|
HC GASTRIN LEVEL
|
Facility
|
IP
|
$42.66
|
|
|
Service Code
|
CPT 82941
|
| Hospital Charge Code |
30100220
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.77 |
| Max. Negotiated Rate |
$38.39 |
| Rate for Payer: Aetna American Axle |
$27.73
|
| Rate for Payer: Aetna Commercial |
$36.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.73
|
| Rate for Payer: Cash Price |
$34.13
|
| Rate for Payer: Cofinity Commercial |
$29.86
|
| Rate for Payer: Cofinity Commercial |
$36.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$29.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.13
|
| Rate for Payer: Healthscope Commercial |
$38.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.26
|
| Rate for Payer: PHP Commercial |
$36.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.73
|
| Rate for Payer: Priority Health SBD |
$26.88
|
| Rate for Payer: UMR Bronson Commercial |
$18.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.00
|
|
|
HC GASTRIN LEVEL
|
Facility
|
OP
|
$42.66
|
|
|
Service Code
|
CPT 82941
|
| Hospital Charge Code |
30100220
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.45 |
| Max. Negotiated Rate |
$49.63 |
| Rate for Payer: Aetna American Axle |
$27.73
|
| Rate for Payer: Aetna Commercial |
$36.26
|
| Rate for Payer: Aetna Medicare |
$18.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.04
|
| Rate for Payer: BCBS Complete |
$9.92
|
| Rate for Payer: BCBS MAPPO |
$17.63
|
| Rate for Payer: BCN Medicare Advantage |
$17.63
|
| Rate for Payer: Cash Price |
$34.13
|
| Rate for Payer: Cash Price |
$34.13
|
| Rate for Payer: Cofinity Commercial |
$36.69
|
| Rate for Payer: Cofinity Commercial |
$29.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$29.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.63
|
| Rate for Payer: Healthscope Commercial |
$38.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.00
|
| Rate for Payer: Mclaren Medicaid |
$9.45
|
| Rate for Payer: Mclaren Medicare |
$17.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.51
|
| Rate for Payer: Meridian Medicaid |
$9.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.26
|
| Rate for Payer: PACE Medicare |
$16.75
|
| Rate for Payer: PACE SWMI |
$17.63
|
| Rate for Payer: PHP Commercial |
$36.26
|
| Rate for Payer: PHP Medicare Advantage |
$17.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.73
|
| Rate for Payer: Priority Health Medicare |
$17.63
|
| Rate for Payer: Priority Health SBD |
$26.88
|
| Rate for Payer: Railroad Medicare Medicare |
$17.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.63
|
| Rate for Payer: UHC Exchange |
$33.69
|
| Rate for Payer: UHC Medicare Advantage |
$17.63
|
| Rate for Payer: UHCCP Medicaid |
$9.45
|
| Rate for Payer: UMR Bronson Commercial |
$15.78
|
| Rate for Payer: VA VA |
$17.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.00
|
|
|
HC GASTROGRAFIN PER ML
|
Facility
|
IP
|
$3.48
|
|
|
Service Code
|
HCPCS Q9963
|
| Hospital Charge Code |
63600010
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.53 |
| Max. Negotiated Rate |
$3.13 |
| Rate for Payer: Aetna American Axle |
$2.26
|
| Rate for Payer: Aetna Commercial |
$2.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.26
|
| Rate for Payer: Cash Price |
$2.78
|
| Rate for Payer: Cofinity Commercial |
$2.44
|
| Rate for Payer: Cofinity Commercial |
$2.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.78
|
| Rate for Payer: Healthscope Commercial |
$3.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.96
|
| Rate for Payer: PHP Commercial |
$2.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.26
|
| Rate for Payer: Priority Health SBD |
$2.19
|
| Rate for Payer: UMR Bronson Commercial |
$1.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.61
|
|
|
HC GASTROGRAFIN PER ML
|
Facility
|
OP
|
$3.48
|
|
|
Service Code
|
HCPCS Q9963
|
| Hospital Charge Code |
63600010
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.29 |
| Max. Negotiated Rate |
$3.13 |
| Rate for Payer: Aetna American Axle |
$2.26
|
| Rate for Payer: Aetna Commercial |
$2.96
|
| Rate for Payer: Aetna Medicare |
$1.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.26
|
| Rate for Payer: BCBS Complete |
$1.39
|
| Rate for Payer: Cash Price |
$2.78
|
| Rate for Payer: Cofinity Commercial |
$2.44
|
| Rate for Payer: Cofinity Commercial |
$2.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.78
|
| Rate for Payer: Healthscope Commercial |
$3.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.96
