|
HC FECAL LEUKOCYTE ASSESSMENT
|
Facility
|
IP
|
$53.86
|
|
|
Service Code
|
CPT 87205
|
| Hospital Charge Code |
30600110
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$23.70 |
| Max. Negotiated Rate |
$48.47 |
| Rate for Payer: Aetna American Axle |
$35.01
|
| Rate for Payer: Aetna Commercial |
$45.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.01
|
| Rate for Payer: Cash Price |
$43.09
|
| Rate for Payer: Cofinity Commercial |
$37.70
|
| Rate for Payer: Cofinity Commercial |
$46.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.09
|
| Rate for Payer: Healthscope Commercial |
$48.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.78
|
| Rate for Payer: PHP Commercial |
$45.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.01
|
| Rate for Payer: Priority Health SBD |
$33.93
|
| Rate for Payer: UMR Bronson Commercial |
$23.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.40
|
|
|
HC FECAL MICROBIOTA INSTILLATION
|
Facility
|
IP
|
$1,307.32
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
36100568
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$575.22 |
| Max. Negotiated Rate |
$1,176.59 |
| Rate for Payer: Aetna American Axle |
$849.76
|
| Rate for Payer: Aetna Commercial |
$1,111.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$849.76
|
| Rate for Payer: Cash Price |
$1,045.86
|
| Rate for Payer: Cofinity Commercial |
$1,124.30
|
| Rate for Payer: Cofinity Commercial |
$915.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$915.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,045.86
|
| Rate for Payer: Healthscope Commercial |
$1,176.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$915.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$980.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,111.22
|
| Rate for Payer: PHP Commercial |
$1,111.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$849.76
|
| Rate for Payer: Priority Health SBD |
$823.61
|
| Rate for Payer: UMR Bronson Commercial |
$575.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$980.49
|
|
|
HC FECAL MICROBIOTA INSTILLATION
|
Facility
|
OP
|
$1,307.32
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
36100568
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$483.71 |
| Max. Negotiated Rate |
$2,573.89 |
| Rate for Payer: Aetna American Axle |
$849.76
|
| Rate for Payer: Aetna Commercial |
$1,111.22
|
| Rate for Payer: Aetna Medicare |
$950.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$849.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,142.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,142.97
|
| Rate for Payer: BCBS Complete |
$514.61
|
| Rate for Payer: BCBS MAPPO |
$914.38
|
| Rate for Payer: BCN Medicare Advantage |
$914.38
|
| Rate for Payer: Cash Price |
$1,045.86
|
| Rate for Payer: Cash Price |
$1,045.86
|
| Rate for Payer: Cofinity Commercial |
$915.12
|
| Rate for Payer: Cofinity Commercial |
$1,124.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$915.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,045.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$914.38
|
| Rate for Payer: Healthscope Commercial |
$1,176.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$915.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$980.49
|
| Rate for Payer: Mclaren Medicaid |
$490.11
|
| Rate for Payer: Mclaren Medicare |
$914.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$960.10
|
| Rate for Payer: Meridian Medicaid |
$514.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,051.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,111.22
|
| Rate for Payer: PACE Medicare |
$868.66
|
| Rate for Payer: PACE SWMI |
$914.38
|
| Rate for Payer: PHP Commercial |
$1,111.22
|
| Rate for Payer: PHP Medicare Advantage |
$914.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$490.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$849.76
|
| Rate for Payer: Priority Health Medicare |
$914.38
|
| Rate for Payer: Priority Health SBD |
$823.61
|
| Rate for Payer: Railroad Medicare Medicare |
$914.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,573.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$914.38
|
| Rate for Payer: UHC Exchange |
$1,747.47
|
| Rate for Payer: UHC Medicare Advantage |
$914.38
|
| Rate for Payer: UHCCP Medicaid |
$490.11
|
| Rate for Payer: UMR Bronson Commercial |
