|
HC POC UREA NITROGEN
|
Facility
|
OP
|
$15.46
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
30100698
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.16 |
| Max. Negotiated Rate |
$13.91 |
| Rate for Payer: Aetna American Axle |
$10.05
|
| Rate for Payer: Aetna Commercial |
$13.14
|
| Rate for Payer: Aetna Medicare |
$4.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.94
|
| Rate for Payer: BCBS Complete |
$2.27
|
| Rate for Payer: BCBS MAPPO |
$3.95
|
| Rate for Payer: BCN Medicare Advantage |
$3.95
|
| Rate for Payer: Cash Price |
$12.37
|
| Rate for Payer: Cash Price |
$12.37
|
| Rate for Payer: Cofinity Commercial |
$10.82
|
| Rate for Payer: Cofinity Commercial |
$13.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.95
|
| Rate for Payer: Healthscope Commercial |
$13.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.60
|
| Rate for Payer: Mclaren Medicaid |
$2.16
|
| Rate for Payer: Mclaren Medicare |
$3.95
|
| Rate for Payer: Meridian Medicaid |
$2.27
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.14
|
| Rate for Payer: PACE Medicare |
$3.75
|
| Rate for Payer: PACE SWMI |
$3.95
|
| Rate for Payer: PHP Commercial |
$13.14
|
| Rate for Payer: PHP Medicare Advantage |
$3.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.17
|
| Rate for Payer: Priority Health Medicare |
$3.95
|
| Rate for Payer: Priority Health Narrow Network |
$4.14
|
| Rate for Payer: Priority Health SBD |
$9.74
|
| Rate for Payer: Railroad Medicare Medicare |
$3.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.74
|
| Rate for Payer: UHC Core |
$6.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.95
|
| Rate for Payer: UHC Exchange |
$3.95
|
| Rate for Payer: UHC Medicare Advantage |
$4.07
|
| Rate for Payer: UMR Bronson Commercial |
$5.72
|
| Rate for Payer: VA VA |
$3.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.60
|
|
|
HC POC UREA NITROGEN
|
Facility
|
IP
|
$15.46
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
30100698
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.80 |
| Max. Negotiated Rate |
$13.91 |
| Rate for Payer: Aetna American Axle |
$10.05
|
| Rate for Payer: Aetna Commercial |
$13.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.05
|
| Rate for Payer: Cash Price |
$12.37
|
| Rate for Payer: Cofinity Commercial |
$10.82
|
| Rate for Payer: Cofinity Commercial |
$13.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.37
|
| Rate for Payer: Healthscope Commercial |
$13.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.14
|
| Rate for Payer: PHP Commercial |
$13.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.82
|
| Rate for Payer: Priority Health SBD |
$9.74
|
| Rate for Payer: UMR Bronson Commercial |
$6.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.60
|
|
|
HC POLARCATH
|
Facility
|
OP
|
$6,937.70
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200064
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$6,243.93 |
| Rate for Payer: Aetna American Axle |
$4,509.50
|
| Rate for Payer: Aetna Commercial |
$5,897.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,509.50
|
| Rate for Payer: BCBS Complete |
$2,775.08
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: Cash Price |
$5,550.16
|
| Rate for Payer: Cash Price |
$5,550.16
|
| Rate for Payer: Cofinity Commercial |
$5,966.42
|
| Rate for Payer: Cofinity Commercial |
$4,856.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,550.16
|
| Rate for Payer: Healthscope Commercial |
$6,243.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,856.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,203.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,897.04
|
| Rate for Payer: PHP Commercial |
$5,897.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,856.39
|
| Rate for Payer: Priority Health SBD |
$4,370.75
|
| Rate for Payer: UMR Bronson Commercial |
$2,566.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,203.28
|
|
|
HC POLARCATH
|
Facility
|
IP
|
$6,937.70
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200064
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,052.59 |
| Max. Negotiated Rate |
$6,243.93 |
| Rate for Payer: Aetna American Axle |
$4,509.50
|
| Rate for Payer: Aetna Commercial |
$5,897.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,509.50
|
| Rate for Payer: Cash Price |