|
| Rate for Payer: PHP Commercial |
$2.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.26
|
| Rate for Payer: Priority Health SBD |
$2.19
|
| Rate for Payer: UMR Bronson Commercial |
$1.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.61
|
|
|
HC GASTROSCOPY
|
Facility
|
OP
|
$1,962.15
|
|
| Hospital Charge Code |
36000047
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$726.00 |
| Max. Negotiated Rate |
$1,765.93 |
| Rate for Payer: Aetna American Axle |
$1,275.40
|
| Rate for Payer: Aetna Commercial |
$1,667.83
|
| Rate for Payer: Aetna Medicare |
$981.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,275.40
|
| Rate for Payer: BCBS Complete |
$784.86
|
| Rate for Payer: Cash Price |
$1,569.72
|
| Rate for Payer: Cofinity Commercial |
$1,373.51
|
| Rate for Payer: Cofinity Commercial |
$1,687.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,373.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,569.72
|
| Rate for Payer: Healthscope Commercial |
$1,765.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,373.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,471.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,667.83
|
| Rate for Payer: PHP Commercial |
$1,667.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,275.40
|
| Rate for Payer: Priority Health SBD |
$1,236.15
|
| Rate for Payer: UMR Bronson Commercial |
$726.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,471.61
|
|
|
HC GASTROSCOPY
|
Facility
|
IP
|
$1,962.15
|
|
| Hospital Charge Code |
36000047
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$863.35 |
| Max. Negotiated Rate |
$1,765.93 |
| Rate for Payer: Aetna American Axle |
$1,275.40
|
| Rate for Payer: Aetna Commercial |
$1,667.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,275.40
|
| Rate for Payer: Cash Price |
$1,569.72
|
| Rate for Payer: Cofinity Commercial |
$1,373.51
|
| Rate for Payer: Cofinity Commercial |
$1,687.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,373.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,569.72
|
| Rate for Payer: Healthscope Commercial |
$1,765.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,373.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,471.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,667.83
|
| Rate for Payer: PHP Commercial |
$1,667.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,275.40
|
| Rate for Payer: Priority Health SBD |
$1,236.15
|
| Rate for Payer: UMR Bronson Commercial |
$863.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,471.61
|
|
|
HC GEL SKIN/WOUND ANTIMICROBIAL ANASEPT
|
Facility
|
OP
|
$80.22
|
|
| Hospital Charge Code |
27000708
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$29.68 |
| Max. Negotiated Rate |
$72.20 |
| Rate for Payer: Aetna American Axle |
$52.14
|
| Rate for Payer: Aetna Commercial |
$68.19
|
| Rate for Payer: Aetna Medicare |
$40.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.14
|
| Rate for Payer: BCBS Complete |
$32.09
|
| Rate for Payer: Cash Price |
$64.18
|
| Rate for Payer: Cofinity Commercial |
$56.15
|
| Rate for Payer: Cofinity Commercial |
$68.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$56.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.18
|
| Rate for Payer: Healthscope Commercial |
$72.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.19
|
| Rate for Payer: PHP Commercial |
$68.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.14
|
| Rate for Payer: Priority Health SBD |
$50.54
|
| Rate for Payer: UMR Bronson Commercial |
$29.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.16
|
|
|
HC GEL SKIN/WOUND ANTIMICROBIAL ANASEPT
|
Facility
|
IP
|
$80.22
|
|
| Hospital Charge Code |
27000708
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$35.30 |
| Max. Negotiated Rate |
$72.20 |
| Rate for Payer: Aetna American Axle |
$52.14
|
| Rate for Payer: Aetna Commercial |
$68.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.14
|
| Rate for Payer: Cash Price |
$64.18
|
| Rate for Payer: Cofinity Commercial |
$56.15
|
| Rate for Payer: Cofinity Commercial |
$68.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$56.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.18
|
| Rate for Payer: Healthscope Commercial |
$72.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.19
|
| Rate for Payer: PHP Commercial |
$68.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.14
|
| Rate for Payer: Priority Health SBD |
