|
HC E- STIM ATTENDED PER 15 MIN
|
Facility
|
IP
|
$106.12
|
|
|
Service Code
|
CPT 97032
|
| Hospital Charge Code |
42000014
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$46.69 |
| Max. Negotiated Rate |
$95.51 |
| Rate for Payer: Aetna American Axle |
$68.98
|
| Rate for Payer: Aetna Commercial |
$90.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.98
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cofinity Commercial |
$74.28
|
| Rate for Payer: Cofinity Commercial |
$91.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$74.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.90
|
| Rate for Payer: Healthscope Commercial |
$95.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$74.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.20
|
| Rate for Payer: PHP Commercial |
$90.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.98
|
| Rate for Payer: Priority Health SBD |
$66.86
|
| Rate for Payer: UMR Bronson Commercial |
$46.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.59
|
|
|
HC E- STIM ATTENDED PER 15 MIN
|
Facility
|
OP
|
$106.12
|
|
|
Service Code
|
CPT 97032
|
| Hospital Charge Code |
42000014
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$39.26 |
| Max. Negotiated Rate |
$294.00 |
| Rate for Payer: Aetna American Axle |
$68.98
|
| Rate for Payer: Aetna Commercial |
$90.20
|
| Rate for Payer: Aetna Medicare |
$53.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.98
|
| Rate for Payer: BCBS Complete |
$42.45
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cofinity Commercial |
$91.26
|
| Rate for Payer: Cofinity Commercial |
$74.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$74.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.90
|
| Rate for Payer: Healthscope Commercial |
$95.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$74.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.20
|
| Rate for Payer: Nomi Health Commercial |
$135.00
|
| Rate for Payer: PHP Commercial |
$90.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.98
|
| Rate for Payer: Priority Health SBD |
$66.86
|
| Rate for Payer: UHC Core |
$294.00
|
| Rate for Payer: UMR Bronson Commercial |
$39.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.59
|
|
|
HC ESTRADIAL, MASS SPEC, S
|
Facility
|
IP
|
$55.08
|
|
|
Service Code
|
CPT 82670
|
| Hospital Charge Code |
30100737
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.24 |
| Max. Negotiated Rate |
$49.57 |
| Rate for Payer: Aetna American Axle |
$35.80
|
| Rate for Payer: Aetna Commercial |
$46.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.80
|
| Rate for Payer: Cash Price |
$44.06
|
| Rate for Payer: Cofinity Commercial |
$38.56
|
| Rate for Payer: Cofinity Commercial |
$47.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$38.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.06
|
| Rate for Payer: Healthscope Commercial |
$49.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$38.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.82
|
| Rate for Payer: PHP Commercial |
$46.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.80
|
| Rate for Payer: Priority Health SBD |
$34.70
|
| Rate for Payer: UMR Bronson Commercial |
$24.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.31
|
|
|
HC ESTRADIAL, MASS SPEC, S
|
Facility
|
OP
|
$55.08
|
|
|
Service Code
|
CPT 82670
|
| Hospital Charge Code |
30100737
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.98 |
| Max. Negotiated Rate |
$78.65 |
| Rate for Payer: Aetna American Axle |
$35.80
|
| Rate for Payer: Aetna Commercial |
$46.82
|
| Rate for Payer: Aetna Medicare |
$29.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.92
|
| Rate for Payer: BCBS Complete |
$15.72
|
| Rate for Payer: BCBS MAPPO |
$27.94
|
| Rate for Payer: BCN Medicare Advantage |
$27.94
|
| Rate for Payer: Cash Price |
$44.06
|
| Rate for Payer: Cash Price |
$44.06
|
| Rate for Payer: Cofinity Commercial |
$47.37
|
| Rate for Payer: Cofinity Commercial |
$38.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$38.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.94
|
| Rate for Payer: Healthscope Commercial |
$49.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$38.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.31
|
| Rate for Payer: Mclaren Medicaid |
