
| Rate for Payer: VA VA |
$693.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,690.69
|
|
|
HC HDR IR 192 BRACHY SOURCE NSTRD
|
Facility
|
IP
|
$573.66
|
|
|
Service Code
|
HCPCS C1717
|
| Hospital Charge Code |
27800090
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$252.41 |
| Max. Negotiated Rate |
$516.29 |
| Rate for Payer: Aetna American Axle |
$372.88
|
| Rate for Payer: Aetna Commercial |
$487.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$372.88
|
| Rate for Payer: Cash Price |
$458.93
|
| Rate for Payer: Cofinity Advantage |
$401.56
|
| Rate for Payer: Cofinity Commercial |
$493.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$458.93
|
| Rate for Payer: Healthscope Commercial |
$516.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$401.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$430.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$487.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$430.25
|
| Rate for Payer: PHP Commercial |
$487.61
|
| Rate for Payer: Priority Health SBD |
$361.41
|
| Rate for Payer: UMR Bronson Commercial |
$252.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$430.25
|
|
|
HC HDR IR 192 BRACHY SOURCE NSTRD
|
Facility
|
OP
|
$573.66
|
|
|
Service Code
|
HCPCS C1717
|
| Hospital Charge Code |
27800090
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$182.34 |
| Max. Negotiated Rate |
$1,127.50 |
| Rate for Payer: Aetna American Axle |
$372.88
|
| Rate for Payer: Aetna Commercial |
$487.61
|
| Rate for Payer: Aetna Medicare |
$362.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$372.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$435.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$435.81
|
| Rate for Payer: BCBS Complete |
$191.48
|
| Rate for Payer: BCBS MAPPO |
$348.65
|
| Rate for Payer: BCN Medicare Advantage |
$348.65
|
| Rate for Payer: Cash Price |
$458.93
|
| Rate for Payer: Cash Price |
$458.93
|
| Rate for Payer: Cofinity Advantage |
$401.56
|
| Rate for Payer: Cofinity Commercial |
$493.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$458.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$348.65
|
| Rate for Payer: Healthscope Commercial |
$516.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$401.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$430.25
|
| Rate for Payer: Mclaren Medicaid |
$348.65
|
| Rate for Payer: Mclaren Medicare |
$348.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$366.08
|
| Rate for Payer: Meridian Medicaid |
$366.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$400.95
|
| Rate for Payer: Molina Medicare/Medicaid |
$383.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$487.61
|
| Rate for Payer: Nomi Health Commercial |
$1,045.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$430.25
|
| Rate for Payer: PACE Medicare |
$331.22
|
| Rate for Payer: PACE SWMI |
$348.65
|
| Rate for Payer: PHP Commercial |
$487.61
|
| Rate for Payer: PHP Medicare Advantage |
$348.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$182.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,127.50
|
| Rate for Payer: Priority Health Medicare |
$348.65
|
| Rate for Payer: Priority Health SBD |
$361.41
|
| Rate for Payer: Priority Health Tiered Network |
$902.00
|
| Rate for Payer: Railroad Medicare Medicare |
$348.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$372.88
|
| Rate for Payer: UHC Core |
$298.88
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$348.65
|
| Rate for Payer: UHC Exchange |
$225.45
|
| Rate for Payer: UHC Medicaid |
$182.34
|
| Rate for Payer: UHCCP Medicaid |
$182.34
|
| Rate for Payer: UMR Bronson Commercial |
$212.25
|
| Rate for Payer: VA VA |
$348.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$430.25
|
|
|
HC HDR OVER 12 CHANNELS
|
Facility
|
OP
|
$2,487.67
|
|
|
Service Code
|
CPT 77772
|
| Hospital Charge Code |
33300057
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$362.95 |
| Max. Negotiated Rate |
$2,244.23 |
| Rate for Payer: Aetna American Axle |
$1,616.99
|
| Rate for Payer: Aetna Commercial |
$2,114.52
|
| Rate for Payer: Aetna Medicare |
$721.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,616.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$867.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$867.46