$50.54
|
| Rate for Payer: UMR Bronson Commercial |
$35.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.16
|
|
|
HC GELSYN-3 FOR INTRA-ARTICULAR INJ, 0.1 MG
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS J7328
|
| Hospital Charge Code |
63600259
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna American Axle |
$0.01
|
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$0.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.01
|
| Rate for Payer: Healthscope Commercial |
$0.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: PHP Commercial |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.01
|
| Rate for Payer: Priority Health SBD |
$0.01
|
| Rate for Payer: UMR Bronson Commercial |
$0.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.01
|
|
|
HC GELSYN-3 FOR INTRA-ARTICULAR INJ, 0.1 MG
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS J7328
|
| Hospital Charge Code |
63600259
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna American Axle |
$0.01
|
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: Aetna Medicare |
$0.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.01
|
| Rate for Payer: BCBS Complete |
$0.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$0.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.01
|
| Rate for Payer: Healthscope Commercial |
$0.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: PHP Commercial |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.01
|
| Rate for Payer: Priority Health SBD |
$0.01
|
| Rate for Payer: UMR Bronson Commercial |
$0.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.01
|
|
|
HC GEN ANES ADDL 15 MIN
|
Facility
|
OP
|
$149.92
|
|
| Hospital Charge Code |
37000001
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$55.47 |
| Max. Negotiated Rate |
$134.93 |
| Rate for Payer: Aetna American Axle |
$97.45
|
| Rate for Payer: Aetna Commercial |
$127.43
|
| Rate for Payer: Aetna Medicare |
$74.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.45
|
| Rate for Payer: BCBS Complete |
$59.97
|
| Rate for Payer: Cash Price |
$119.94
|
| Rate for Payer: Cofinity Commercial |
$104.94
|
| Rate for Payer: Cofinity Commercial |
$128.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$104.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.94
|
| Rate for Payer: Healthscope Commercial |
$134.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$104.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.43
|
| Rate for Payer: PHP Commercial |
$127.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.45
|
| Rate for Payer: Priority Health SBD |
$94.45
|
| Rate for Payer: UMR Bronson Commercial |
$55.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.44
|
|
|
HC GEN ANES ADDL 15 MIN
|
Facility
|
IP
|
$149.92
|
|
| Hospital Charge Code |
37000001
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$65.96 |
| Max. Negotiated Rate |
$134.93 |
| Rate for Payer: Aetna American Axle |
$97.45
|
| Rate for Payer: Aetna Commercial |
$127.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.45
|
| Rate for Payer: Cash Price |
$119.94
|
| Rate for Payer: Cofinity Commercial |
$104.94
|
| Rate for Payer: Cofinity Commercial |
$128.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$104.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.94
|
| Rate for Payer: Healthscope Commercial |
$134.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$104.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.43
|
| Rate for Payer: PHP Commercial |
$127.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.45
|
| Rate for Payer: Priority Health SBD |
$94.45
|
| Rate for Payer: UMR Bronson Commercial |
$65.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.44
|
|
|
HC GEN ANES INIT 30 MIN
|
Facility
|
OP
|
$589.72
|
|
| Hospital Charge Code |
37000002
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$218.20 |
| Max. Negotiated Rate |
$530.75 |
| Rate for Payer: Aetna American Axle |
$383.32
|
| Rate for Payer: Aetna Commercial |
$501.26
|
| Rate for Payer: Aetna Medicare |
$294.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$383.32
|
| Rate for Payer: BCBS Complete |
$235.89
|
| Rate for Payer: Cash Price |
$471.78
|
| Rate for Payer: Cofinity Commercial |
$412.80
|
| Rate for Payer: Cofinity Commercial |
$507.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$412.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$471.78
|
| Rate for Payer: Healthscope Commercial |