$14.98
|
| Rate for Payer: Mclaren Medicare |
$27.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.34
|
| Rate for Payer: Meridian Medicaid |
$15.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.82
|
| Rate for Payer: PACE Medicare |
$26.54
|
| Rate for Payer: PACE SWMI |
$27.94
|
| Rate for Payer: PHP Commercial |
$46.82
|
| Rate for Payer: PHP Medicare Advantage |
$27.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.80
|
| Rate for Payer: Priority Health Medicare |
$27.94
|
| Rate for Payer: Priority Health SBD |
$34.70
|
| Rate for Payer: Railroad Medicare Medicare |
$27.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.94
|
| Rate for Payer: UHC Exchange |
$53.40
|
| Rate for Payer: UHC Medicare Advantage |
$27.94
|
| Rate for Payer: UHCCP Medicaid |
$14.98
|
| Rate for Payer: UMR Bronson Commercial |
$20.38
|
| Rate for Payer: VA VA |
$27.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.31
|
|
|
HC ESTRADIOL LEVEL
|
Facility
|
OP
|
$78.03
|
|
|
Service Code
|
CPT 82670
|
| Hospital Charge Code |
30100192
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.98 |
| Max. Negotiated Rate |
$78.65 |
| Rate for Payer: Aetna American Axle |
$50.72
|
| Rate for Payer: Aetna Commercial |
$66.33
|
| Rate for Payer: Aetna Medicare |
$29.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.92
|
| Rate for Payer: BCBS Complete |
$15.72
|
| Rate for Payer: BCBS MAPPO |
$27.94
|
| Rate for Payer: BCN Medicare Advantage |
$27.94
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cofinity Commercial |
$67.11
|
| Rate for Payer: Cofinity Commercial |
$54.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$54.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.94
|
| Rate for Payer: Healthscope Commercial |
$70.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$54.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.52
|
| Rate for Payer: Mclaren Medicaid |
$14.98
|
| Rate for Payer: Mclaren Medicare |
$27.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.34
|
| Rate for Payer: Meridian Medicaid |
$15.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.33
|
| Rate for Payer: PACE Medicare |
$26.54
|
| Rate for Payer: PACE SWMI |
$27.94
|
| Rate for Payer: PHP Commercial |
$66.33
|
| Rate for Payer: PHP Medicare Advantage |
$27.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.72
|
| Rate for Payer: Priority Health Medicare |
$27.94
|
| Rate for Payer: Priority Health SBD |
$49.16
|
| Rate for Payer: Railroad Medicare Medicare |
$27.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.94
|
| Rate for Payer: UHC Exchange |
$53.40
|
| Rate for Payer: UHC Medicare Advantage |
$27.94
|
| Rate for Payer: UHCCP Medicaid |
$14.98
|
| Rate for Payer: UMR Bronson Commercial |
$28.87
|
| Rate for Payer: VA VA |
$27.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.52
|
|
|
HC ESTRADIOL LEVEL
|
Facility
|
IP
|
$78.03
|
|
|
Service Code
|
CPT 82670
|
| Hospital Charge Code |
30100192
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.33 |
| Max. Negotiated Rate |
$70.23 |
| Rate for Payer: Aetna American Axle |
$50.72
|
| Rate for Payer: Aetna Commercial |
$66.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.72
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cofinity Commercial |
$54.62
|
| Rate for Payer: Cofinity Commercial |
$67.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$54.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.42
|
| Rate for Payer: Healthscope Commercial |
$70.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$54.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.33
|
| Rate for Payer: PHP Commercial |
$66.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.72
|
| Rate for Payer: Priority Health SBD |
$49.16
|
| Rate for Payer: UMR Bronson Commercial |
$34.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.52
|
|
|
HC ESTRIOL
|
Facility
|
IP
|
$50.98
|
|
|
Service Code
|
CPT 82677
|
| Hospital Charge Code |
30100195
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.43 |
| Max. Negotiated Rate |
$45.88 |
| Rate for Payer: Aetna American Axle |
$33.14
|
| Rate for Payer: Aetna Commercial |
$43.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.14
|
| Rate for Payer: Cash Price |
$40.78
|
| Rate for Payer: Cofinity Commercial |