$483.71
|
| Rate for Payer: VA VA |
$914.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$980.49
|
|
|
HC FECAL OCCULT BLOOD IMMUNOASSAY
|
Facility
|
IP
|
$31.21
|
|
|
Service Code
|
CPT 82274
|
| Hospital Charge Code |
30100123
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.73 |
| Max. Negotiated Rate |
$28.09 |
| Rate for Payer: Aetna American Axle |
$20.29
|
| Rate for Payer: Aetna Commercial |
$26.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.29
|
| Rate for Payer: Cash Price |
$24.97
|
| Rate for Payer: Cofinity Commercial |
$21.85
|
| Rate for Payer: Cofinity Commercial |
$26.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.97
|
| Rate for Payer: Healthscope Commercial |
$28.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.53
|
| Rate for Payer: PHP Commercial |
$26.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.29
|
| Rate for Payer: Priority Health SBD |
$19.66
|
| Rate for Payer: UMR Bronson Commercial |
$13.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.41
|
|
|
HC FECAL OCCULT BLOOD IMMUNOASSAY
|
Facility
|
OP
|
$31.21
|
|
|
Service Code
|
CPT 82274
|
| Hospital Charge Code |
30100123
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.53 |
| Max. Negotiated Rate |
$44.81 |
| Rate for Payer: Aetna American Axle |
$20.29
|
| Rate for Payer: Aetna Commercial |
$26.53
|
| Rate for Payer: Aetna Medicare |
$16.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.90
|
| Rate for Payer: BCBS Complete |
$8.96
|
| Rate for Payer: BCBS MAPPO |
$15.92
|
| Rate for Payer: BCN Medicare Advantage |
$15.92
|
| Rate for Payer: Cash Price |
$24.97
|
| Rate for Payer: Cash Price |
$24.97
|
| Rate for Payer: Cofinity Commercial |
$26.84
|
| Rate for Payer: Cofinity Commercial |
$21.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.92
|
| Rate for Payer: Healthscope Commercial |
$28.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.41
|
| Rate for Payer: Mclaren Medicaid |
$8.53
|
| Rate for Payer: Mclaren Medicare |
$15.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.72
|
| Rate for Payer: Meridian Medicaid |
$8.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.53
|
| Rate for Payer: PACE Medicare |
$15.12
|
| Rate for Payer: PACE SWMI |
$15.92
|
| Rate for Payer: PHP Commercial |
$26.53
|
| Rate for Payer: PHP Medicare Advantage |
$15.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.29
|
| Rate for Payer: Priority Health Medicare |
$15.92
|
| Rate for Payer: Priority Health SBD |
$19.66
|
| Rate for Payer: Railroad Medicare Medicare |
$15.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.92
|
| Rate for Payer: UHC Exchange |
$30.42
|
| Rate for Payer: UHC Medicare Advantage |
$15.92
|
| Rate for Payer: UHCCP Medicaid |
$8.53
|
| Rate for Payer: UMR Bronson Commercial |
$11.55
|
| Rate for Payer: VA VA |
$15.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.41
|
|
|
HC FECAL OCCULT BLOOD PEROXIDASE
|
Facility
|
OP
|
$30.60
|
|
|
Service Code
|
CPT 82270
|
| Hospital Charge Code |
30100121
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.35 |
| Max. Negotiated Rate |
$27.54 |
| Rate for Payer: Aetna American Axle |
$19.89
|
| Rate for Payer: Aetna Commercial |
$26.01
|
| Rate for Payer: Aetna Medicare |
$4.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.47
|
| Rate for Payer: BCBS Complete |
$2.47
|
| Rate for Payer: BCBS MAPPO |
$4.38
|
| Rate for Payer: BCN Medicare Advantage |
$4.38
|
| Rate for Payer: Cash Price |
$24.48
|
| Rate for Payer: Cash Price |
$24.48
|
| Rate for Payer: Cofinity Commercial |
$26.32
|
| Rate for Payer: Cofinity Commercial |
$21.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.38
|
| Rate for Payer: Healthscope Commercial |
$27.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.95
|
| Rate for Payer: Mclaren Medicaid |
$2.35
|
| Rate for Payer: Mclaren Medicare |
$4.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.60
|
| Rate for Payer: Meridian Medicaid |
$2.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.01
|
| Rate for Payer: PACE Medicare |
$4.16
|
| Rate for Payer: PACE SWMI |
$4.38
|
| Rate for Payer: PHP Commercial |
$26.01
|
| Rate for Payer: PHP Medicare Advantage |
$4.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.89
|
| Rate for Payer: Priority Health Medicare |
$4.38
|
| Rate for Payer: Priority Health SBD |
$19.28