$530.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$412.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$442.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$501.26
|
| Rate for Payer: PHP Commercial |
$501.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$383.32
|
| Rate for Payer: Priority Health SBD |
$371.52
|
| Rate for Payer: UMR Bronson Commercial |
$218.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$442.29
|
|
|
HC GEN ANES INIT 30 MIN
|
Facility
|
IP
|
$589.72
|
|
| Hospital Charge Code |
37000002
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$259.48 |
| Max. Negotiated Rate |
$530.75 |
| Rate for Payer: Aetna American Axle |
$383.32
|
| Rate for Payer: Aetna Commercial |
$501.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$383.32
|
| Rate for Payer: Cash Price |
$471.78
|
| Rate for Payer: Cofinity Commercial |
$412.80
|
| Rate for Payer: Cofinity Commercial |
$507.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$412.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$471.78
|
| Rate for Payer: Healthscope Commercial |
$530.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$412.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$442.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$501.26
|
| Rate for Payer: PHP Commercial |
$501.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$383.32
|
| Rate for Payer: Priority Health SBD |
$371.52
|
| Rate for Payer: UMR Bronson Commercial |
$259.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$442.29
|
|
|
HC GENERAL ANESTHESIA PER MINUTE
|
Facility
|
OP
|
$16.00
|
|
| Hospital Charge Code |
37000024
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$5.92 |
| Max. Negotiated Rate |
$14.40 |
| Rate for Payer: Aetna American Axle |
$10.40
|
| Rate for Payer: Aetna Commercial |
$13.60
|
| Rate for Payer: Aetna Medicare |
$8.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.40
|
| Rate for Payer: BCBS Complete |
$6.40
|
| Rate for Payer: Cash Price |
$12.80
|
| Rate for Payer: Cofinity Commercial |
$11.20
|
| Rate for Payer: Cofinity Commercial |
$13.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.80
|
| Rate for Payer: Healthscope Commercial |
$14.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.60
|
| Rate for Payer: PHP Commercial |
$13.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.40
|
| Rate for Payer: Priority Health SBD |
$10.08
|
| Rate for Payer: UMR Bronson Commercial |
$5.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.00
|
|
|
HC GENERAL ANESTHESIA PER MINUTE
|
Facility
|
IP
|
$16.00
|
|
| Hospital Charge Code |
37000024
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$7.04 |
| Max. Negotiated Rate |
$14.40 |
| Rate for Payer: Aetna American Axle |
$10.40
|
| Rate for Payer: Aetna Commercial |
$13.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.40
|
| Rate for Payer: Cash Price |
$12.80
|
| Rate for Payer: Cofinity Commercial |
$11.20
|
| Rate for Payer: Cofinity Commercial |
$13.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.80
|
| Rate for Payer: Healthscope Commercial |
$14.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.60
|
| Rate for Payer: PHP Commercial |
$13.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.40
|
| Rate for Payer: Priority Health SBD |
$10.08
|
| Rate for Payer: UMR Bronson Commercial |
$7.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.00
|
|
|
HC GENERAL HEALTH PANEL
|
Facility
|
OP
|
$230.72
|
|
|
Service Code
|
CPT 80050
|
| Hospital Charge Code |
30100011
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$85.37 |
| Max. Negotiated Rate |
$207.65 |
| Rate for Payer: Aetna American Axle |
$149.97
|
| Rate for Payer: Aetna Commercial |
$196.11
|
| Rate for Payer: Aetna Medicare |
$115.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$149.97
|
| Rate for Payer: BCBS Complete |
$92.29
|
| Rate for Payer: Cash Price |
$184.58
|
| Rate for Payer: Cofinity Commercial |
$161.50
|
| Rate for Payer: Cofinity Commercial |
$198.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$161.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$184.58
|
| Rate for Payer: Healthscope Commercial |
$207.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$161.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$173.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$196.11
|
| Rate for Payer: PHP Commercial |
$196.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.97
|