$35.69
|
| Rate for Payer: Cofinity Commercial |
$43.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.78
|
| Rate for Payer: Healthscope Commercial |
$45.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.33
|
| Rate for Payer: PHP Commercial |
$43.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.14
|
| Rate for Payer: Priority Health SBD |
$32.12
|
| Rate for Payer: UMR Bronson Commercial |
$22.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.23
|
|
|
HC ESTRIOL
|
Facility
|
OP
|
$50.98
|
|
|
Service Code
|
CPT 82677
|
| Hospital Charge Code |
30100195
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.96 |
| Max. Negotiated Rate |
$68.06 |
| Rate for Payer: Aetna American Axle |
$33.14
|
| Rate for Payer: Aetna Commercial |
$43.33
|
| Rate for Payer: Aetna Medicare |
$25.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.23
|
| Rate for Payer: BCBS Complete |
$13.61
|
| Rate for Payer: BCBS MAPPO |
$24.18
|
| Rate for Payer: BCN Medicare Advantage |
$24.18
|
| Rate for Payer: Cash Price |
$40.78
|
| Rate for Payer: Cash Price |
$40.78
|
| Rate for Payer: Cofinity Commercial |
$43.84
|
| Rate for Payer: Cofinity Commercial |
$35.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.18
|
| Rate for Payer: Healthscope Commercial |
$45.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.23
|
| Rate for Payer: Mclaren Medicaid |
$12.96
|
| Rate for Payer: Mclaren Medicare |
$24.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.39
|
| Rate for Payer: Meridian Medicaid |
$13.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.33
|
| Rate for Payer: PACE Medicare |
$22.97
|
| Rate for Payer: PACE SWMI |
$24.18
|
| Rate for Payer: PHP Commercial |
$43.33
|
| Rate for Payer: PHP Medicare Advantage |
$24.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.14
|
| Rate for Payer: Priority Health Medicare |
$24.18
|
| Rate for Payer: Priority Health SBD |
$32.12
|
| Rate for Payer: Railroad Medicare Medicare |
$24.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.18
|
| Rate for Payer: UHC Exchange |
$46.21
|
| Rate for Payer: UHC Medicare Advantage |
$24.18
|
| Rate for Payer: UHCCP Medicaid |
$12.96
|
| Rate for Payer: UMR Bronson Commercial |
$18.86
|
| Rate for Payer: VA VA |
$24.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.23
|
|
|
HC ESTROGEN RECEPTOR
|
Facility
|
OP
|
$118.19
|
|
|
Service Code
|
CPT 84233
|
| Hospital Charge Code |
30100416
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$43.73 |
| Max. Negotiated Rate |
$247.37 |
| Rate for Payer: Aetna American Axle |
$76.82
|
| Rate for Payer: Aetna Commercial |
$100.46
|
| Rate for Payer: Aetna Medicare |
$91.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$109.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$109.85
|
| Rate for Payer: BCBS Complete |
$49.46
|
| Rate for Payer: BCBS MAPPO |
$87.88
|
| Rate for Payer: BCN Medicare Advantage |
$87.88
|
| Rate for Payer: Cash Price |
$94.55
|
| Rate for Payer: Cash Price |
$94.55
|
| Rate for Payer: Cofinity Commercial |
$82.73
|
| Rate for Payer: Cofinity Commercial |
$101.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$82.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$87.88
|
| Rate for Payer: Healthscope Commercial |
$106.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$82.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$88.64
|
| Rate for Payer: Mclaren Medicaid |
$47.10
|
| Rate for Payer: Mclaren Medicare |
$87.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$92.27
|
| Rate for Payer: Meridian Medicaid |
$49.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$101.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100.46
|
| Rate for Payer: PACE Medicare |
$83.49
|
| Rate for Payer: PACE SWMI |
$87.88
|
| Rate for Payer: PHP Commercial |
$100.46
|
| Rate for Payer: PHP Medicare Advantage |
$87.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$47.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.82
|
| Rate for Payer: Priority Health Medicare |
$87.88
|
| Rate for Payer: Priority Health SBD |
$74.46
|
| Rate for Payer: Railroad Medicare Medicare |
$87.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$247.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$87.88
|
| Rate for Payer: UHC Exchange |