|
| Rate for Payer: Railroad Medicare Medicare |
$4.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.38
|
| Rate for Payer: UHC Exchange |
$8.37
|
| Rate for Payer: UHC Medicare Advantage |
$4.38
|
| Rate for Payer: UHCCP Medicaid |
$2.35
|
| Rate for Payer: UMR Bronson Commercial |
$11.32
|
| Rate for Payer: VA VA |
$4.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.95
|
|
|
HC FECAL OCCULT BLOOD PEROXIDASE
|
Facility
|
IP
|
$30.60
|
|
|
Service Code
|
CPT 82270
|
| Hospital Charge Code |
30100121
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.46 |
| Max. Negotiated Rate |
$27.54 |
| Rate for Payer: Aetna American Axle |
$19.89
|
| Rate for Payer: Aetna Commercial |
$26.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.89
|
| Rate for Payer: Cash Price |
$24.48
|
| Rate for Payer: Cofinity Commercial |
$21.42
|
| Rate for Payer: Cofinity Commercial |
$26.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.48
|
| Rate for Payer: Healthscope Commercial |
$27.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.01
|
| Rate for Payer: PHP Commercial |
$26.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.89
|
| Rate for Payer: Priority Health SBD |
$19.28
|
| Rate for Payer: UMR Bronson Commercial |
$13.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.95
|
|
|
HC FECAL PH
|
Facility
|
IP
|
$23.93
|
|
|
Service Code
|
CPT 83986
|
| Hospital Charge Code |
30100491
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.53 |
| Max. Negotiated Rate |
$21.54 |
| Rate for Payer: Aetna American Axle |
$15.55
|
| Rate for Payer: Aetna Commercial |
$20.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.55
|
| Rate for Payer: Cash Price |
$19.14
|
| Rate for Payer: Cofinity Commercial |
$16.75
|
| Rate for Payer: Cofinity Commercial |
$20.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.14
|
| Rate for Payer: Healthscope Commercial |
$21.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.34
|
| Rate for Payer: PHP Commercial |
$20.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.55
|
| Rate for Payer: Priority Health SBD |
$15.08
|
| Rate for Payer: UMR Bronson Commercial |
$10.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.95
|
|
|
HC FECAL PH
|
Facility
|
OP
|
$23.93
|
|
|
Service Code
|
CPT 83986
|
| Hospital Charge Code |
30100491
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.92 |
| Max. Negotiated Rate |
$21.54 |
| Rate for Payer: Aetna American Axle |
$15.55
|
| Rate for Payer: Aetna Commercial |
$20.34
|
| Rate for Payer: Aetna Medicare |
$3.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.47
|
| Rate for Payer: BCBS Complete |
$2.01
|
| Rate for Payer: BCBS MAPPO |
$3.58
|
| Rate for Payer: BCN Medicare Advantage |
$3.58
|
| Rate for Payer: Cash Price |
$19.14
|
| Rate for Payer: Cash Price |
$19.14
|
| Rate for Payer: Cofinity Commercial |
$20.58
|
| Rate for Payer: Cofinity Commercial |
$16.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.58
|
| Rate for Payer: Healthscope Commercial |
$21.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.95
|
| Rate for Payer: Mclaren Medicaid |
$1.92
|
| Rate for Payer: Mclaren Medicare |
$3.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.76
|
| Rate for Payer: Meridian Medicaid |
$2.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.34
|
| Rate for Payer: PACE Medicare |
$3.40
|
| Rate for Payer: PACE SWMI |
$3.58
|
| Rate for Payer: PHP Commercial |
$20.34
|
| Rate for Payer: PHP Medicare Advantage |
$3.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.55
|
| Rate for Payer: Priority Health Medicare |
$3.58
|
| Rate for Payer: Priority Health SBD |
$15.08
|
| Rate for Payer: Railroad Medicare Medicare |
$3.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.58
|
| Rate for Payer: UHC Exchange |
$6.84
|
| Rate for Payer: UHC Medicare Advantage |
$3.58
|
| Rate for Payer: UHCCP Medicaid |
$1.92
|
| Rate for Payer: UMR Bronson Commercial |
$8.85
|
| Rate for Payer: VA VA |
$3.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.95
|
|
|
HC FECAL REDUCING SUBSTANCE
|
Facility
|
IP
|
$51.31
|
|
|
Service Code
|
CPT 84376
|
| Hospital Charge Code |
30100427
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.58 |
| Max. Negotiated Rate |
$46.18 |
| Rate for Payer: Aetna American Axle |
$33.35
|
| Rate for Payer: Aetna Commercial |