| Rate for Payer: Priority Health SBD |
$145.35
|
| Rate for Payer: UMR Bronson Commercial |
$85.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$173.04
|
|
|
HC GENERAL HEALTH PANEL
|
Facility
|
IP
|
$230.72
|
|
|
Service Code
|
CPT 80050
|
| Hospital Charge Code |
30100011
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$101.52 |
| Max. Negotiated Rate |
$207.65 |
| Rate for Payer: Aetna American Axle |
$149.97
|
| Rate for Payer: Aetna Commercial |
$196.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$149.97
|
| Rate for Payer: Cash Price |
$184.58
|
| Rate for Payer: Cofinity Commercial |
$161.50
|
| Rate for Payer: Cofinity Commercial |
$198.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$161.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$184.58
|
| Rate for Payer: Healthscope Commercial |
$207.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$161.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$173.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$196.11
|
| Rate for Payer: PHP Commercial |
$196.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.97
|
| Rate for Payer: Priority Health SBD |
$145.35
|
| Rate for Payer: UMR Bronson Commercial |
$101.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$173.04
|
|
|
HC GENTAMICIN LEVEL
|
Facility
|
IP
|
$123.01
|
|
|
Service Code
|
CPT 80170
|
| Hospital Charge Code |
30100030
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$54.12 |
| Max. Negotiated Rate |
$110.71 |
| Rate for Payer: Aetna American Axle |
$79.96
|
| Rate for Payer: Aetna Commercial |
$104.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.96
|
| Rate for Payer: Cash Price |
$98.41
|
| Rate for Payer: Cofinity Commercial |
$105.79
|
| Rate for Payer: Cofinity Commercial |
$86.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$86.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.41
|
| Rate for Payer: Healthscope Commercial |
$110.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$86.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$92.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.56
|
| Rate for Payer: PHP Commercial |
$104.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.96
|
| Rate for Payer: Priority Health SBD |
$77.50
|
| Rate for Payer: UMR Bronson Commercial |
$54.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$92.26
|
|
|
HC GENTAMICIN LEVEL
|
Facility
|
OP
|
$123.01
|
|
|
Service Code
|
CPT 80170
|
| Hospital Charge Code |
30100030
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.78 |
| Max. Negotiated Rate |
$110.71 |
| Rate for Payer: Aetna American Axle |
$79.96
|
| Rate for Payer: Aetna Commercial |
$104.56
|
| Rate for Payer: Aetna Medicare |
$17.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.48
|
| Rate for Payer: BCBS Complete |
$9.22
|
| Rate for Payer: BCBS MAPPO |
$16.38
|
| Rate for Payer: BCN Medicare Advantage |
$16.38
|
| Rate for Payer: Cash Price |
$98.41
|
| Rate for Payer: Cash Price |
$98.41
|
| Rate for Payer: Cofinity Commercial |
$86.11
|
| Rate for Payer: Cofinity Commercial |
$105.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$86.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.38
|
| Rate for Payer: Healthscope Commercial |
$110.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$86.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$92.26
|
| Rate for Payer: Mclaren Medicaid |
$8.78
|
| Rate for Payer: Mclaren Medicare |
$16.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.20
|
| Rate for Payer: Meridian Medicaid |
$9.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.56
|
| Rate for Payer: PACE Medicare |
$15.56
|
| Rate for Payer: PACE SWMI |
$16.38
|
| Rate for Payer: PHP Commercial |
$104.56
|
| Rate for Payer: PHP Medicare Advantage |
$16.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.96
|
| Rate for Payer: Priority Health Medicare |
$16.38
|
| Rate for Payer: Priority Health SBD |
$77.50
|
| Rate for Payer: Railroad Medicare Medicare |
$16.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.38
|
| Rate for Payer: UHC Exchange |
$31.30
|
| Rate for Payer: UHC Medicare Advantage |
$16.38
|
| Rate for Payer: UHCCP Medicaid |
$8.78
|
| Rate for Payer: UMR Bronson Commercial |
$45.51
|
| Rate for Payer: VA VA |
$16.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$92.26
|
|
|
HC GGTP
|
Facility
|
OP
|
$69.36
|
|
|
Service Code
|
CPT 82977
|
| Hospital Charge Code |
30100229
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.86 |