$167.95
|
| Rate for Payer: UHC Medicare Advantage |
$87.88
|
| Rate for Payer: UHCCP Medicaid |
$47.10
|
| Rate for Payer: UMR Bronson Commercial |
$43.73
|
| Rate for Payer: VA VA |
$87.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$88.64
|
|
|
HC ESTROGEN RECEPTOR
|
Facility
|
IP
|
$118.19
|
|
|
Service Code
|
CPT 84233
|
| Hospital Charge Code |
30100416
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$52.00 |
| Max. Negotiated Rate |
$106.37 |
| Rate for Payer: Aetna American Axle |
$76.82
|
| Rate for Payer: Aetna Commercial |
$100.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.82
|
| Rate for Payer: Cash Price |
$94.55
|
| Rate for Payer: Cofinity Commercial |
$101.64
|
| Rate for Payer: Cofinity Commercial |
$82.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$82.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.55
|
| Rate for Payer: Healthscope Commercial |
$106.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$82.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$88.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100.46
|
| Rate for Payer: PHP Commercial |
$100.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.82
|
| Rate for Payer: Priority Health SBD |
$74.46
|
| Rate for Payer: UMR Bronson Commercial |
$52.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$88.64
|
|
|
HC ESTROGEN RECEPTOR-PROGESTERONE
|
Facility
|
OP
|
$119.02
|
|
|
Service Code
|
CPT 84234
|
| Hospital Charge Code |
30100417
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.78 |
| Max. Negotiated Rate |
$182.63 |
| Rate for Payer: Aetna American Axle |
$77.36
|
| Rate for Payer: Aetna Commercial |
$101.17
|
| Rate for Payer: Aetna Medicare |
$67.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$81.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$81.10
|
| Rate for Payer: BCBS Complete |
$36.51
|
| Rate for Payer: BCBS MAPPO |
$64.88
|
| Rate for Payer: BCN Medicare Advantage |
$64.88
|
| Rate for Payer: Cash Price |
$95.22
|
| Rate for Payer: Cash Price |
$95.22
|
| Rate for Payer: Cofinity Commercial |
$83.31
|
| Rate for Payer: Cofinity Commercial |
$102.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$83.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$64.88
|
| Rate for Payer: Healthscope Commercial |
$107.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$83.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.27
|
| Rate for Payer: Mclaren Medicaid |
$34.78
|
| Rate for Payer: Mclaren Medicare |
$64.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$68.12
|
| Rate for Payer: Meridian Medicaid |
$36.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$74.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.17
|
| Rate for Payer: PACE Medicare |
$61.64
|
| Rate for Payer: PACE SWMI |
$64.88
|
| Rate for Payer: PHP Commercial |
$101.17
|
| Rate for Payer: PHP Medicare Advantage |
$64.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.36
|
| Rate for Payer: Priority Health Medicare |
$64.88
|
| Rate for Payer: Priority Health SBD |
$74.98
|
| Rate for Payer: Railroad Medicare Medicare |
$64.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$182.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$64.88
|
| Rate for Payer: UHC Exchange |
$123.99
|
| Rate for Payer: UHC Medicare Advantage |
$64.88
|
| Rate for Payer: UHCCP Medicaid |
$34.78
|
| Rate for Payer: UMR Bronson Commercial |
$44.04
|
| Rate for Payer: VA VA |
$64.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.27
|
|
|
HC ESTROGEN RECEPTOR-PROGESTERONE
|
Facility
|
IP
|
$119.02
|
|
|
Service Code
|
CPT 84234
|
| Hospital Charge Code |
30100417
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$52.37 |
| Max. Negotiated Rate |
$107.12 |
| Rate for Payer: Aetna American Axle |
$77.36
|
| Rate for Payer: Aetna Commercial |
$101.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.36
|
| Rate for Payer: Cash Price |
$95.22
|
| Rate for Payer: Cofinity Commercial |
$102.36
|
| Rate for Payer: Cofinity Commercial |
$83.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$83.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.22
|
| Rate for Payer: Healthscope Commercial |
$107.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$83.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.17
