|
HC PREGNENOLONE
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
CPT 84140
|
| Hospital Charge Code |
30100561
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.31 |
| Max. Negotiated Rate |
$81.00 |
| Rate for Payer: Aetna American Axle |
$58.50
|
| Rate for Payer: Aetna Commercial |
$76.50
|
| Rate for Payer: Aetna Medicare |
$21.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.84
|
| Rate for Payer: BCBS Complete |
$11.87
|
| Rate for Payer: BCBS MAPPO |
$20.67
|
| Rate for Payer: BCBS Trust/PPO |
$18.59
|
| Rate for Payer: BCN Medicare Advantage |
$20.67
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cofinity Commercial |
$77.40
|
| Rate for Payer: Cofinity Commercial |
$63.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.67
|
| Rate for Payer: Healthscope Commercial |
$81.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$63.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.50
|
| Rate for Payer: Mclaren Medicaid |
$11.31
|
| Rate for Payer: Mclaren Medicare |
$20.67
|
| Rate for Payer: Meridian Medicaid |
$11.87
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$21.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.50
|
| Rate for Payer: PACE Medicare |
$19.64
|
| Rate for Payer: PACE SWMI |
$20.67
|
| Rate for Payer: PHP Commercial |
$76.50
|
| Rate for Payer: PHP Medicare Advantage |
$20.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$28.36
|
| Rate for Payer: Priority Health Medicare |
$20.67
|
| Rate for Payer: Priority Health Narrow Network |
$22.69
|
| Rate for Payer: Priority Health SBD |
$56.70
|
| Rate for Payer: Railroad Medicare Medicare |
$20.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.80
|
| Rate for Payer: UHC Core |
$34.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.67
|
| Rate for Payer: UHC Exchange |
$20.67
|
| Rate for Payer: UHC Medicare Advantage |
$21.29
|
| Rate for Payer: UMR Bronson Commercial |
$33.30
|
| Rate for Payer: VA VA |
$20.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.50
|
|
|
HC PRENATAL ANEUPLOIDY DETECTION, FISH
|
Facility
|
IP
|
$94.86
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
31000130
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$41.74 |
| Max. Negotiated Rate |
$85.37 |
| Rate for Payer: Aetna American Axle |
$61.66
|
| Rate for Payer: Aetna Commercial |
$80.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.66
|
| Rate for Payer: Cash Price |
$75.89
|
| Rate for Payer: Cofinity Commercial |
$66.40
|
| Rate for Payer: Cofinity Commercial |
$81.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.89
|
| Rate for Payer: Healthscope Commercial |
$85.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$80.63
|
| Rate for Payer: PHP Commercial |
$80.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.40
|
| Rate for Payer: Priority Health SBD |
$59.76
|
| Rate for Payer: UMR Bronson Commercial |
$41.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.14
|
|
|
HC PRENATAL ANEUPLOIDY DETECTION, FISH
|
Facility
|
OP
|
$94.86
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
31000130
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$11.72 |
| Max. Negotiated Rate |
$85.37 |
| Rate for Payer: Aetna American Axle |
$61.66
|
| Rate for Payer: Aetna Commercial |
$80.63
|
| Rate for Payer: Aetna Medicare |
$22.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.78
|
| Rate for Payer: BCBS Complete |
$12.30
|
| Rate for Payer: BCBS MAPPO |
$21.42
|
| Rate for Payer: BCBS Trust/PPO |
$19.27
|
| Rate for Payer: BCN Medicare Advantage |
$21.42
|
| Rate for Payer: Cash Price |
$75.89
|
| Rate for Payer: Cash Price |
$75.89
|
| Rate for Payer: Cofinity Commercial |
$66.40
|
| Rate for Payer: Cofinity Commercial |
$81.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.42
|
| Rate for Payer: Healthscope Commercial |
$85.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.14
|
| Rate for Payer: Mclaren Medicaid |
$11.72
|
| Rate for Payer: Mclaren Medicare |
$21.42
|
| Rate for Payer: Meridian Medicaid |
$12.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$22.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$80.63
|
| Rate for Payer: PACE Medicare |
$20.35
|
| Rate for Payer: PACE SWMI |
$21.42
|
| Rate for Payer: PHP Commercial |
$80.63
|
| Rate for Payer: PHP Medicare Advantage |
$21.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.86
|
| Rate for Payer: Priority Health Medicare |
$21.42
|
| Rate for Payer: Priority Health Narrow Network |
$15.89
|
| Rate for Payer: Priority Health SBD |
$59.76
|
| Rate for Payer: Railroad Medicare Medicare |
$21.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.70
|
| Rate for Payer: UHC Core |
$35.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.42
|
| Rate for Payer: UHC Exchange |
$21.42
|
| Rate for Payer: UHC Medicare Advantage |
$22.06
|
| Rate for Payer: UMR Bronson Commercial |
$35.10
|
| Rate for Payer: VA VA |