$5,550.16
|
| Rate for Payer: Cofinity Commercial |
$4,856.39
|
| Rate for Payer: Cofinity Commercial |
$5,966.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,550.16
|
| Rate for Payer: Healthscope Commercial |
$6,243.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,856.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,203.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,897.04
|
| Rate for Payer: PHP Commercial |
$5,897.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,856.39
|
| Rate for Payer: Priority Health SBD |
$4,370.75
|
| Rate for Payer: UMR Bronson Commercial |
$3,052.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,203.28
|
|
|
HC POLARCATH N.O. CARTRIDGE
|
Facility
|
IP
|
$268.79
|
|
| Hospital Charge Code |
27200148
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$118.27 |
| Max. Negotiated Rate |
$241.91 |
| Rate for Payer: Aetna American Axle |
$174.71
|
| Rate for Payer: Aetna Commercial |
$228.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.71
|
| Rate for Payer: Cash Price |
$215.03
|
| Rate for Payer: Cofinity Commercial |
$188.15
|
| Rate for Payer: Cofinity Commercial |
$231.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.03
|
| Rate for Payer: Healthscope Commercial |
$241.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$188.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$201.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$228.47
|
| Rate for Payer: PHP Commercial |
$228.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.15
|
| Rate for Payer: Priority Health SBD |
$169.34
|
| Rate for Payer: UMR Bronson Commercial |
$118.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$201.59
|
|
|
HC POLARCATH N.O. CARTRIDGE
|
Facility
|
OP
|
$268.79
|
|
| Hospital Charge Code |
27200148
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$99.45 |
| Max. Negotiated Rate |
$241.91 |
| Rate for Payer: Aetna American Axle |
$174.71
|
| Rate for Payer: Aetna Commercial |
$228.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.71
|
| Rate for Payer: BCBS Complete |
$107.52
|
| Rate for Payer: Cash Price |
$215.03
|
| Rate for Payer: Cofinity Commercial |
$188.15
|
| Rate for Payer: Cofinity Commercial |
$231.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.03
|
| Rate for Payer: Healthscope Commercial |
$241.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$188.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$201.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$228.47
|
| Rate for Payer: PHP Commercial |
$228.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.15
|
| Rate for Payer: Priority Health SBD |
$169.34
|
| Rate for Payer: UMR Bronson Commercial |
$99.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$201.59
|
|
|
HC POLIOVIRUS VACCINE, INACTIVATED (IPV) SUBQ/IM
|
Facility
|
IP
|
$42.64
|
|
|
Service Code
|
CPT 90713
|
| Hospital Charge Code |
63600082
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.76 |
| Max. Negotiated Rate |
$38.38 |
| Rate for Payer: Aetna American Axle |
$27.72
|
| Rate for Payer: Aetna Commercial |
$36.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.72
|
| Rate for Payer: Cash Price |
$34.11
|
| Rate for Payer: Cofinity Commercial |
$29.85
|
| Rate for Payer: Cofinity Commercial |
$36.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.11
|
| Rate for Payer: Healthscope Commercial |
$38.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$36.24
|
| Rate for Payer: PHP Commercial |
$36.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.85
|
| Rate for Payer: Priority Health SBD |
$26.86
|
| Rate for Payer: UMR Bronson Commercial |
$18.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.98
|
|
|
HC POLIOVIRUS VACCINE, INACTIVATED (IPV) SUBQ/IM
|
Facility
|
OP
|
$42.64
|
|
|
Service Code
|
CPT 90713
|
| Hospital Charge Code |
63600082
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.78 |
| Max. Negotiated Rate |
$127.31 |
| Rate for Payer: Aetna American Axle |
$27.72
|
| Rate for Payer: Aetna Commercial |
$36.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.72
|
| Rate for Payer: BCBS Complete |
$17.06
|
| Rate for Payer: BCBS Trust/PPO |
$127.31
|
| Rate for Payer: Cash Price |
$34.11
|
| Rate for Payer: Cash Price |
$34.11
|
| Rate for Payer: Cofinity Commercial |
$29.85
|