|
| Rate for Payer: BCBS Complete |
$381.13
|
| Rate for Payer: BCBS MAPPO |
$693.97
|
| Rate for Payer: BCBS Trust/PPO |
$833.42
|
| Rate for Payer: BCN Commercial |
$833.42
|
| Rate for Payer: BCN Medicare Advantage |
$693.97
|
| Rate for Payer: Cash Price |
$1,990.14
|
| Rate for Payer: Cash Price |
$1,990.14
|
| Rate for Payer: Cash Price |
$1,990.14
|
| Rate for Payer: Cofinity Advantage |
$1,741.37
|
| Rate for Payer: Cofinity Commercial |
$2,139.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,990.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$693.97
|
| Rate for Payer: Healthscope Commercial |
$2,238.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,741.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,865.75
|
| Rate for Payer: Mclaren Medicaid |
$693.97
|
| Rate for Payer: Mclaren Medicare |
$693.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$728.67
|
| Rate for Payer: Meridian Medicaid |
$728.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$798.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$763.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,114.52
|
| Rate for Payer: Nomi Health Commercial |
$2,081.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,865.75
|
| Rate for Payer: PACE Medicare |
$659.27
|
| Rate for Payer: PACE SWMI |
$693.97
|
| Rate for Payer: PHP Commercial |
$2,114.52
|
| Rate for Payer: PHP Medicare Advantage |
$693.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$362.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,244.23
|
| Rate for Payer: Priority Health Medicare |
$693.97
|
| Rate for Payer: Priority Health SBD |
$1,567.23
|
| Rate for Payer: Priority Health Tiered Network |
$1,795.38
|
| Rate for Payer: Railroad Medicare Medicare |
$693.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,616.99
|
| Rate for Payer: UHC Core |
$1,296.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$693.97
|
| Rate for Payer: UHC Exchange |
$977.65
|
| Rate for Payer: UHC Medicaid |
$362.95
|
| Rate for Payer: UHCCP Medicaid |
$362.95
|
| Rate for Payer: UMR Bronson Commercial |
$920.44
|
| Rate for Payer: VA VA |
$693.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,865.75
|
|
|
HC HDR OVER 12 CHANNELS
|
Facility
|
IP
|
$2,487.67
|
|
|
Service Code
|
CPT 77772
|
| Hospital Charge Code |
33300057
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,094.57 |
| Max. Negotiated Rate |
$2,238.90 |
| Rate for Payer: Aetna American Axle |
$1,616.99
|
| Rate for Payer: Aetna Commercial |
$2,114.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,616.99
|
| Rate for Payer: Cash Price |
$1,990.14
|
| Rate for Payer: Cofinity Advantage |
$1,741.37
|
| Rate for Payer: Cofinity Commercial |
$2,139.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,990.14
|
| Rate for Payer: Healthscope Commercial |
$2,238.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,741.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,865.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,114.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,865.75
|
| Rate for Payer: PHP Commercial |
$2,114.52
|
| Rate for Payer: Priority Health SBD |
$1,567.23
|
| Rate for Payer: UMR Bronson Commercial |
$1,094.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,865.75
|
|
|
HC HDR SKIN SURFACE 1 CHANNEL
|
Facility
|
IP
|
$491.40
|
|
|
Service Code
|
CPT 77767
|
| Hospital Charge Code |
33300053
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$216.22 |
| Max. Negotiated Rate |
$442.26 |
| Rate for Payer: Aetna American Axle |
$319.41
|
| Rate for Payer: Aetna Commercial |
$417.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$319.41
|
| Rate for Payer: Cash Price |
$393.12
|
| Rate for Payer: Cofinity Advantage |
$343.98
|
| Rate for Payer: Cofinity Commercial |
$422.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$393.12
|
| Rate for Payer: Healthscope Commercial |
$442.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$343.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$368.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$417.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$368.55
|
| Rate for Payer: PHP Commercial |