$43.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.35
|
| Rate for Payer: Cash Price |
$41.05
|
| Rate for Payer: Cofinity Commercial |
$35.92
|
| Rate for Payer: Cofinity Commercial |
$44.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.05
|
| Rate for Payer: Healthscope Commercial |
$46.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.61
|
| Rate for Payer: PHP Commercial |
$43.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.35
|
| Rate for Payer: Priority Health SBD |
$32.33
|
| Rate for Payer: UMR Bronson Commercial |
$22.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.48
|
|
|
HC FECAL REDUCING SUBSTANCE
|
Facility
|
OP
|
$51.31
|
|
|
Service Code
|
CPT 84376
|
| Hospital Charge Code |
30100427
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.95 |
| Max. Negotiated Rate |
$46.18 |
| Rate for Payer: Aetna American Axle |
$33.35
|
| Rate for Payer: Aetna Commercial |
$43.61
|
| Rate for Payer: Aetna Medicare |
$5.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.88
|
| Rate for Payer: BCBS Complete |
$3.10
|
| Rate for Payer: BCBS MAPPO |
$5.50
|
| Rate for Payer: BCN Medicare Advantage |
$5.50
|
| Rate for Payer: Cash Price |
$41.05
|
| Rate for Payer: Cash Price |
$41.05
|
| Rate for Payer: Cofinity Commercial |
$44.13
|
| Rate for Payer: Cofinity Commercial |
$35.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.50
|
| Rate for Payer: Healthscope Commercial |
$46.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.48
|
| Rate for Payer: Mclaren Medicaid |
$2.95
|
| Rate for Payer: Mclaren Medicare |
$5.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.78
|
| Rate for Payer: Meridian Medicaid |
$3.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.61
|
| Rate for Payer: PACE Medicare |
$5.22
|
| Rate for Payer: PACE SWMI |
$5.50
|
| Rate for Payer: PHP Commercial |
$43.61
|
| Rate for Payer: PHP Medicare Advantage |
$5.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.35
|
| Rate for Payer: Priority Health Medicare |
$5.50
|
| Rate for Payer: Priority Health SBD |
$32.33
|
| Rate for Payer: Railroad Medicare Medicare |
$5.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.50
|
| Rate for Payer: UHC Exchange |
$10.51
|
| Rate for Payer: UHC Medicare Advantage |
$5.50
|
| Rate for Payer: UHCCP Medicaid |
$2.95
|
| Rate for Payer: UMR Bronson Commercial |
$18.98
|
| Rate for Payer: VA VA |
$5.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.48
|
|
|
HC FECAL WBC LACTOFERRIN
|
Facility
|
IP
|
$75.33
|
|
|
Service Code
|
CPT 83630
|
| Hospital Charge Code |
30100273
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.15 |
| Max. Negotiated Rate |
$67.80 |
| Rate for Payer: Aetna American Axle |
$48.96
|
| Rate for Payer: Aetna Commercial |
$64.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.96
|
| Rate for Payer: Cash Price |
$60.26
|
| Rate for Payer: Cofinity Commercial |
$52.73
|
| Rate for Payer: Cofinity Commercial |
$64.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$52.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.26
|
| Rate for Payer: Healthscope Commercial |
$67.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.03
|
| Rate for Payer: PHP Commercial |
$64.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.96
|
| Rate for Payer: Priority Health SBD |
$47.46
|
| Rate for Payer: UMR Bronson Commercial |
$33.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.50
|
|
|
HC FECAL WBC LACTOFERRIN
|
Facility
|
OP
|
$75.33
|
|
|
Service Code
|
CPT 83630
|
| Hospital Charge Code |
30100273
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.56 |
| Max. Negotiated Rate |
$67.80 |
| Rate for Payer: Aetna American Axle |
$48.96
|
| Rate for Payer: Aetna Commercial |
$64.03
|
| Rate for Payer: Aetna Medicare |
$20.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.62
|
| Rate for Payer: BCBS Complete |
$11.09
|
| Rate for Payer: BCBS MAPPO |
$19.70
|
| Rate for Payer: BCN Medicare Advantage |
$19.70
|
| Rate for Payer: Cash Price |
$60.26
|
| Rate for Payer: Cash Price |
$60.26
|
| Rate for Payer: Cofinity Commercial |
$64.78
|
| Rate for Payer: Cofinity Commercial |
$52.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$52.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.70
|
| Rate for Payer: Healthscope Commercial |
$67.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.50
|