$21.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.14
|
|
|
HC PRENATAL ZIKA VIRUS MAC ELISA IGM
|
Facility
|
IP
|
$184.00
|
|
|
Service Code
|
CPT 86794
|
| Hospital Charge Code |
30000149
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$80.96 |
| Max. Negotiated Rate |
$165.60 |
| Rate for Payer: Aetna American Axle |
$119.60
|
| Rate for Payer: Aetna Commercial |
$156.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$119.60
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Cofinity Commercial |
$128.80
|
| Rate for Payer: Cofinity Commercial |
$158.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$147.20
|
| Rate for Payer: Healthscope Commercial |
$165.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$128.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$138.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$156.40
|
| Rate for Payer: PHP Commercial |
$156.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.80
|
| Rate for Payer: Priority Health SBD |
$115.92
|
| Rate for Payer: UMR Bronson Commercial |
$80.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$138.00
|
|
|
HC PRENATAL ZIKA VIRUS MAC ELISA IGM
|
Facility
|
OP
|
$184.00
|
|
|
Service Code
|
CPT 86794
|
| Hospital Charge Code |
30000149
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.22 |
| Max. Negotiated Rate |
$165.60 |
| Rate for Payer: Aetna American Axle |
$119.60
|
| Rate for Payer: Aetna Commercial |
$156.40
|
| Rate for Payer: Aetna Medicare |
$17.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$119.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.06
|
| Rate for Payer: BCBS Complete |
$9.68
|
| Rate for Payer: BCBS MAPPO |
$16.85
|
| Rate for Payer: BCBS Trust/PPO |
$15.16
|
| Rate for Payer: BCN Medicare Advantage |
$16.85
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Cofinity Commercial |
$158.24
|
| Rate for Payer: Cofinity Commercial |
$128.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$147.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.85
|
| Rate for Payer: Healthscope Commercial |
$165.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$128.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$138.00
|
| Rate for Payer: Mclaren Medicaid |
$9.22
|
| Rate for Payer: Mclaren Medicare |
$16.85
|
| Rate for Payer: Meridian Medicaid |
$9.68
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$156.40
|
| Rate for Payer: PACE Medicare |
$16.01
|
| Rate for Payer: PACE SWMI |
$16.85
|
| Rate for Payer: PHP Commercial |
$156.40
|
| Rate for Payer: PHP Medicare Advantage |
$16.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.23
|
| Rate for Payer: Priority Health Medicare |
$16.85
|
| Rate for Payer: Priority Health Narrow Network |
$14.58
|
| Rate for Payer: Priority Health SBD |
$115.92
|
| Rate for Payer: Railroad Medicare Medicare |
$16.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.22
|
| Rate for Payer: UHC Core |
$24.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.85
|
| Rate for Payer: UHC Exchange |
$16.85
|
| Rate for Payer: UHC Medicare Advantage |
$17.36
|
| Rate for Payer: UMR Bronson Commercial |
$68.08
|
| Rate for Payer: VA VA |
$16.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$138.00
|
|
|
HC PRENATLA ANEUPLOIDY DETECTION, FISH CMPT
|
Facility
|
OP
|
$69.36
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
31000131
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$11.72 |
| Max. Negotiated Rate |
$62.42 |
| Rate for Payer: Aetna American Axle |
$45.08
|
| Rate for Payer: Aetna Commercial |
$58.96
|
| Rate for Payer: Aetna Medicare |
$22.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.78
|
| Rate for Payer: BCBS Complete |
$12.30
|
| Rate for Payer: BCBS MAPPO |
$21.42
|
| Rate for Payer: BCBS Trust/PPO |
$19.27
|
| Rate for Payer: BCN Medicare Advantage |
$21.42
|
| Rate for Payer: Cash Price |
$55.49
|
| Rate for Payer: Cash Price |
$55.49
|
| Rate for Payer: Cofinity Commercial |
$48.55
|
| Rate for Payer: Cofinity Commercial |
$59.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.42
|
| Rate for Payer: Healthscope Commercial |
$62.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.02
|
| Rate for Payer: Mclaren Medicaid |
$11.72
|
| Rate for Payer: Mclaren Medicare |
$21.42
|
| Rate for Payer: Meridian Medicaid |
$12.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$22.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$58.96
|
| Rate for Payer: PACE Medicare |
$20.35
|
| Rate for Payer: PACE SWMI |
$21.42
|
| Rate for Payer: PHP Commercial |
$58.96
|
| Rate for Payer: PHP Medicare Advantage |
$21.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.86
|
| Rate for Payer: Priority Health Medicare |
$21.42
|
| Rate for Payer: Priority Health Narrow Network |
$15.89
|
| Rate for Payer: Priority Health SBD |
$43.70
|
| Rate for Payer: Railroad Medicare Medicare |
$21.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.70
|
| Rate for Payer: UHC Core |