| Rate for Payer: Cofinity Commercial |
$36.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.11
|
| Rate for Payer: Healthscope Commercial |
$38.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$36.24
|
| Rate for Payer: PHP Commercial |
$36.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.85
|
| Rate for Payer: Priority Health SBD |
$26.86
|
| Rate for Payer: UMR Bronson Commercial |
$15.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.98
|
|
|
HC POLYPECTOMY
|
Facility
|
IP
|
$482.14
|
|
| Hospital Charge Code |
36000080
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$212.14 |
| Max. Negotiated Rate |
$433.93 |
| Rate for Payer: Aetna American Axle |
$313.39
|
| Rate for Payer: Aetna Commercial |
$409.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$313.39
|
| Rate for Payer: Cash Price |
$385.71
|
| Rate for Payer: Cofinity Commercial |
$337.50
|
| Rate for Payer: Cofinity Commercial |
$414.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$385.71
|
| Rate for Payer: Healthscope Commercial |
$433.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$337.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$361.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$409.82
|
| Rate for Payer: PHP Commercial |
$409.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$337.50
|
| Rate for Payer: Priority Health SBD |
$303.75
|
| Rate for Payer: UMR Bronson Commercial |
$212.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$361.60
|
|
|
HC POLYPECTOMY
|
Facility
|
OP
|
$482.14
|
|
| Hospital Charge Code |
36000080
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$178.39 |
| Max. Negotiated Rate |
$433.93 |
| Rate for Payer: Aetna American Axle |
$313.39
|
| Rate for Payer: Aetna Commercial |
$409.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$313.39
|
| Rate for Payer: BCBS Complete |
$192.86
|
| Rate for Payer: Cash Price |
$385.71
|
| Rate for Payer: Cofinity Commercial |
$337.50
|
| Rate for Payer: Cofinity Commercial |
$414.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$385.71
|
| Rate for Payer: Healthscope Commercial |
$433.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$337.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$361.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$409.82
|
| Rate for Payer: PHP Commercial |
$409.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$337.50
|
| Rate for Payer: Priority Health SBD |
$303.75
|
| Rate for Payer: UMR Bronson Commercial |
$178.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$361.60
|
|
|
HC POLYPECTOMY ADDL 45 MIN OR MORE
|
Facility
|
OP
|
$179.15
|
|
| Hospital Charge Code |
36000004
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$66.29 |
| Max. Negotiated Rate |
$161.24 |
| Rate for Payer: Aetna American Axle |
$116.45
|
| Rate for Payer: Aetna Commercial |
$152.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.45
|
| Rate for Payer: BCBS Complete |
$71.66
|
| Rate for Payer: Cash Price |
$143.32
|
| Rate for Payer: Cofinity Commercial |
$125.40
|
| Rate for Payer: Cofinity Commercial |
$154.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$143.32
|
| Rate for Payer: Healthscope Commercial |
$161.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$125.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$134.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$152.28
|
| Rate for Payer: PHP Commercial |
$152.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$125.40
|
| Rate for Payer: Priority Health SBD |
$112.86
|
| Rate for Payer: UMR Bronson Commercial |
$66.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$134.36
|
|
|
HC POLYPECTOMY ADDL 45 MIN OR MORE
|
Facility
|
IP
|
$179.15
|
|
| Hospital Charge Code |
36000004
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$78.83 |
| Max. Negotiated Rate |
$161.24 |
| Rate for Payer: Aetna American Axle |
$116.45
|
| Rate for Payer: Aetna Commercial |
$152.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.45
|
| Rate for Payer: Cash Price |
$143.32
|
| Rate for Payer: Cofinity Commercial |
$125.40
|
| Rate for Payer: Cofinity Commercial |
$154.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$143.32
|
| Rate for Payer: Healthscope Commercial |