| Rate for Payer: Mclaren Medicaid |
$10.56
|
| Rate for Payer: Mclaren Medicare |
$19.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.68
|
| Rate for Payer: Meridian Medicaid |
$11.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.03
|
| Rate for Payer: PACE Medicare |
$18.71
|
| Rate for Payer: PACE SWMI |
$19.70
|
| Rate for Payer: PHP Commercial |
$64.03
|
| Rate for Payer: PHP Medicare Advantage |
$19.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.96
|
| Rate for Payer: Priority Health Medicare |
$19.70
|
| Rate for Payer: Priority Health SBD |
$47.46
|
| Rate for Payer: Railroad Medicare Medicare |
$19.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.70
|
| Rate for Payer: UHC Exchange |
$37.65
|
| Rate for Payer: UHC Medicare Advantage |
$19.70
|
| Rate for Payer: UHCCP Medicaid |
$10.56
|
| Rate for Payer: UMR Bronson Commercial |
$27.87
|
| Rate for Payer: VA VA |
$19.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.50
|
|
|
HC FELBAMATE (FELBATOL)
|
Facility
|
OP
|
$62.42
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100470
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.99 |
| Max. Negotiated Rate |
$56.18 |
| Rate for Payer: Aetna American Axle |
$40.57
|
| Rate for Payer: Aetna Commercial |
$53.06
|
| Rate for Payer: Aetna Medicare |
$19.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.30
|
| Rate for Payer: BCBS Complete |
$10.49
|
| Rate for Payer: BCBS MAPPO |
$18.64
|
| Rate for Payer: BCN Medicare Advantage |
$18.64
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cofinity Commercial |
$53.68
|
| Rate for Payer: Cofinity Commercial |
$43.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.64
|
| Rate for Payer: Healthscope Commercial |
$56.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.81
|
| Rate for Payer: Mclaren Medicaid |
$9.99
|
| Rate for Payer: Mclaren Medicare |
$18.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.57
|
| Rate for Payer: Meridian Medicaid |
$10.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.06
|
| Rate for Payer: PACE Medicare |
$17.71
|
| Rate for Payer: PACE SWMI |
$18.64
|
| Rate for Payer: PHP Commercial |
$53.06
|
| Rate for Payer: PHP Medicare Advantage |
$18.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.57
|
| Rate for Payer: Priority Health Medicare |
$18.64
|
| Rate for Payer: Priority Health SBD |
$39.32
|
| Rate for Payer: Railroad Medicare Medicare |
$18.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.64
|
| Rate for Payer: UHC Exchange |
$35.62
|
| Rate for Payer: UHC Medicare Advantage |
$18.64
|
| Rate for Payer: UHCCP Medicaid |
$9.99
|
| Rate for Payer: UMR Bronson Commercial |
$23.10
|
| Rate for Payer: VA VA |
$18.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.81
|
|
|
HC FELBAMATE (FELBATOL)
|
Facility
|
IP
|
$62.42
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100470
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.46 |
| Max. Negotiated Rate |
$56.18 |
| Rate for Payer: Aetna American Axle |
$40.57
|
| Rate for Payer: Aetna Commercial |
$53.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.57
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cofinity Commercial |
$43.69
|
| Rate for Payer: Cofinity Commercial |
$53.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.94
|
| Rate for Payer: Healthscope Commercial |
$56.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.06
|
| Rate for Payer: PHP Commercial |
$53.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.57
|
| Rate for Payer: Priority Health SBD |
$39.32
|
| Rate for Payer: UMR Bronson Commercial |
$27.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.81
|
|
|
HC FEMOSTOP
|
Facility
|
IP
|
$479.81
|
|
| Hospital Charge Code |
62200003
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$211.12 |
| Max. Negotiated Rate |
$431.83 |
| Rate for Payer: Aetna American Axle |
$311.88
|
| Rate for Payer: Aetna Commercial |
$407.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$311.88
|
| Rate for Payer: Cash Price |
$383.85
|
| Rate for Payer: Cofinity Commercial |
$335.87
|
| Rate for Payer: Cofinity Commercial |
$412.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$335.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$383.85
|
| Rate for Payer: Healthscope Commercial |