$35.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.42
|
| Rate for Payer: UHC Exchange |
$21.42
|
| Rate for Payer: UHC Medicare Advantage |
$22.06
|
| Rate for Payer: UMR Bronson Commercial |
$25.66
|
| Rate for Payer: VA VA |
$21.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.02
|
|
|
HC PRENATLA ANEUPLOIDY DETECTION, FISH CMPT
|
Facility
|
IP
|
$69.36
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
31000131
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$30.52 |
| Max. Negotiated Rate |
$62.42 |
| Rate for Payer: Aetna American Axle |
$45.08
|
| Rate for Payer: Aetna Commercial |
$58.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.08
|
| Rate for Payer: Cash Price |
$55.49
|
| Rate for Payer: Cofinity Commercial |
$48.55
|
| Rate for Payer: Cofinity Commercial |
$59.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.49
|
| Rate for Payer: Healthscope Commercial |
$62.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$58.96
|
| Rate for Payer: PHP Commercial |
$58.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.55
|
| Rate for Payer: Priority Health SBD |
$43.70
|
| Rate for Payer: UMR Bronson Commercial |
$30.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.02
|
|
|
HC PREOP DUPLX HEMODIALYSIS ASSESS BIL
|
Facility
|
OP
|
$1,467.38
|
|
|
Service Code
|
CPT 93985
|
| Hospital Charge Code |
92100036
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$119.14 |
| Max. Negotiated Rate |
$1,320.64 |
| Rate for Payer: Aetna American Axle |
$953.80
|
| Rate for Payer: Aetna Commercial |
$1,247.27
|
| Rate for Payer: Aetna Medicare |
$226.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$953.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$272.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$272.26
|
| Rate for Payer: BCBS Complete |
$125.11
|
| Rate for Payer: BCBS MAPPO |
$217.81
|
| Rate for Payer: BCBS Trust/PPO |
$1,059.00
|
| Rate for Payer: BCN Medicare Advantage |
$217.81
|
| Rate for Payer: Cash Price |
$1,173.90
|
| Rate for Payer: Cash Price |
$1,173.90
|
| Rate for Payer: Cash Price |
$1,173.90
|
| Rate for Payer: Cofinity Commercial |
$1,261.95
|
| Rate for Payer: Cofinity Commercial |
$1,027.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,173.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$217.81
|
| Rate for Payer: Healthscope Commercial |
$1,320.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,027.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,100.54
|
| Rate for Payer: Mclaren Medicaid |
$119.14
|
| Rate for Payer: Mclaren Medicare |
$217.81
|
| Rate for Payer: Meridian Medicaid |
$125.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$228.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$250.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,247.27
|
| Rate for Payer: PACE Medicare |
$206.92
|
| Rate for Payer: PACE SWMI |
$217.81
|
| Rate for Payer: PHP Commercial |
$1,247.27
|
| Rate for Payer: PHP Medicare Advantage |
$217.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$119.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,027.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$685.66
|
| Rate for Payer: Priority Health Medicare |
$217.81
|
| Rate for Payer: Priority Health Narrow Network |
$548.53
|
| Rate for Payer: Priority Health SBD |
$924.45
|
| Rate for Payer: Railroad Medicare Medicare |
$217.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$267.62
|
| Rate for Payer: UHC Core |
$587.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$217.81
|
| Rate for Payer: UHC Exchange |
$243.29
|
| Rate for Payer: UHC Medicare Advantage |
$224.34
|
| Rate for Payer: UMR Bronson Commercial |
$542.93
|
| Rate for Payer: VA VA |
$217.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,100.54
|
|
|
HC PREOP DUPLX HEMODIALYSIS ASSESS BIL
|
Facility
|
IP
|
$1,467.38
|
|
|
Service Code
|
CPT 93985
|
| Hospital Charge Code |
92100036
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$645.65 |
| Max. Negotiated Rate |
$1,320.64 |
| Rate for Payer: Aetna American Axle |
$953.80
|
| Rate for Payer: Aetna Commercial |
$1,247.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$953.80
|
| Rate for Payer: Cash Price |
$1,173.90
|
| Rate for Payer: Cofinity Commercial |
$1,027.17
|
| Rate for Payer: Cofinity Commercial |
$1,261.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,173.90
|
| Rate for Payer: Healthscope Commercial |
$1,320.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,027.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,100.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,247.27
|
| Rate for Payer: PHP Commercial |
$1,247.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,027.17
|
| Rate for Payer: Priority Health SBD |
$924.45
|
| Rate for Payer: UMR Bronson Commercial |
$645.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,100.54
|
|
|
HC PREOP DUPLX HEMODIALYSIS ASSESS UNI.