|
| Rate for Payer: PHP Commercial |
$101.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.36
|
| Rate for Payer: Priority Health SBD |
$74.98
|
| Rate for Payer: UMR Bronson Commercial |
$52.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.27
|
|
|
HC ESTRONE
|
Facility
|
OP
|
$66.59
|
|
|
Service Code
|
CPT 82679
|
| Hospital Charge Code |
30100196
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.37 |
| Max. Negotiated Rate |
$70.23 |
| Rate for Payer: Aetna American Axle |
$43.28
|
| Rate for Payer: Aetna Commercial |
$56.60
|
| Rate for Payer: Aetna Medicare |
$25.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.19
|
| Rate for Payer: BCBS Complete |
$14.04
|
| Rate for Payer: BCBS MAPPO |
$24.95
|
| Rate for Payer: BCN Medicare Advantage |
$24.95
|
| Rate for Payer: Cash Price |
$53.27
|
| Rate for Payer: Cash Price |
$53.27
|
| Rate for Payer: Cofinity Commercial |
$57.27
|
| Rate for Payer: Cofinity Commercial |
$46.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$46.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.95
|
| 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: Mclaren Medicaid |
$13.37
|
| Rate for Payer: Mclaren Medicare |
$24.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.20
|
| Rate for Payer: Meridian Medicaid |
$14.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.60
|
| Rate for Payer: PACE Medicare |
$23.70
|
| Rate for Payer: PACE SWMI |
$24.95
|
| Rate for Payer: PHP Commercial |
$56.60
|
| Rate for Payer: PHP Medicare Advantage |
$24.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.28
|
| Rate for Payer: Priority Health Medicare |
$24.95
|
| Rate for Payer: Priority Health SBD |
$41.95
|
| Rate for Payer: Railroad Medicare Medicare |
$24.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.95
|
| Rate for Payer: UHC Exchange |
$47.68
|
| Rate for Payer: UHC Medicare Advantage |
$24.95
|
| Rate for Payer: UHCCP Medicaid |
$13.37
|
| Rate for Payer: UMR Bronson Commercial |
$24.64
|
| Rate for Payer: VA VA |
$24.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.94
|
|
|
HC ESTRONE
|
Facility
|
IP
|
$66.59
|
|
|
Service Code
|
CPT 82679
|
| Hospital Charge Code |
30100196
|
|
Hospital Revenue Code
|
301
|
| 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 Commercial |
$46.61
|
| Rate for Payer: Cofinity Commercial |
$57.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$46.61
|
| 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: PHP Commercial |
$56.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.28
|
| 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 ETHANOL CONFIRM URINE
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
30100614
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$67.32 |
| Max. Negotiated Rate |
$137.70 |
| Rate for Payer: Aetna American Axle |
$99.45
|
| Rate for Payer: Aetna Commercial |
$130.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.45
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cofinity Commercial |
$107.10
|
| Rate for Payer: Cofinity Commercial |
$131.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$107.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.40
|
| Rate for Payer: Healthscope Commercial |
$137.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$107.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.05
|
| Rate for Payer: PHP Commercial |
$130.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
| Rate for Payer: Priority Health SBD |
$96.39
|
| Rate for Payer: UMR Bronson Commercial |
$67.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.75
|
|
|
HC ETHANOL CONFIRM URINE
|
Facility
|
OP
|
$153.00
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
30100614
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$56.61 |
| Max. Negotiated Rate |
$137.70 |
| Rate for Payer: Aetna American Axle |
$99.45
|
| Rate for Payer: Aetna Commercial |
$130.05
|
| Rate for Payer: Aetna Medicare |
$76.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.45
|
| Rate for Payer: BCBS Complete |
$61.20
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cofinity Commercial |
$107.10
|
| Rate for Payer: Cofinity Commercial |
$131.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$107.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.40