$431.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$335.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$359.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$407.84
|
| Rate for Payer: PHP Commercial |
$407.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$311.88
|
| Rate for Payer: Priority Health SBD |
$302.28
|
| Rate for Payer: UMR Bronson Commercial |
$211.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$359.86
|
|
|
HC FEMOSTOP
|
Facility
|
OP
|
$479.81
|
|
| Hospital Charge Code |
62200003
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$177.53 |
| Max. Negotiated Rate |
$431.83 |
| Rate for Payer: Aetna American Axle |
$311.88
|
| Rate for Payer: Aetna Commercial |
$407.84
|
| Rate for Payer: Aetna Medicare |
$239.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$311.88
|
| Rate for Payer: BCBS Complete |
$191.92
|
| Rate for Payer: Cash Price |
$383.85
|
| Rate for Payer: Cofinity Commercial |
$335.87
|
| Rate for Payer: Cofinity Commercial |
$412.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$335.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$383.85
|
| Rate for Payer: Healthscope Commercial |
$431.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$335.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$359.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$407.84
|
| Rate for Payer: PHP Commercial |
$407.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$311.88
|
| Rate for Payer: Priority Health SBD |
$302.28
|
| Rate for Payer: UMR Bronson Commercial |
$177.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$359.86
|
|
|
HC FEMUR 1 VIEW
|
Facility
|
IP
|
$356.50
|
|
|
Service Code
|
CPT 73551
|
| Hospital Charge Code |
32000315
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$156.86 |
| Max. Negotiated Rate |
$320.85 |
| Rate for Payer: Aetna American Axle |
$231.72
|
| Rate for Payer: Aetna Commercial |
$303.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$231.72
|
| Rate for Payer: Cash Price |
$285.20
|
| Rate for Payer: Cofinity Commercial |
$249.55
|
| Rate for Payer: Cofinity Commercial |
$306.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$249.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$285.20
|
| Rate for Payer: Healthscope Commercial |
$320.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$249.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$267.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$303.02
|
| Rate for Payer: PHP Commercial |
$303.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$231.72
|
| Rate for Payer: Priority Health SBD |
$224.59
|
| Rate for Payer: UMR Bronson Commercial |
$156.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$267.38
|
|
|
HC FEMUR 1 VIEW
|
Facility
|
OP
|
$356.50
|
|
|
Service Code
|
CPT 73551
|
| Hospital Charge Code |
32000315
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$46.03 |
| Max. Negotiated Rate |
$320.85 |
| Rate for Payer: Aetna American Axle |
$231.72
|
| Rate for Payer: Aetna Commercial |
$303.02
|
| Rate for Payer: Aetna Medicare |
$89.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$231.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$107.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$107.34
|
| Rate for Payer: BCBS Complete |
$48.33
|
| Rate for Payer: BCBS MAPPO |
$85.87
|
| Rate for Payer: BCN Medicare Advantage |
$85.87
|
| Rate for Payer: Cash Price |
$285.20
|
| Rate for Payer: Cash Price |
$285.20
|
| Rate for Payer: Cofinity Commercial |
$306.59
|
| Rate for Payer: Cofinity Commercial |
$249.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$249.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$285.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.87
|
| Rate for Payer: Healthscope Commercial |
$320.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$249.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$267.38
|
| Rate for Payer: Mclaren Medicaid |
$46.03
|
| Rate for Payer: Mclaren Medicare |
$85.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.16
|
| Rate for Payer: Meridian Medicaid |
$48.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$98.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$303.02
|
| Rate for Payer: PACE Medicare |
$81.58
|
| Rate for Payer: PACE SWMI |
$85.87
|
| Rate for Payer: PHP Commercial |
$303.02
|
| Rate for Payer: PHP Medicare Advantage |