|
Facility
|
OP
|
$850.62
|
|
|
Service Code
|
CPT 93986
|
| Hospital Charge Code |
92100037
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$53.45 |
| Max. Negotiated Rate |
$765.56 |
| Rate for Payer: Aetna American Axle |
$552.90
|
| Rate for Payer: Aetna Commercial |
$723.03
|
| Rate for Payer: Aetna Medicare |
$101.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$552.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.15
|
| Rate for Payer: BCBS Complete |
$56.13
|
| Rate for Payer: BCBS MAPPO |
$97.72
|
| Rate for Payer: BCBS Trust/PPO |
$625.02
|
| Rate for Payer: BCN Medicare Advantage |
$97.72
|
| Rate for Payer: Cash Price |
$680.50
|
| Rate for Payer: Cash Price |
$680.50
|
| Rate for Payer: Cash Price |
$680.50
|
| Rate for Payer: Cofinity Commercial |
$731.53
|
| Rate for Payer: Cofinity Commercial |
$595.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$680.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.72
|
| Rate for Payer: Healthscope Commercial |
$765.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$595.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$637.96
|
| Rate for Payer: Mclaren Medicaid |
$53.45
|
| Rate for Payer: Mclaren Medicare |
$97.72
|
| Rate for Payer: Meridian Medicaid |
$56.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$723.03
|
| Rate for Payer: PACE Medicare |
$92.83
|
| Rate for Payer: PACE SWMI |
$97.72
|
| Rate for Payer: PHP Commercial |
$723.03
|
| Rate for Payer: PHP Medicare Advantage |
$97.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$595.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$307.65
|
| Rate for Payer: Priority Health Medicare |
$97.72
|
| Rate for Payer: Priority Health Narrow Network |
$246.12
|
| Rate for Payer: Priority Health SBD |
$535.89
|
| Rate for Payer: Railroad Medicare Medicare |
$97.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$157.40
|
| Rate for Payer: UHC Core |
$587.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.72
|
| Rate for Payer: UHC Exchange |
$143.09
|
| Rate for Payer: UHC Medicare Advantage |
$100.65
|
| Rate for Payer: UMR Bronson Commercial |
$314.73
|
| Rate for Payer: VA VA |
$97.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$637.96
|
|
|
HC PREOP DUPLX HEMODIALYSIS ASSESS UNI.