$161.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$125.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$134.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$152.28
|
| Rate for Payer: PHP Commercial |
$152.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$125.40
|
| Rate for Payer: Priority Health SBD |
$112.86
|
| Rate for Payer: UMR Bronson Commercial |
$78.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$134.36
|
|
|
HC PORPHYRIN URINE QUANTITATIVE
|
Facility
|
IP
|
$32.64
|
|
|
Service Code
|
CPT 84120
|
| Hospital Charge Code |
30100395
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.36 |
| Max. Negotiated Rate |
$29.38 |
| Rate for Payer: Aetna American Axle |
$21.22
|
| Rate for Payer: Aetna Commercial |
$27.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.22
|
| Rate for Payer: Cash Price |
$26.11
|
| Rate for Payer: Cofinity Commercial |
$22.85
|
| Rate for Payer: Cofinity Commercial |
$28.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.11
|
| Rate for Payer: Healthscope Commercial |
$29.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$27.74
|
| Rate for Payer: PHP Commercial |
$27.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.85
|
| Rate for Payer: Priority Health SBD |
$20.56
|
| Rate for Payer: UMR Bronson Commercial |
$14.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.48
|
|
|
HC PORPHYRIN URINE QUANTITATIVE
|
Facility
|
OP
|
$32.64
|
|
|
Service Code
|
CPT 84120
|
| Hospital Charge Code |
30100395
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.05 |
| Max. Negotiated Rate |
$29.38 |
| Rate for Payer: Aetna American Axle |
$21.22
|
| Rate for Payer: Aetna Commercial |
$27.74
|
| Rate for Payer: Aetna Medicare |
$15.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.39
|
| Rate for Payer: BCBS Complete |
$8.45
|
| Rate for Payer: BCBS MAPPO |
$14.71
|
| Rate for Payer: BCBS Trust/PPO |
$13.23
|
| Rate for Payer: BCN Medicare Advantage |
$14.71
|
| Rate for Payer: Cash Price |
$26.11
|
| Rate for Payer: Cash Price |
$26.11
|
| Rate for Payer: Cofinity Commercial |
$22.85
|
| Rate for Payer: Cofinity Commercial |
$28.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.71
|
| Rate for Payer: Healthscope Commercial |
$29.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.48
|
| Rate for Payer: Mclaren Medicaid |
$8.05
|
| Rate for Payer: Mclaren Medicare |
$14.71
|
| Rate for Payer: Meridian Medicaid |
$8.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$27.74
|
| Rate for Payer: PACE Medicare |
$13.97
|
| Rate for Payer: PACE SWMI |
$14.71
|
| Rate for Payer: PHP Commercial |
$27.74
|
| Rate for Payer: PHP Medicare Advantage |
$14.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.18
|
| Rate for Payer: Priority Health Medicare |
$14.71
|
| Rate for Payer: Priority Health Narrow Network |
$16.14
|
| Rate for Payer: Priority Health SBD |
$20.56
|
| Rate for Payer: Railroad Medicare Medicare |
$14.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.65
|
| Rate for Payer: UHC Core |
$24.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.71
|
| Rate for Payer: UHC Exchange |
$14.71
|
| Rate for Payer: UHC Medicare Advantage |
$15.15
|
| Rate for Payer: UMR Bronson Commercial |
$12.08
|
| Rate for Payer: VA VA |
$14.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.48
|
|
|
HC PORPHYRIN URINE QUANTITATIVE C
|
Facility
|
IP
|
$31.00
|
|
|
Service Code
|
CPT 84110
|
| Hospital Charge Code |
30100394
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.64 |
| Max. Negotiated Rate |
$27.90 |
| Rate for Payer: Aetna American Axle |
$20.15
|
| Rate for Payer: Aetna Commercial |
$26.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.15
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cofinity Commercial |
$21.70
|
| Rate for Payer: Cofinity Commercial |
$26.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.80
|
| Rate for Payer: Healthscope Commercial |
$27.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.35
|
| Rate for Payer: PHP Commercial |
$26.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.70
|
| Rate for Payer: Priority Health SBD |
$19.53
|
| Rate for Payer: UMR Bronson Commercial |
$13.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.25
|
|
|
HC PORPHYRIN URINE QUANTITATIVE C
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
CPT 84110
|
| Hospital Charge Code |
30100394
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.62 |