$417.69
|
| Rate for Payer: Priority Health SBD |
$309.58
|
| Rate for Payer: UMR Bronson Commercial |
$216.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$368.55
|
|
|
HC HDR SKIN SURFACE 1 CHANNEL
|
Facility
|
OP
|
$491.40
|
|
|
Service Code
|
CPT 77767
|
| Hospital Charge Code |
33300053
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$181.82 |
| Max. Negotiated Rate |
$1,242.83 |
| Rate for Payer: Aetna American Axle |
$319.41
|
| Rate for Payer: Aetna Commercial |
$417.69
|
| Rate for Payer: Aetna Medicare |
$399.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$319.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$480.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$480.39
|
| Rate for Payer: BCBS Complete |
$211.06
|
| Rate for Payer: BCBS MAPPO |
$384.31
|
| Rate for Payer: BCBS Trust/PPO |
$230.76
|
| Rate for Payer: BCN Commercial |
$230.76
|
| Rate for Payer: BCN Medicare Advantage |
$384.31
|
| Rate for Payer: Cash Price |
$393.12
|
| Rate for Payer: Cash Price |
$393.12
|
| Rate for Payer: Cash Price |
$393.12
|
| Rate for Payer: Cofinity Advantage |
$343.98
|
| Rate for Payer: Cofinity Commercial |
$422.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$393.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$384.31
|
| Rate for Payer: Healthscope Commercial |
$442.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$343.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$368.55
|
| Rate for Payer: Mclaren Medicaid |
$384.31
|
| Rate for Payer: Mclaren Medicare |
$384.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$403.53
|
| Rate for Payer: Meridian Medicaid |
$403.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$441.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$422.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$417.69
|
| Rate for Payer: Nomi Health Commercial |
$1,152.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$368.55
|
| Rate for Payer: PACE Medicare |
$365.09
|
| Rate for Payer: PACE SWMI |
$384.31
|
| Rate for Payer: PHP Commercial |
$417.69
|
| Rate for Payer: PHP Medicare Advantage |
$384.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$200.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,242.83
|
| Rate for Payer: Priority Health Medicare |
$384.31
|
| Rate for Payer: Priority Health SBD |
$309.58
|
| Rate for Payer: Priority Health Tiered Network |
$994.26
|
| Rate for Payer: Railroad Medicare Medicare |
$384.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$319.41
|
| Rate for Payer: UHC Core |
$256.02
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$384.31
|
| Rate for Payer: UHC Exchange |
$193.12
|
| Rate for Payer: UHC Medicaid |
$200.99
|
| Rate for Payer: UHCCP Medicaid |
$200.99
|
| Rate for Payer: UMR Bronson Commercial |
$181.82
|
| Rate for Payer: VA VA |
$384.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$368.55
|
|
|
HC HDR SKIN SURFACE 2 OR MORE CHANNELS
|
Facility
|
IP
|
$552.83
|
|
|
Service Code
|
CPT 77768
|
| Hospital Charge Code |
33300054
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$243.25 |
| Max. Negotiated Rate |
$497.55 |
| Rate for Payer: Aetna American Axle |
$359.34
|
| Rate for Payer: Aetna Commercial |
$469.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$359.34
|
| Rate for Payer: Cash Price |
$442.26
|
| Rate for Payer: Cofinity Advantage |
$386.98
|
| Rate for Payer: Cofinity Commercial |
$475.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$442.26
|
| Rate for Payer: Healthscope Commercial |
$497.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$386.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$414.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$469.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$414.62
|
| Rate for Payer: PHP Commercial |
$469.91
|
| Rate for Payer: Priority Health SBD |
$348.28
|
| Rate for Payer: UMR Bronson Commercial |
$243.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$414.62
|
|
|
HC HDR SKIN SURFACE 2 OR MORE CHANNELS
|
Facility
|
OP
|
$552.83
|
|
|
Service Code
|
CPT 77768
|
| Hospital Charge Code |
33300054
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$200.99 |
| Max. Negotiated Rate |
$1,242.83 |
| Rate for Payer: Aetna American Axle |