|
Facility
|
IP
|
$850.62
|
|
|
Service Code
|
CPT 93986
|
| Hospital Charge Code |
92100037
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$374.27 |
| Max. Negotiated Rate |
$765.56 |
| Rate for Payer: Aetna American Axle |
$552.90
|
| Rate for Payer: Aetna Commercial |
$723.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$552.90
|
| Rate for Payer: Cash Price |
$680.50
|
| Rate for Payer: Cofinity Commercial |
$595.43
|
| Rate for Payer: Cofinity Commercial |
$731.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$680.50
|
| Rate for Payer: Healthscope Commercial |
$765.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$595.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$637.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$723.03
|
| Rate for Payer: PHP Commercial |
$723.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$595.43
|
| Rate for Payer: Priority Health SBD |
$535.89
|
| Rate for Payer: UMR Bronson Commercial |
$374.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$637.96
|
|
|
HC PREP SITE F/S/N/H/F/G/M/D GT 1ST 100 SQ CM/1PCT
|
Facility
|
IP
|
$1,000.00
|
|
|
Service Code
|
CPT 15004
|
| Hospital Charge Code |
76100397
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$440.00 |
| Max. Negotiated Rate |
$900.00 |
| Rate for Payer: Aetna American Axle |
$650.00
|
| Rate for Payer: Aetna Commercial |
$850.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$650.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cofinity Commercial |
$700.00
|
| Rate for Payer: Cofinity Commercial |
$860.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$800.00
|
| Rate for Payer: Healthscope Commercial |
$900.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$700.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$750.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$850.00
|
| Rate for Payer: PHP Commercial |
$850.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$700.00
|
| Rate for Payer: Priority Health SBD |
$630.00
|
| Rate for Payer: UMR Bronson Commercial |
$440.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$750.00
|
|
|
HC PREP SITE F/S/N/H/F/G/M/D GT 1ST 100 SQ CM/1PCT
|
Facility
|
OP
|
$1,000.00
|
|
|
Service Code
|
CPT 15004
|
| Hospital Charge Code |
76100397
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$252.46 |
| Max. Negotiated Rate |
$1,757.43 |
| Rate for Payer: Aetna American Axle |
$650.00
|
| Rate for Payer: Aetna Commercial |
$850.00
|
| Rate for Payer: Aetna Medicare |
$580.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$650.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$697.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$697.82
|
| Rate for Payer: BCBS Complete |
$320.66
|
| Rate for Payer: BCBS MAPPO |
$558.26
|
| Rate for Payer: BCBS Trust/PPO |
$363.59
|
| Rate for Payer: BCN Medicare Advantage |
$558.26
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cofinity Commercial |
$860.00
|
| Rate for Payer: Cofinity Commercial |
$700.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$800.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$558.26
|
| Rate for Payer: Healthscope Commercial |
$900.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$700.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$750.00
|
| Rate for Payer: Mclaren Medicaid |
$305.37
|
| Rate for Payer: Mclaren Medicare |
$558.26
|
| Rate for Payer: Meridian Medicaid |
$320.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$586.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$642.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$850.00
|
| Rate for Payer: PACE Medicare |
$530.35
|
| Rate for Payer: PACE SWMI |
$558.26
|
| Rate for Payer: PHP Commercial |
$850.00
|
| Rate for Payer: PHP Medicare Advantage |
$558.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$305.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$700.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,757.43
|
| Rate for Payer: Priority Health Medicare |
$558.26
|
| Rate for Payer: Priority Health Narrow Network |
$1,405.94
|
| Rate for Payer: Priority Health SBD |
$630.00
|
| Rate for Payer: Railroad Medicare Medicare |
$558.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$277.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$558.26
|
| Rate for Payer: UHC Exchange |
$252.46
|
| Rate for Payer: UHC Medicare Advantage |
$575.01
|
| Rate for Payer: UMR Bronson Commercial |
$370.00
|
| Rate for Payer: VA VA |
$558.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$750.00
|
|
|
HC PRESBYOPIA LENS
|
Facility
|
IP
|
$3,586.48
|
|
|
Service Code
|
HCPCS C1780
|
| Hospital Charge Code |
27600001
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$1,578.05 |
| Max. Negotiated Rate |
$3,227.83 |
| Rate for Payer: Aetna American Axle |
$2,331.21
|
| Rate for Payer: Aetna Commercial |
$3,048.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,331.21
|
| Rate for Payer: Cash Price |
$2,869.18
|
| Rate for Payer: Cofinity Commercial |
$2,510.54
|
| Rate for Payer: Cofinity Commercial |
$3,084.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,869.18
|
| Rate for Payer: Healthscope Commercial |