| Max. Negotiated Rate |
$27.90 |
| Rate for Payer: Aetna American Axle |
$20.15
|
| Rate for Payer: Aetna Commercial |
$26.35
|
| Rate for Payer: Aetna Medicare |
$8.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.55
|
| Rate for Payer: BCBS Complete |
$4.85
|
| Rate for Payer: BCBS MAPPO |
$8.44
|
| Rate for Payer: BCBS Trust/PPO |
$7.59
|
| Rate for Payer: BCN Medicare Advantage |
$8.44
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cofinity Commercial |
$21.70
|
| Rate for Payer: Cofinity Commercial |
$26.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.44
|
| Rate for Payer: Healthscope Commercial |
$27.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.25
|
| Rate for Payer: Mclaren Medicaid |
$4.62
|
| Rate for Payer: Mclaren Medicare |
$8.44
|
| Rate for Payer: Meridian Medicaid |
$4.85
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.35
|
| Rate for Payer: PACE Medicare |
$8.02
|
| Rate for Payer: PACE SWMI |
$8.44
|
| Rate for Payer: PHP Commercial |
$26.35
|
| Rate for Payer: PHP Medicare Advantage |
$8.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.58
|
| Rate for Payer: Priority Health Medicare |
$8.44
|
| Rate for Payer: Priority Health Narrow Network |
$9.26
|
| Rate for Payer: Priority Health SBD |
$19.53
|
| Rate for Payer: Railroad Medicare Medicare |
$8.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.13
|
| Rate for Payer: UHC Core |
$13.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.44
|
| Rate for Payer: UHC Exchange |
$8.44
|
| Rate for Payer: UHC Medicare Advantage |
$8.69
|
| Rate for Payer: UMR Bronson Commercial |
$11.47
|
| Rate for Payer: VA VA |
$8.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.25
|
|
|
HC PORTAL FILMS
|
Facility
|
OP
|
$212.00
|
|
|
Service Code
|
CPT 77417
|
| Hospital Charge Code |
33300023
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$14.73 |
| Max. Negotiated Rate |
$979.00 |
| Rate for Payer: Aetna American Axle |
$137.80
|
| Rate for Payer: Aetna American Axle |
$170.39
|
| Rate for Payer: Aetna Commercial |
$180.20
|
| Rate for Payer: Aetna Commercial |
$222.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.80
|
| Rate for Payer: BCBS Complete |
$84.80
|
| Rate for Payer: BCBS Complete |
$104.86
|
| Rate for Payer: BCBS Trust/PPO |
$25.97
|
| Rate for Payer: BCBS Trust/PPO |
$25.97
|
| Rate for Payer: Cash Price |
$209.71
|
| Rate for Payer: Cash Price |
$209.71
|
| Rate for Payer: Cash Price |
$169.60
|
| Rate for Payer: Cash Price |
$169.60
|
| Rate for Payer: Cash Price |
$209.71
|
| Rate for Payer: Cash Price |
$169.60
|
| Rate for Payer: Cofinity Commercial |
$225.44
|
| Rate for Payer: Cofinity Commercial |
$148.40
|
| Rate for Payer: Cofinity Commercial |
$182.32
|
| Rate for Payer: Cofinity Commercial |
$183.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.60
|
| Rate for Payer: Healthscope Commercial |
$190.80
|
| Rate for Payer: Healthscope Commercial |
$235.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$148.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$183.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$196.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$159.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$222.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$180.20
|
| Rate for Payer: PHP Commercial |
$180.20
|
| Rate for Payer: PHP Commercial |
$222.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.50
|
| Rate for Payer: Priority Health SBD |
$165.15
|
| Rate for Payer: Priority Health SBD |
$133.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.20
|
| Rate for Payer: UHC Core |
$979.00
|
| Rate for Payer: UHC Core |
$979.00
|
| Rate for Payer: UHC Exchange |
$14.73
|
| Rate for Payer: UHC Exchange |
$14.73
|
| Rate for Payer: UMR Bronson Commercial |
$78.44
|
| Rate for Payer: UMR Bronson Commercial |
$96.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$159.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$196.60
|
|
|
HC PORTAL FILMS
|
Facility
|
IP
|
$212.00
|
|
|
Service Code
|
CPT 77417
|
| Hospital Charge Code |
33300023
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$93.28 |
| Max. Negotiated Rate |
$190.80 |
| Rate for Payer: Aetna American Axle |
$137.80
|
| Rate for Payer: Aetna American Axle |
$170.39
|