|
| Rate for Payer: Healthscope Commercial |
$137.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$107.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.05
|
| Rate for Payer: PHP Commercial |
$130.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
| Rate for Payer: Priority Health SBD |
$96.39
|
| Rate for Payer: UMR Bronson Commercial |
$56.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.75
|
|
|
HC ETHOSUXIMIDE/ZARONTIN LEVEL
|
Facility
|
OP
|
$57.12
|
|
|
Service Code
|
CPT 80168
|
| Hospital Charge Code |
30100029
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.76 |
| Max. Negotiated Rate |
$51.41 |
| Rate for Payer: Aetna American Axle |
$37.13
|
| Rate for Payer: Aetna Commercial |
$48.55
|
| Rate for Payer: Aetna Medicare |
$16.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.43
|
| Rate for Payer: BCBS Complete |
$9.20
|
| Rate for Payer: BCBS MAPPO |
$16.34
|
| Rate for Payer: BCN Medicare Advantage |
$16.34
|
| Rate for Payer: Cash Price |
$45.70
|
| Rate for Payer: Cash Price |
$45.70
|
| Rate for Payer: Cofinity Commercial |
$49.12
|
| Rate for Payer: Cofinity Commercial |
$39.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$39.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.34
|
| Rate for Payer: Healthscope Commercial |
$51.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.84
|
| Rate for Payer: Mclaren Medicaid |
$8.76
|
| Rate for Payer: Mclaren Medicare |
$16.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.16
|
| Rate for Payer: Meridian Medicaid |
$9.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.55
|
| Rate for Payer: PACE Medicare |
$15.52
|
| Rate for Payer: PACE SWMI |
$16.34
|
| Rate for Payer: PHP Commercial |
$48.55
|
| Rate for Payer: PHP Medicare Advantage |
$16.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.13
|
| Rate for Payer: Priority Health Medicare |
$16.34
|
| Rate for Payer: Priority Health SBD |
$35.99
|
| Rate for Payer: Railroad Medicare Medicare |
$16.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.34
|
| Rate for Payer: UHC Exchange |
$31.23
|
| Rate for Payer: UHC Medicare Advantage |
$16.34
|
| Rate for Payer: UHCCP Medicaid |
$8.76
|
| Rate for Payer: UMR Bronson Commercial |
$21.13
|
| Rate for Payer: VA VA |
$16.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.84
|
|
|
HC ETHOSUXIMIDE/ZARONTIN LEVEL
|
Facility
|
IP
|
$57.12
|
|
|
Service Code
|
CPT 80168
|
| Hospital Charge Code |
30100029
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.13 |
| Max. Negotiated Rate |
$51.41 |
| Rate for Payer: Aetna American Axle |
$37.13
|
| Rate for Payer: Aetna Commercial |
$48.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.13
|
| Rate for Payer: Cash Price |
$45.70
|
| Rate for Payer: Cofinity Commercial |
$39.98
|
| Rate for Payer: Cofinity Commercial |
$49.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$39.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.70
|
| Rate for Payer: Healthscope Commercial |
$51.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.55
|
| Rate for Payer: PHP Commercial |
$48.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.13
|
| Rate for Payer: Priority Health SBD |
$35.99
|
| Rate for Payer: UMR Bronson Commercial |
$25.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.84
|
|
|
HC ETHYLENE GLYCOL
|
Facility
|
OP
|
$164.22
|
|
|
Service Code
|
CPT 82693
|
| Hospital Charge Code |
30100197
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.99 |
| Max. Negotiated Rate |
$147.80 |
| Rate for Payer: Aetna American Axle |
$106.74
|
| Rate for Payer: Aetna Commercial |
$139.59
|
| Rate for Payer: Aetna Medicare |
$15.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.62
|
| Rate for Payer: BCBS Complete |
$8.39
|
| Rate for Payer: BCBS MAPPO |
$14.90
|
| Rate for Payer: BCN Medicare Advantage |
$14.90
|
| Rate for Payer: Cash Price |
$131.38
|
| Rate for Payer: Cash Price |
$131.38
|
| Rate for Payer: Cofinity Commercial |
$141.23
|
| Rate for Payer: Cofinity Commercial |
$114.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$114.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.90
|
| Rate for Payer: Healthscope Commercial |
$147.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$114.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.17