$3,227.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,510.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,689.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,048.51
|
| Rate for Payer: PHP Commercial |
$3,048.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,510.54
|
| Rate for Payer: Priority Health SBD |
$2,259.48
|
| Rate for Payer: UMR Bronson Commercial |
$1,578.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,689.86
|
|
|
HC PRESBYOPIA LENS
|
Facility
|
OP
|
$3,586.48
|
|
|
Service Code
|
HCPCS C1780
|
| Hospital Charge Code |
27600001
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$1,327.00 |
| Max. Negotiated Rate |
$3,227.83 |
| Rate for Payer: Aetna American Axle |
$2,331.21
|
| Rate for Payer: Aetna Commercial |
$3,048.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,331.21
|
| Rate for Payer: BCBS Complete |
$1,434.59
|
| Rate for Payer: Cash Price |
$2,869.18
|
| Rate for Payer: Cofinity Commercial |
$2,510.54
|
| Rate for Payer: Cofinity Commercial |
$3,084.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,869.18
|
| Rate for Payer: Healthscope Commercial |
$3,227.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,510.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,689.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,048.51
|
| Rate for Payer: PHP Commercial |
$3,048.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,510.54
|
| Rate for Payer: Priority Health SBD |
$2,259.48
|
| Rate for Payer: UMR Bronson Commercial |
$1,327.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,689.86
|
|
|
HC PRESSURE WIRE
|
Facility
|
OP
|
$2,158.09
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200065
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$798.49 |
| Max. Negotiated Rate |
$1,942.28 |
| Rate for Payer: Aetna American Axle |
$1,402.76
|
| Rate for Payer: Aetna Commercial |
$1,834.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,402.76
|
| Rate for Payer: BCBS Complete |
$863.24
|
| Rate for Payer: Cash Price |
$1,726.47
|
| Rate for Payer: Cofinity Commercial |
$1,855.96
|
| Rate for Payer: Cofinity Commercial |
$1,510.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,726.47
|
| Rate for Payer: Healthscope Commercial |
$1,942.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,510.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,618.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,834.38
|
| Rate for Payer: PHP Commercial |
$1,834.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,510.66
|
| Rate for Payer: Priority Health SBD |
$1,359.60
|
| Rate for Payer: UMR Bronson Commercial |
$798.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,618.57
|
|
|
HC PRESSURE WIRE
|
Facility
|
IP
|
$2,158.09
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200065
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$949.56 |
| Max. Negotiated Rate |
$1,942.28 |
| Rate for Payer: Aetna American Axle |
$1,402.76
|
| Rate for Payer: Aetna Commercial |
$1,834.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,402.76
|
| Rate for Payer: Cash Price |
$1,726.47
|
| Rate for Payer: Cofinity Commercial |
$1,510.66
|
| Rate for Payer: Cofinity Commercial |
$1,855.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,726.47
|
| Rate for Payer: Healthscope Commercial |
$1,942.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,510.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,618.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,834.38
|
| Rate for Payer: PHP Commercial |
$1,834.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,510.66
|
| Rate for Payer: Priority Health SBD |
$1,359.60
|
| Rate for Payer: UMR Bronson Commercial |
$949.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,618.57
|
|
|
HC PRESUMPTIVE DRUG TEST CHEM ANALYZER
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100727
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$44.88 |
| Max. Negotiated Rate |
$91.80 |
| Rate for Payer: Aetna American Axle |
$66.30
|
| Rate for Payer: Aetna Commercial |
$86.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.30
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cofinity Commercial |
$71.40
|
| Rate for Payer: Cofinity Commercial |
$87.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.60
|
| Rate for Payer: Healthscope Commercial |
$91.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$71.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$86.70
|
| Rate for Payer: PHP Commercial |
$86.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.40
|
| Rate for Payer: Priority Health SBD |
$64.26
|
| Rate for Payer: UMR Bronson Commercial |
$44.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.50
|
|
|
HC PRESUMPTIVE DRUG TEST CHEM ANALYZER
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100727
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.99 |
| Max. Negotiated Rate |
$95.77 |
| Rate for Payer: Aetna American Axle |
$66.30
|
| Rate for Payer: Aetna Commercial |
$86.70
|
| Rate for Payer: Aetna Medicare |
$64.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.68
|
| Rate for Payer: BCBS Complete |