| Rate for Payer: Aetna Commercial |
$222.82
|
| Rate for Payer: Aetna Commercial |
$180.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.39
|
| Rate for Payer: Cash Price |
$209.71
|
| Rate for Payer: Cash Price |
$169.60
|
| Rate for Payer: Cofinity Commercial |
$148.40
|
| Rate for Payer: Cofinity Commercial |
$182.32
|
| Rate for Payer: Cofinity Commercial |
$225.44
|
| Rate for Payer: Cofinity Commercial |
$183.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.71
|
| Rate for Payer: Healthscope Commercial |
$235.93
|
| Rate for Payer: Healthscope Commercial |
$190.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$148.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$183.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$196.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$159.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$222.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$180.20
|
| Rate for Payer: PHP Commercial |
$180.20
|
| Rate for Payer: PHP Commercial |
$222.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.50
|
| Rate for Payer: Priority Health SBD |
$133.56
|
| Rate for Payer: Priority Health SBD |
$165.15
|
| Rate for Payer: UMR Bronson Commercial |
$93.28
|
| Rate for Payer: UMR Bronson Commercial |
$115.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$159.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$196.60
|
|
|
HC PORT PLAN, TOTAL BODY
|
Facility
|
IP
|
$527.00
|
|
|
Service Code
|
CPT 77321
|
| Hospital Charge Code |
33300031
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$231.88 |
| Max. Negotiated Rate |
$474.30 |
| Rate for Payer: Aetna American Axle |
$342.55
|
| Rate for Payer: Aetna American Axle |
$352.72
|
| Rate for Payer: Aetna Commercial |
$461.24
|
| Rate for Payer: Aetna Commercial |
$447.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$342.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$352.72
|
| Rate for Payer: Cash Price |
$421.60
|
| Rate for Payer: Cash Price |
$434.11
|
| Rate for Payer: Cofinity Commercial |
$453.22
|
| Rate for Payer: Cofinity Commercial |
$466.67
|
| Rate for Payer: Cofinity Commercial |
$368.90
|
| Rate for Payer: Cofinity Commercial |
$379.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$434.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$421.60
|
| Rate for Payer: Healthscope Commercial |
$488.38
|
| Rate for Payer: Healthscope Commercial |
$474.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$379.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$368.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$395.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$406.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$461.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$447.95
|
| Rate for Payer: PHP Commercial |
$447.95
|
| Rate for Payer: PHP Commercial |
$461.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$379.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$368.90
|
| Rate for Payer: Priority Health SBD |
$332.01
|
| Rate for Payer: Priority Health SBD |
$341.86
|
| Rate for Payer: UMR Bronson Commercial |
$238.76
|
| Rate for Payer: UMR Bronson Commercial |
$231.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$406.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$395.25
|
|
|
HC PORT PLAN, TOTAL BODY
|
Facility
|
OP
|
$542.64
|
|
|
Service Code
|
CPT 77321
|
| Hospital Charge Code |
33300031
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$82.99 |
| Max. Negotiated Rate |
$1,033.94 |
| Rate for Payer: Aetna American Axle |
$352.72
|
| Rate for Payer: Aetna American Axle |
$342.55
|
| Rate for Payer: Aetna Commercial |
$461.24
|
| Rate for Payer: Aetna Commercial |
$447.95
|
| Rate for Payer: Aetna Medicare |
$341.57
|
| Rate for Payer: Aetna Medicare |
$341.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$352.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$342.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$410.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$410.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$410.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$410.54
|
| Rate for Payer: BCBS Complete |
$188.65
|
| Rate for Payer: BCBS Complete |
$188.65
|
| Rate for Payer: BCBS MAPPO |
$328.43
|
| Rate for Payer: BCBS MAPPO |
$328.43
|