$85.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$231.72
|
| Rate for Payer: Priority Health Medicare |
$85.87
|
| Rate for Payer: Priority Health SBD |
$224.59
|
| Rate for Payer: Railroad Medicare Medicare |
$85.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$241.72
|
| Rate for Payer: UHC Core |
$262.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$85.87
|
| Rate for Payer: UHC Exchange |
$164.11
|
| Rate for Payer: UHC Medicare Advantage |
$85.87
|
| Rate for Payer: UHCCP Medicaid |
$46.03
|
| Rate for Payer: UMR Bronson Commercial |
$131.91
|
| Rate for Payer: VA VA |
$85.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$267.38
|
|
|
HC FEMUR 2 VIEWS
|
Facility
|
IP
|
$356.50
|
|
|
Service Code
|
CPT 73552
|
| Hospital Charge Code |
32000316
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$156.86 |
| Max. Negotiated Rate |
$320.85 |
| Rate for Payer: Aetna American Axle |
$231.72
|
| Rate for Payer: Aetna Commercial |
$303.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$231.72
|
| Rate for Payer: Cash Price |
$285.20
|
| Rate for Payer: Cofinity Commercial |
$249.55
|
| Rate for Payer: Cofinity Commercial |
$306.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$249.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$285.20
|
| Rate for Payer: Healthscope Commercial |
$320.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$249.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$267.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$303.02
|
| Rate for Payer: PHP Commercial |
$303.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$231.72
|
| Rate for Payer: Priority Health SBD |
$224.59
|
| Rate for Payer: UMR Bronson Commercial |
$156.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$267.38
|
|
|
HC FEMUR 2 VIEWS
|
Facility
|
OP
|
$356.50
|
|
|
Service Code
|
CPT 73552
|
| Hospital Charge Code |
32000316
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$46.03 |
| Max. Negotiated Rate |
$320.85 |
| Rate for Payer: Aetna American Axle |
$231.72
|
| Rate for Payer: Aetna Commercial |
$303.02
|
| Rate for Payer: Aetna Medicare |
$89.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$231.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$107.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$107.34
|
| Rate for Payer: BCBS Complete |
$48.33
|
| Rate for Payer: BCBS MAPPO |
$85.87
|
| Rate for Payer: BCN Medicare Advantage |
$85.87
|
| Rate for Payer: Cash Price |
$285.20
|
| Rate for Payer: Cash Price |
$285.20
|
| Rate for Payer: Cofinity Commercial |
$306.59
|
| Rate for Payer: Cofinity Commercial |
$249.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$249.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$285.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.87
|
| Rate for Payer: Healthscope Commercial |
$320.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$249.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$267.38
|
| Rate for Payer: Mclaren Medicaid |
$46.03
|
| Rate for Payer: Mclaren Medicare |
$85.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.16
|
| Rate for Payer: Meridian Medicaid |
$48.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$98.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$303.02
|
| Rate for Payer: PACE Medicare |
$81.58
|
| Rate for Payer: PACE SWMI |
$85.87
|
| Rate for Payer: PHP Commercial |
$303.02
|
| Rate for Payer: PHP Medicare Advantage |
$85.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$231.72
|
| Rate for Payer: Priority Health Medicare |
$85.87
|
| Rate for Payer: Priority Health SBD |
$224.59
|
| Rate for Payer: Railroad Medicare Medicare |
$85.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$241.72
|
| Rate for Payer: UHC Core |
$262.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$85.87
|
| Rate for Payer: UHC Exchange |
$164.11
|
| Rate for Payer: UHC Medicare Advantage |
$85.87
|
| Rate for Payer: UHCCP Medicaid |
$46.03
|
| Rate for Payer: UMR Bronson Commercial |
$131.91
|
| Rate for Payer: VA VA |
$85.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$267.38
|
|
|
HC FENTANYL SERUM LVL
|
Facility
|
OP
|
$202.98
|
|
|
Service Code
|
CPT 80354
|
| Hospital Charge Code |
30100564
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$75.10 |
| Max. Negotiated Rate |
$182.68 |
| Rate for Payer: Aetna American Axle |