$35.69
|
| Rate for Payer: BCBS MAPPO |
$62.14
|
| Rate for Payer: BCBS Trust/PPO |
$55.89
|
| Rate for Payer: BCN Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cofinity Commercial |
$87.72
|
| Rate for Payer: Cofinity Commercial |
$71.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Healthscope Commercial |
$91.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$71.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.50
|
| Rate for Payer: Mclaren Medicaid |
$33.99
|
| Rate for Payer: Mclaren Medicare |
$62.14
|
| Rate for Payer: Meridian Medicaid |
$35.69
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$65.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$86.70
|
| Rate for Payer: PACE Medicare |
$59.03
|
| Rate for Payer: PACE SWMI |
$62.14
|
| Rate for Payer: PHP Commercial |
$86.70
|
| Rate for Payer: PHP Medicare Advantage |
$62.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$48.58
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: Priority Health Narrow Network |
$38.86
|
| Rate for Payer: Priority Health SBD |
$64.26
|
| Rate for Payer: Railroad Medicare Medicare |
$62.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.57
|
| Rate for Payer: UHC Core |
$95.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.14
|
| Rate for Payer: UHC Exchange |
$62.14
|
| Rate for Payer: UHC Medicare Advantage |
$64.00
|
| Rate for Payer: UMR Bronson Commercial |
$37.74
|
| Rate for Payer: VA VA |
$62.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.50
|
|
|
HC PRESUMPTIVE DRUG TEST OPTICAL
|
Facility
|
OP
|
$50.49
|
|
|
Service Code
|
CPT 80305
|
| Hospital Charge Code |
30100728
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.89 |
| Max. Negotiated Rate |
$45.44 |
| Rate for Payer: Aetna American Axle |
$32.82
|
| Rate for Payer: Aetna Commercial |
$42.92
|
| Rate for Payer: Aetna Medicare |
$13.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.75
|
| Rate for Payer: BCBS Complete |
$7.24
|
| Rate for Payer: BCBS MAPPO |
$12.60
|
| Rate for Payer: BCBS Trust/PPO |
$11.33
|
| Rate for Payer: BCN Medicare Advantage |
$12.60
|
| Rate for Payer: Cash Price |
$40.39
|
| Rate for Payer: Cash Price |
$40.39
|
| Rate for Payer: Cofinity Commercial |
$43.42
|
| Rate for Payer: Cofinity Commercial |
$35.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.60
|
| Rate for Payer: Healthscope Commercial |
$45.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.87
|
| Rate for Payer: Mclaren Medicaid |
$6.89
|
| Rate for Payer: Mclaren Medicare |
$12.60
|
| Rate for Payer: Meridian Medicaid |
$7.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$42.92
|
| Rate for Payer: PACE Medicare |
$11.97
|
| Rate for Payer: PACE SWMI |
$12.60
|
| Rate for Payer: PHP Commercial |
$42.92
|
| Rate for Payer: PHP Medicare Advantage |
$12.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.11
|
| Rate for Payer: Priority Health Medicare |
$12.60
|
| Rate for Payer: Priority Health Narrow Network |
$7.29
|
| Rate for Payer: Priority Health SBD |
$31.81
|
| Rate for Payer: Railroad Medicare Medicare |
$12.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.12
|
| Rate for Payer: UHC Core |
$17.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.60
|
| Rate for Payer: UHC Exchange |
$12.60
|
| Rate for Payer: UHC Medicare Advantage |
$12.98
|
| Rate for Payer: UMR Bronson Commercial |
$18.68
|
| Rate for Payer: VA VA |
$12.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.87
|
|
|
HC PRESUMPTIVE DRUG TEST OPTICAL
|
Facility
|
IP
|
$50.49
|
|
|
Service Code
|
CPT 80305
|
| Hospital Charge Code |
30100728
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.22 |
| Max. Negotiated Rate |
$45.44 |
| Rate for Payer: Aetna American Axle |
$32.82
|
| Rate for Payer: Aetna Commercial |
$42.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.82
|
| Rate for Payer: Cash Price |
$40.39
|
| Rate for Payer: Cofinity Commercial |
$35.34
|
| Rate for Payer: Cofinity Commercial |
$43.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.39
|
| Rate for Payer: Healthscope Commercial |
$45.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$42.92
|
| Rate for Payer: PHP Commercial |
$42.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.34
|
| Rate for Payer: Priority Health SBD |
$31.81
|
| Rate for Payer: UMR Bronson Commercial |
$22.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.87
|
|
|
HC PRIMARY MEMBRANOUS NEPH DX CASCADE S
|
Facility
|
IP
|
$207.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100757
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$91.08 |
| Max. Negotiated Rate |
$186.30 |
| Rate for Payer: Aetna American Axle |
$134.55
|
| Rate for Payer: Aetna Commercial |
$175.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.55
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cofinity Commercial |
$144.90
|
| Rate for Payer: Cofinity Commercial |
$178.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.60
|
| Rate for Payer: Healthscope Commercial |
$186.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$144.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$155.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$175.95