|
| Rate for Payer: Mclaren Medicaid |
$7.99
|
| Rate for Payer: Mclaren Medicare |
$14.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.64
|
| Rate for Payer: Meridian Medicaid |
$8.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.59
|
| Rate for Payer: PACE Medicare |
$14.15
|
| Rate for Payer: PACE SWMI |
$14.90
|
| Rate for Payer: PHP Commercial |
$139.59
|
| Rate for Payer: PHP Medicare Advantage |
$14.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.74
|
| Rate for Payer: Priority Health Medicare |
$14.90
|
| Rate for Payer: Priority Health SBD |
$103.46
|
| Rate for Payer: Railroad Medicare Medicare |
$14.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.90
|
| Rate for Payer: UHC Exchange |
$28.48
|
| Rate for Payer: UHC Medicare Advantage |
$14.90
|
| Rate for Payer: UHCCP Medicaid |
$7.99
|
| Rate for Payer: UMR Bronson Commercial |
$60.76
|
| Rate for Payer: VA VA |
$14.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.17
|
|
|
HC ETHYLENE GLYCOL
|
Facility
|
IP
|
$164.22
|
|
|
Service Code
|
CPT 82693
|
| Hospital Charge Code |
30100197
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$72.26 |
| Max. Negotiated Rate |
$147.80 |
| Rate for Payer: Aetna American Axle |
$106.74
|
| Rate for Payer: Aetna Commercial |
$139.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.74
|
| Rate for Payer: Cash Price |
$131.38
|
| Rate for Payer: Cofinity Commercial |
$114.95
|
| Rate for Payer: Cofinity Commercial |
$141.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$114.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.38
|
| Rate for Payer: Healthscope Commercial |
$147.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$114.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.59
|
| Rate for Payer: PHP Commercial |
$139.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.74
|
| Rate for Payer: Priority Health SBD |
$103.46
|
| Rate for Payer: UMR Bronson Commercial |
$72.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.17
|
|
|
HC ETHYL GLUCURONIDE SCREEN W/REFLEX, URINE
|
Facility
|
OP
|
$128.42
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100749
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.31 |
| Max. Negotiated Rate |
$174.92 |
| Rate for Payer: Aetna American Axle |
$83.47
|
| Rate for Payer: Aetna Commercial |
$109.16
|
| Rate for Payer: Aetna Medicare |
$64.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.67
|
| Rate for Payer: BCBS Complete |
$34.97
|
| Rate for Payer: BCBS MAPPO |
$62.14
|
| Rate for Payer: BCN Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$102.74
|
| Rate for Payer: Cash Price |
$102.74
|
| Rate for Payer: Cofinity Commercial |
$89.89
|
| Rate for Payer: Cofinity Commercial |
$110.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$89.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Healthscope Commercial |
$115.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$89.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.31
|
| Rate for Payer: Mclaren Medicaid |
$33.31
|
| Rate for Payer: Mclaren Medicare |
$62.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.25
|
| Rate for Payer: Meridian Medicaid |
$34.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.16
|
| Rate for Payer: PACE Medicare |
$59.03
|
| Rate for Payer: PACE SWMI |
$62.14
|
| Rate for Payer: PHP Commercial |
$109.16
|
| Rate for Payer: PHP Medicare Advantage |
$62.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.47
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: Priority Health SBD |
$80.90
|
| Rate for Payer: Railroad Medicare Medicare |
$62.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$174.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.14
|
| Rate for Payer: UHC Exchange |
$118.76
|
| Rate for Payer: UHC Medicare Advantage |
$62.14
|
| Rate for Payer: UHCCP Medicaid |
$33.31
|
| Rate for Payer: UMR Bronson Commercial |
$47.52
|
| Rate for Payer: VA VA |
$62.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.31
|
|
|
HC ETHYL GLUCURONIDE SCREEN W/REFLEX, URINE
|
Facility
|
IP
|
$128.42
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100749
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$56.50 |
| Max. Negotiated Rate |
$115.58 |
| Rate for Payer: Aetna American Axle |