$359.34
|
| Rate for Payer: Aetna Commercial |
$469.91
|
| Rate for Payer: Aetna Medicare |
$399.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$359.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$480.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$480.39
|
| Rate for Payer: BCBS Complete |
$211.06
|
| Rate for Payer: BCBS MAPPO |
$384.31
|
| Rate for Payer: BCBS Trust/PPO |
$230.76
|
| Rate for Payer: BCN Commercial |
$230.76
|
| Rate for Payer: BCN Medicare Advantage |
$384.31
|
| Rate for Payer: Cash Price |
$442.26
|
| Rate for Payer: Cash Price |
$442.26
|
| Rate for Payer: Cash Price |
$442.26
|
| Rate for Payer: Cofinity Advantage |
$386.98
|
| Rate for Payer: Cofinity Commercial |
$475.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$442.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$384.31
|
| Rate for Payer: Healthscope Commercial |
$497.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$386.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$414.62
|
| Rate for Payer: Mclaren Medicaid |
$384.31
|
| Rate for Payer: Mclaren Medicare |
$384.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$403.53
|
| Rate for Payer: Meridian Medicaid |
$403.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$441.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$422.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$469.91
|
| Rate for Payer: Nomi Health Commercial |
$1,152.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$414.62
|
| Rate for Payer: PACE Medicare |
$365.09
|
| Rate for Payer: PACE SWMI |
$384.31
|
| Rate for Payer: PHP Commercial |
$469.91
|
| Rate for Payer: PHP Medicare Advantage |
$384.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$200.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,242.83
|
| Rate for Payer: Priority Health Medicare |
$384.31
|
| Rate for Payer: Priority Health SBD |
$348.28
|
| Rate for Payer: Priority Health Tiered Network |
$994.26
|
| Rate for Payer: Railroad Medicare Medicare |
$384.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$359.34
|
| Rate for Payer: UHC Core |
$288.02
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$384.31
|
| Rate for Payer: UHC Exchange |
$217.26
|
| Rate for Payer: UHC Medicaid |
$200.99
|
| Rate for Payer: UHCCP Medicaid |
$200.99
|
| Rate for Payer: UMR Bronson Commercial |
$204.55
|
| Rate for Payer: VA VA |
$384.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$414.62
|
|
|
HC HEALTH & BEHAV ASSESS OR REASSESS
|
Facility
|
IP
|
$125.23
|
|
|
Service Code
|
CPT 96156
|
| Hospital Charge Code |
91400009
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$55.10 |
| Max. Negotiated Rate |
$112.71 |
| Rate for Payer: Aetna American Axle |
$81.40
|
| Rate for Payer: Aetna Commercial |
$106.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.40
|
| Rate for Payer: Cash Price |
$100.18
|
| Rate for Payer: Cofinity Advantage |
$87.66
|
| Rate for Payer: Cofinity Commercial |
$107.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.18
|
| Rate for Payer: Healthscope Commercial |
$112.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$87.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.92
|
| Rate for Payer: PHP Commercial |
$106.45
|
| Rate for Payer: Priority Health SBD |
$78.89
|
| Rate for Payer: UMR Bronson Commercial |
$55.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.92
|
|
|
HC HEALTH & BEHAV ASSESS OR REASSESS
|
Facility
|
OP
|
$125.23
|
|
|
Service Code
|
CPT 96156
|
| Hospital Charge Code |
91400009
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$46.34 |
| Max. Negotiated Rate |
$327.36 |
| Rate for Payer: Aetna American Axle |
$81.40
|
| Rate for Payer: Aetna Commercial |
$106.45
|
| Rate for Payer: Aetna Medicare |
$105.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$126.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$126.53
|
| Rate for Payer: BCBS Complete |
$55.59
|
| Rate for Payer: BCBS MAPPO |
$101.22
|
| Rate for Payer: BCN Medicare Advantage |
$101.22
|
| Rate for Payer: Cash Price |
$100.18
|
| Rate for Payer: Cash Price |
$100.18
|
| Rate for Payer: Cofinity Advantage |
$87.66
|
| Rate for Payer: Cofinity Commercial |
$107.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.22