|
| Rate for Payer: PHP Commercial |
$175.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$144.90
|
| Rate for Payer: Priority Health SBD |
$130.41
|
| Rate for Payer: UMR Bronson Commercial |
$91.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$155.25
|
|
|
HC PRIMARY MEMBRANOUS NEPH DX CASCADE S
|
Facility
|
OP
|
$207.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100757
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.45 |
| Max. Negotiated Rate |
$186.30 |
| Rate for Payer: Aetna American Axle |
$134.55
|
| Rate for Payer: Aetna Commercial |
$175.95
|
| Rate for Payer: Aetna Medicare |
$17.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.59
|
| Rate for Payer: BCBS Complete |
$9.92
|
| Rate for Payer: BCBS MAPPO |
$17.27
|
| Rate for Payer: BCBS Trust/PPO |
$15.53
|
| Rate for Payer: BCN Medicare Advantage |
$17.27
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cofinity Commercial |
$178.02
|
| Rate for Payer: Cofinity Commercial |
$144.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.27
|
| Rate for Payer: Healthscope Commercial |
$186.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$144.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$155.25
|
| Rate for Payer: Mclaren Medicaid |
$9.45
|
| Rate for Payer: Mclaren Medicare |
$17.27
|
| Rate for Payer: Meridian Medicaid |
$9.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$175.95
|
| Rate for Payer: PACE Medicare |
$16.41
|
| Rate for Payer: PACE SWMI |
$17.27
|
| Rate for Payer: PHP Commercial |
$175.95
|
| Rate for Payer: PHP Medicare Advantage |
$17.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$144.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.76
|
| Rate for Payer: Priority Health Medicare |
$17.27
|
| Rate for Payer: Priority Health Narrow Network |
$14.21
|
| Rate for Payer: Priority Health SBD |
$130.41
|
| Rate for Payer: Railroad Medicare Medicare |
$17.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.72
|
| Rate for Payer: UHC Core |
$21.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.27
|
| Rate for Payer: UHC Exchange |
$17.27
|
| Rate for Payer: UHC Medicare Advantage |
$17.79
|
| Rate for Payer: UMR Bronson Commercial |
$76.59
|
| Rate for Payer: VA VA |
$17.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$155.25
|
|
|
HC PRIMIDONE MYSOLINE LEVEL
|
Facility
|
OP
|
$26.52
|
|
|
Service Code
|
CPT 80184
|
| Hospital Charge Code |
30100038
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.37 |
| Max. Negotiated Rate |
$23.87 |
| Rate for Payer: Aetna American Axle |
$17.24
|
| Rate for Payer: Aetna Commercial |
$22.54
|
| Rate for Payer: Aetna Medicare |
$15.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.12
|
| Rate for Payer: BCBS Complete |
$8.79
|
| Rate for Payer: BCBS MAPPO |
$15.30
|
| Rate for Payer: BCBS Trust/PPO |
$13.77
|
| Rate for Payer: BCN Medicare Advantage |
$15.30
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cofinity Commercial |
$18.56
|
| Rate for Payer: Cofinity Commercial |
$22.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.30
|
| Rate for Payer: Healthscope Commercial |
$23.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.89
|
| Rate for Payer: Mclaren Medicaid |
$8.37
|
| Rate for Payer: Mclaren Medicare |
$15.30
|
| Rate for Payer: Meridian Medicaid |
$8.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.54
|
| Rate for Payer: PACE Medicare |
$14.54
|
| Rate for Payer: PACE SWMI |
$15.30
|
| Rate for Payer: PHP Commercial |
$22.54
|
| Rate for Payer: PHP Medicare Advantage |
$15.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.71
|
| Rate for Payer: Priority Health Medicare |
$15.30
|
| Rate for Payer: Priority Health Narrow Network |
$12.57
|
| Rate for Payer: Priority Health SBD |
$16.71
|
| Rate for Payer: Railroad Medicare Medicare |
$15.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.36
|
| Rate for Payer: UHC Core |
$18.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.30
|
| Rate for Payer: UHC Exchange |
$15.30
|
| Rate for Payer: UHC Medicare Advantage |
$15.76
|
| Rate for Payer: UMR Bronson Commercial |
$9.81
|
| Rate for Payer: VA VA |
$15.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.89
|
|
|
HC PRIMIDONE MYSOLINE LEVEL
|
Facility
|
IP
|
$26.52
|
|
|
Service Code
|
CPT 80184
|
| Hospital Charge Code |
30100038
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.67 |
| Max. Negotiated Rate |
$23.87 |
| Rate for Payer: Aetna American Axle |
$17.24
|
| Rate for Payer: Aetna Commercial |
$22.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.24
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cofinity Commercial |
$18.56
|
| Rate for Payer: Cofinity Commercial |
$22.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.22
|
| Rate for Payer: Healthscope Commercial |
$23.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.54
|
| Rate for Payer: PHP Commercial |
$22.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.56
|
| Rate for Payer: Priority Health SBD |
$16.71
|
| Rate for Payer: UMR Bronson Commercial |
$11.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.89
|
|