| Rate for Payer: BCBS Trust/PPO |
$82.99
|
| Rate for Payer: BCBS Trust/PPO |
$82.99
|
| Rate for Payer: BCN Medicare Advantage |
$328.43
|
| Rate for Payer: BCN Medicare Advantage |
$328.43
|
| Rate for Payer: Cash Price |
$421.60
|
| Rate for Payer: Cash Price |
$434.11
|
| Rate for Payer: Cash Price |
$434.11
|
| Rate for Payer: Cash Price |
$434.11
|
| Rate for Payer: Cash Price |
$421.60
|
| Rate for Payer: Cash Price |
$421.60
|
| Rate for Payer: Cofinity Commercial |
$466.67
|
| Rate for Payer: Cofinity Commercial |
$379.85
|
| Rate for Payer: Cofinity Commercial |
$368.90
|
| Rate for Payer: Cofinity Commercial |
$453.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$434.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$421.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$328.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$328.43
|
| Rate for Payer: Healthscope Commercial |
$474.30
|
| Rate for Payer: Healthscope Commercial |
$488.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$368.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$379.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$406.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$395.25
|
| Rate for Payer: Mclaren Medicaid |
$179.65
|
| Rate for Payer: Mclaren Medicaid |
$179.65
|
| Rate for Payer: Mclaren Medicare |
$328.43
|
| Rate for Payer: Mclaren Medicare |
$328.43
|
| Rate for Payer: Meridian Medicaid |
$188.65
|
| Rate for Payer: Meridian Medicaid |
$188.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$344.85
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$344.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$377.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$377.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$461.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$447.95
|
| Rate for Payer: PACE Medicare |
$312.01
|
| Rate for Payer: PACE Medicare |
$312.01
|
| Rate for Payer: PACE SWMI |
$328.43
|
| Rate for Payer: PACE SWMI |
$328.43
|
| Rate for Payer: PHP Commercial |
$461.24
|
| Rate for Payer: PHP Commercial |
$447.95
|
| Rate for Payer: PHP Medicare Advantage |
$328.43
|
| Rate for Payer: PHP Medicare Advantage |
$328.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$179.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$179.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$368.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$379.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,033.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,033.94
|
| Rate for Payer: Priority Health Medicare |
$328.43
|
| Rate for Payer: Priority Health Medicare |
$328.43
|
| Rate for Payer: Priority Health Narrow Network |
$827.15
|
| Rate for Payer: Priority Health Narrow Network |
$827.15
|
| Rate for Payer: Priority Health SBD |
$341.86
|
| Rate for Payer: Priority Health SBD |
$332.01
|
| Rate for Payer: Railroad Medicare Medicare |
$328.43
|
| Rate for Payer: Railroad Medicare Medicare |
$328.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$101.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$101.94
|
| Rate for Payer: UHC Core |
$979.00
|
| Rate for Payer: UHC Core |
$979.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$328.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$328.43
|
| Rate for Payer: UHC Exchange |
$92.67
|
| Rate for Payer: UHC Exchange |
$92.67
|
| Rate for Payer: UHC Medicare Advantage |
$338.28
|
| Rate for Payer: UHC Medicare Advantage |
$338.28
|
| Rate for Payer: UMR Bronson Commercial |
$200.78
|
| Rate for Payer: UMR Bronson Commercial |
$194.99
|
| Rate for Payer: VA VA |
$328.43
|
| Rate for Payer: VA VA |
$328.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$395.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$406.98
|
|
|
HC POST MASTECTOMY SLEEVE A
|
Facility
|
IP
|
$68.00
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000049
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$29.92 |
| Max. Negotiated Rate |
$61.20 |
| Rate for Payer: Aetna American Axle |
$44.20
|
| Rate for Payer: Aetna Commercial |
$57.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.20
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Cofinity Commercial |
$47.60
|
| Rate for Payer: Cofinity Commercial |
$58.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.40