|
| Rate for Payer: Healthscope Commercial |
$112.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$87.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.92
|
| Rate for Payer: Mclaren Medicaid |
$101.22
|
| Rate for Payer: Mclaren Medicare |
$101.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$106.28
|
| Rate for Payer: Meridian Medicaid |
$106.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$116.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$111.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.45
|
| Rate for Payer: Nomi Health Commercial |
$303.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.92
|
| Rate for Payer: PACE Medicare |
$96.16
|
| Rate for Payer: PACE SWMI |
$101.22
|
| Rate for Payer: PHP Commercial |
$106.45
|
| Rate for Payer: PHP Medicare Advantage |
$101.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$52.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$327.36
|
| Rate for Payer: Priority Health Medicare |
$101.22
|
| Rate for Payer: Priority Health SBD |
$78.89
|
| Rate for Payer: Priority Health Tiered Network |
$261.89
|
| Rate for Payer: Railroad Medicare Medicare |
$101.22
|
| Rate for Payer: UHC Medicaid |
$52.94
|
| Rate for Payer: UHCCP Medicaid |
$52.94
|
| Rate for Payer: UMR Bronson Commercial |
$46.34
|
| Rate for Payer: VA VA |
$101.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.92
|
|
|
HC HEALTH & BEHAV INTERVENT INDIV EA ADD 15 MIN
|
Facility
|
OP
|
$62.61
|
|
|
Service Code
|
CPT 96159
|
| Hospital Charge Code |
91400011
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$23.17 |
| Max. Negotiated Rate |
$56.35 |
| Rate for Payer: Aetna American Axle |
$40.70
|
| Rate for Payer: Aetna Commercial |
$53.22
|
| Rate for Payer: Aetna Medicare |
$31.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.70
|
| Rate for Payer: BCBS Complete |
$25.04
|
| Rate for Payer: Cash Price |
$50.09
|
| Rate for Payer: Cofinity Advantage |
$43.83
|
| Rate for Payer: Cofinity Commercial |
$53.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.09
|
| Rate for Payer: Healthscope Commercial |
$56.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.96
|
| Rate for Payer: PHP Commercial |
$53.22
|
| Rate for Payer: Priority Health SBD |
$39.44
|
| Rate for Payer: UMR Bronson Commercial |
$23.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.96
|
|
|
HC HEALTH & BEHAV INTERVENT INDIV EA ADD 15 MIN
|
Facility
|
IP
|
$62.61
|
|
|
Service Code
|
CPT 96159
|
| Hospital Charge Code |
91400011
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$27.55 |
| Max. Negotiated Rate |
$56.35 |
| Rate for Payer: Aetna American Axle |
$40.70
|
| Rate for Payer: Aetna Commercial |
$53.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.70
|
| Rate for Payer: Cash Price |
$50.09
|
| Rate for Payer: Cofinity Advantage |
$43.83
|
| Rate for Payer: Cofinity Commercial |
$53.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.09
|
| Rate for Payer: Healthscope Commercial |
$56.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.96
|
| Rate for Payer: PHP Commercial |
$53.22
|
| Rate for Payer: Priority Health SBD |
$39.44
|
| Rate for Payer: UMR Bronson Commercial |
$27.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.96
|
|
|
HC HEALTH & BEHAV INTERVENT INDIV INIT 30 MIN
|
Facility
|
IP
|
$125.23
|
|
|
Service Code
|
CPT 96158
|
| Hospital Charge Code |
91400010
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$55.10 |
| Max. Negotiated Rate |
$112.71 |
| Rate for Payer: Aetna American Axle |
$81.40
|
| Rate for Payer: Aetna Commercial |
$106.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.40
|
| Rate for Payer: Cash Price |
$100.18
|
| Rate for Payer: Cofinity Advantage |
$87.66
|
| Rate for Payer: Cofinity Commercial |
$107.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.18
|
| Rate for Payer: Healthscope Commercial |
$112.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$87.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.92
|
| Rate for Payer: PHP Commercial |
$106.45
|
| Rate for Payer: Priority Health SBD |
$78.89
|
| Rate for Payer: UMR Bronson Commercial |
$55.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.92
|
|
|