$131.94
|
| Rate for Payer: Aetna Commercial |
$172.53
|
| Rate for Payer: Aetna Medicare |
$101.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$131.94
|
| Rate for Payer: BCBS Complete |
$81.19
|
| Rate for Payer: Cash Price |
$162.38
|
| Rate for Payer: Cofinity Commercial |
$142.09
|
| Rate for Payer: Cofinity Commercial |
$174.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$142.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.38
|
| Rate for Payer: Healthscope Commercial |
$182.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$142.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$152.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$172.53
|
| Rate for Payer: PHP Commercial |
$172.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$131.94
|
| Rate for Payer: Priority Health SBD |
$127.88
|
| Rate for Payer: UMR Bronson Commercial |
$75.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$152.24
|
|
|
HC FENTANYL SERUM LVL
|
Facility
|
IP
|
$202.98
|
|
|
Service Code
|
CPT 80354
|
| Hospital Charge Code |
30100564
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$89.31 |
| Max. Negotiated Rate |
$182.68 |
| Rate for Payer: Aetna American Axle |
$131.94
|
| Rate for Payer: Aetna Commercial |
$172.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$131.94
|
| Rate for Payer: Cash Price |
$162.38
|
| Rate for Payer: Cofinity Commercial |
$142.09
|
| Rate for Payer: Cofinity Commercial |
$174.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$142.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.38
|
| Rate for Payer: Healthscope Commercial |
$182.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$142.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$152.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$172.53
|
| Rate for Payer: PHP Commercial |
$172.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$131.94
|
| Rate for Payer: Priority Health SBD |
$127.88
|
| Rate for Payer: UMR Bronson Commercial |
$89.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$152.24
|
|
|
HC FENTANYL UR
|
Facility
|
IP
|
$234.60
|
|
|
Service Code
|
CPT 80354
|
| Hospital Charge Code |
30100609
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$103.22 |
| Max. Negotiated Rate |
$211.14 |
| Rate for Payer: Aetna American Axle |
$152.49
|
| Rate for Payer: Aetna Commercial |
$199.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.49
|
| Rate for Payer: Cash Price |
$187.68
|
| Rate for Payer: Cofinity Commercial |
$164.22
|
| Rate for Payer: Cofinity Commercial |
$201.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$164.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.68
|
| Rate for Payer: Healthscope Commercial |
$211.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$164.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$175.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$199.41
|
| Rate for Payer: PHP Commercial |
$199.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.49
|
| Rate for Payer: Priority Health SBD |
$147.80
|
| Rate for Payer: UMR Bronson Commercial |
$103.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$175.95
|
|
|
HC FENTANYL UR
|
Facility
|
OP
|
$234.60
|
|
|
Service Code
|
CPT 80354
|
| Hospital Charge Code |
30100609
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$86.80 |
| Max. Negotiated Rate |
$211.14 |
| Rate for Payer: Aetna American Axle |
$152.49
|
| Rate for Payer: Aetna Commercial |
$199.41
|
| Rate for Payer: Aetna Medicare |
$117.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.49
|
| Rate for Payer: BCBS Complete |
$93.84
|
| Rate for Payer: Cash Price |
$187.68
|
| Rate for Payer: Cofinity Commercial |
$164.22
|
| Rate for Payer: Cofinity Commercial |
$201.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$164.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.68
|
| Rate for Payer: Healthscope Commercial |
$211.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$164.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$175.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$199.41
|
| Rate for Payer: PHP Commercial |
$199.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.49
|
| Rate for Payer: Priority Health SBD |
$147.80
|
| Rate for Payer: UMR Bronson Commercial |
$86.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$175.95
|
|