$83.47
|
| Rate for Payer: Aetna Commercial |
$109.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.47
|
| Rate for Payer: Cash Price |
$102.74
|
| Rate for Payer: Cofinity Commercial |
$110.44
|
| Rate for Payer: Cofinity Commercial |
$89.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$89.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.74
|
| Rate for Payer: Healthscope Commercial |
$115.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$89.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.16
|
| Rate for Payer: PHP Commercial |
$109.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.47
|
| Rate for Payer: Priority Health SBD |
$80.90
|
| Rate for Payer: UMR Bronson Commercial |
$56.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.31
|
|
|
HC ETONOGESTREL IMPLANT SYSTEM
|
Facility
|
IP
|
$1,546.41
|
|
|
Service Code
|
HCPCS J7307
|
| Hospital Charge Code |
63600148
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$680.42 |
| Max. Negotiated Rate |
$1,391.77 |
| Rate for Payer: Aetna American Axle |
$1,005.17
|
| Rate for Payer: Aetna Commercial |
$1,314.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,005.17
|
| Rate for Payer: Cash Price |
$1,237.13
|
| Rate for Payer: Cofinity Commercial |
$1,082.49
|
| Rate for Payer: Cofinity Commercial |
$1,329.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,082.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,237.13
|
| Rate for Payer: Healthscope Commercial |
$1,391.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,082.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,159.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,314.45
|
| Rate for Payer: PHP Commercial |
$1,314.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,005.17
|
| Rate for Payer: Priority Health SBD |
$974.24
|
| Rate for Payer: UMR Bronson Commercial |
$680.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,159.81
|
|
|
HC ETONOGESTREL IMPLANT SYSTEM
|
Facility
|
OP
|
$1,546.41
|
|
|
Service Code
|
HCPCS J7307
|
| Hospital Charge Code |
63600148
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$572.17 |
| Max. Negotiated Rate |
$1,391.77 |
| Rate for Payer: Aetna American Axle |
$1,005.17
|
| Rate for Payer: Aetna Commercial |
$1,314.45
|
| Rate for Payer: Aetna Medicare |
$773.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,005.17
|
| Rate for Payer: BCBS Complete |
$618.56
|
| Rate for Payer: Cash Price |
$1,237.13
|
| Rate for Payer: Cofinity Commercial |
$1,082.49
|
| Rate for Payer: Cofinity Commercial |
$1,329.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,082.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,237.13
|
| Rate for Payer: Healthscope Commercial |
$1,391.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,082.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,159.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,314.45
|
| Rate for Payer: PHP Commercial |
$1,314.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,005.17
|
| Rate for Payer: Priority Health SBD |
$974.24
|
| Rate for Payer: UMR Bronson Commercial |
$572.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,159.81
|
|
|
HC EUFLEXXA INJ PER DOSE
|
Facility
|
IP
|
$300.99
|
|
|
Service Code
|
HCPCS J7323
|
| Hospital Charge Code |
63600145
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$132.44 |
| Max. Negotiated Rate |
$270.89 |
| Rate for Payer: Aetna American Axle |
$195.64
|
| Rate for Payer: Aetna Commercial |
$255.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$195.64
|
| Rate for Payer: Cash Price |
$240.79
|
| Rate for Payer: Cofinity Commercial |
$210.69
|
| Rate for Payer: Cofinity Commercial |
$258.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$210.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.79
|
| Rate for Payer: Healthscope Commercial |
$270.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$210.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$225.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.84
|
| Rate for Payer: PHP Commercial |
$255.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.64
|
| Rate for Payer: Priority Health SBD |
$189.62
|
| Rate for Payer: UMR Bronson Commercial |
$132.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.74
|
|