HC HEALTH & BEHAV INTERVENT INDIV INIT 30 MIN
|
Facility
|
OP
|
$125.23
|
|
|
Service Code
|
CPT 96158
|
| Hospital Charge Code |
91400010
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$46.34 |
| Max. Negotiated Rate |
$571.94 |
| Rate for Payer: Aetna American Axle |
$81.40
|
| Rate for Payer: Aetna Commercial |
$106.45
|
| Rate for Payer: Aetna Medicare |
$183.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$221.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$221.07
|
| Rate for Payer: BCBS Complete |
$97.13
|
| Rate for Payer: BCBS MAPPO |
$176.86
|
| Rate for Payer: BCN Medicare Advantage |
$176.86
|
| Rate for Payer: Cash Price |
$100.18
|
| Rate for Payer: Cash Price |
$100.18
|
| Rate for Payer: Cofinity Advantage |
$87.66
|
| Rate for Payer: Cofinity Commercial |
$107.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$176.86
|
| Rate for Payer: Healthscope Commercial |
$112.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$87.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.92
|
| Rate for Payer: Mclaren Medicaid |
$176.86
|
| Rate for Payer: Mclaren Medicare |
$176.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$185.70
|
| Rate for Payer: Meridian Medicaid |
$185.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$203.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$194.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.45
|
| Rate for Payer: Nomi Health Commercial |
$530.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.92
|
| Rate for Payer: PACE Medicare |
$168.02
|
| Rate for Payer: PACE SWMI |
$176.86
|
| Rate for Payer: PHP Commercial |
$106.45
|
| Rate for Payer: PHP Medicare Advantage |
$176.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$92.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$571.94
|
| Rate for Payer: Priority Health Medicare |
$176.86
|
| Rate for Payer: Priority Health SBD |
$78.89
|
| Rate for Payer: Priority Health Tiered Network |
$457.55
|
| Rate for Payer: Railroad Medicare Medicare |
$176.86
|
| Rate for Payer: UHC Medicaid |
$92.50
|
| Rate for Payer: UHCCP Medicaid |
$92.50
|
| Rate for Payer: UMR Bronson Commercial |
$46.34
|
| Rate for Payer: VA VA |
$176.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.92
|
|
|
HC HEARING AID CHECK BINAURAL
|
Facility
|
IP
|
$62.42
|
|
|
Service Code
|
CPT 92593
|
| Hospital Charge Code |
76100499
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$27.46 |
| Max. Negotiated Rate |
$56.18 |
| Rate for Payer: Aetna American Axle |
$40.57
|
| Rate for Payer: Aetna Commercial |
$53.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.57
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cofinity Advantage |
$43.69
|
| Rate for Payer: Cofinity Commercial |
$53.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.94
|
| Rate for Payer: Healthscope Commercial |
$56.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.81
|
| Rate for Payer: PHP Commercial |
$53.06
|
| Rate for Payer: Priority Health SBD |
$39.32
|
| Rate for Payer: UMR Bronson Commercial |
$27.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.81
|
|
|
HC HEARING AID CHECK BINAURAL
|
Facility
|
OP
|
$62.42
|
|
|
Service Code
|
CPT 92593
|
| Hospital Charge Code |
76100499
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$23.10 |
| Max. Negotiated Rate |
$56.18 |
| Rate for Payer: Aetna American Axle |
$40.57
|
| Rate for Payer: Aetna Commercial |
$53.06
|
| Rate for Payer: Aetna Medicare |
$31.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.57
|
| Rate for Payer: BCBS Complete |
$24.97
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cofinity Advantage |
$43.69
|
| Rate for Payer: Cofinity Commercial |
$53.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.94
|
| Rate for Payer: Healthscope Commercial |
$56.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$49.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.81
|
| Rate for Payer: PHP Commercial |
$53.06
|
| Rate for Payer: Priority Health SBD |
$39.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.57
|
| Rate for Payer: UHC Core |
$32.52
|
| Rate for Payer: UHC Exchange |
$24.53
|
| Rate for Payer: UMR Bronson Commercial |
$23.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.81
|
|