|
| Rate for Payer: Healthscope Commercial |
$61.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$57.80
|
| Rate for Payer: PHP Commercial |
$57.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.60
|
| Rate for Payer: Priority Health SBD |
$42.84
|
| Rate for Payer: UMR Bronson Commercial |
$29.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.00
|
|
|
HC POST MASTECTOMY SLEEVE A
|
Facility
|
OP
|
$68.00
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000049
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$25.16 |
| Max. Negotiated Rate |
$161.76 |
| Rate for Payer: Aetna American Axle |
$44.20
|
| Rate for Payer: Aetna Commercial |
$57.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.20
|
| Rate for Payer: BCBS Complete |
$27.20
|
| Rate for Payer: BCBS Trust/PPO |
$161.76
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Cofinity Commercial |
$47.60
|
| Rate for Payer: Cofinity Commercial |
$58.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.40
|
| Rate for Payer: Healthscope Commercial |
$61.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$57.80
|
| Rate for Payer: PHP Commercial |
$57.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.60
|
| Rate for Payer: Priority Health SBD |
$42.84
|
| Rate for Payer: UMR Bronson Commercial |
$25.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.00
|
|
|
HC POST MASTECTOMY SLEEVE B
|
Facility
|
OP
|
$80.00
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000050
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$29.60 |
| Max. Negotiated Rate |
$161.76 |
| Rate for Payer: Aetna American Axle |
$52.00
|
| Rate for Payer: Aetna Commercial |
$68.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.00
|
| Rate for Payer: BCBS Complete |
$32.00
|
| Rate for Payer: BCBS Trust/PPO |
$161.76
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cofinity Commercial |
$56.00
|
| Rate for Payer: Cofinity Commercial |
$68.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.00
|
| Rate for Payer: Healthscope Commercial |
$72.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$68.00
|
| Rate for Payer: PHP Commercial |
$68.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.00
|
| Rate for Payer: Priority Health SBD |
$50.40
|
| Rate for Payer: UMR Bronson Commercial |
$29.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.00
|
|
|
HC POST MASTECTOMY SLEEVE B
|
Facility
|
IP
|
$80.00
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000050
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$35.20 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Aetna American Axle |
$52.00
|
| Rate for Payer: Aetna Commercial |
$68.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.00
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cofinity Commercial |
$56.00
|
| Rate for Payer: Cofinity Commercial |
$68.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.00
|
| Rate for Payer: Healthscope Commercial |
$72.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$68.00
|
| Rate for Payer: PHP Commercial |
$68.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.00
|
| Rate for Payer: Priority Health SBD |
$50.40
|
| Rate for Payer: UMR Bronson Commercial |
$35.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.00
|
|
|
HC POST MASTECTOMY SLEEVE C
|
Facility
|
IP
|
$216.00
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000051
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$95.04 |
| Max. Negotiated Rate |
$194.40 |
| Rate for Payer: Aetna American Axle |
$140.40
|
| Rate for Payer: Aetna Commercial |
$183.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$140.40
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Cofinity Commercial |
$151.20
|
| Rate for Payer: Cofinity Commercial |
$185.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.80
|
| Rate for Payer: Healthscope Commercial |
$194.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$151.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$162.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$183.60
|
| Rate for Payer: PHP Commercial |
$183.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.20
|
| Rate for Payer: Priority Health SBD |
$136.08
|
| Rate for Payer: UMR Bronson Commercial |
$95.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$162.00
|
|