| 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 |
$7.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.00
|
| Rate for Payer: BCBS Complete |
$4.05
|
| Rate for Payer: BCBS MAPPO |
$7.20
|
| Rate for Payer: BCN Medicare Advantage |
$7.20
|
| Rate for Payer: Cash Price |
$55.49
|
| Rate for Payer: Cash Price |
$55.49
|
| Rate for Payer: Cofinity Commercial |
$59.65
|
| Rate for Payer: Cofinity Commercial |
$48.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$48.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.20
|
| 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 |
$3.86
|
| Rate for Payer: Mclaren Medicare |
$7.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.56
|
| Rate for Payer: Meridian Medicaid |
$4.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.96
|
| Rate for Payer: PACE Medicare |
$6.84
|
| Rate for Payer: PACE SWMI |
$7.20
|
| Rate for Payer: PHP Commercial |
$58.96
|
| Rate for Payer: PHP Medicare Advantage |
$7.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.08
|
| Rate for Payer: Priority Health Medicare |
$7.20
|
| Rate for Payer: Priority Health SBD |
$43.70
|
| Rate for Payer: Railroad Medicare Medicare |
$7.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.20
|
| Rate for Payer: UHC Exchange |
$13.76
|
| Rate for Payer: UHC Medicare Advantage |
$7.20
|
| Rate for Payer: UHCCP Medicaid |
$3.86
|
| Rate for Payer: UMR Bronson Commercial |
$25.66
|
| Rate for Payer: VA VA |
$7.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.02
|
|
|
HC GGTP
|
Facility
|
IP
|
$69.36
|
|
|
Service Code
|
CPT 82977
|
| Hospital Charge Code |
30100229
|
|
Hospital Revenue Code
|
301
|
| 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: Cofinity Medicare Advantage |
$48.55
|
| 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 Commercial |
$58.96
|
| Rate for Payer: PHP Commercial |
$58.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.08
|
| 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 GIARDIA SCREEN
|
Facility
|
IP
|
$45.78
|
|
|
Service Code
|
CPT 87329
|
| Hospital Charge Code |
30600119
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$20.14 |
| Max. Negotiated Rate |
$41.20 |
| Rate for Payer: Aetna American Axle |
$29.76
|
| Rate for Payer: Aetna Commercial |
$38.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.76
|
| Rate for Payer: Cash Price |
$36.62
|
| Rate for Payer: Cofinity Commercial |
$32.05
|
| Rate for Payer: Cofinity Commercial |
$39.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$32.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.62
|
| Rate for Payer: Healthscope Commercial |
$41.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.91
|
| Rate for Payer: PHP Commercial |
$38.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.76
|
| Rate for Payer: Priority Health SBD |
$28.84
|
| Rate for Payer: UMR Bronson Commercial |
$20.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.34
|
|
|
HC GIARDIA SCREEN
|
Facility
|
OP
|
$45.78
|
|
|
Service Code
|
CPT 87329
|
| Hospital Charge Code |
30600119
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.42 |
| Max. Negotiated Rate |
$41.20 |
| Rate for Payer: Aetna American Axle |
$29.76
|
| Rate for Payer: Aetna Commercial |
$38.91
|
| Rate for Payer: Aetna Medicare |
$12.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.97
|
| Rate for Payer: BCBS Complete |
$6.74
|
| Rate for Payer: BCBS MAPPO |
$11.98
|
| Rate for Payer: BCN Medicare Advantage |
$11.98
|
| Rate for Payer: Cash Price |
$36.62
|
| Rate for Payer: Cash Price |
$36.62
|
| Rate for Payer: Cofinity Commercial |
$39.37
|
| Rate for Payer: Cofinity Commercial |
$32.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$32.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.98
|
| Rate for Payer: Healthscope Commercial |
$41.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.34
|
| Rate for Payer: Mclaren Medicaid |
$6.42
|
| Rate for Payer: Mclaren Medicare |
$11.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.58
|
| Rate for Payer: Meridian Medicaid |
$6.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.91
|
| Rate for Payer: PACE Medicare |
$11.38
|
| Rate for Payer: PACE SWMI |
$11.98
|
| Rate for Payer: PHP Commercial |
$38.91
|
| Rate for Payer: PHP Medicare Advantage |
$11.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.76
|
| Rate for Payer: Priority Health Medicare |
$11.98
|
| Rate for Payer: Priority Health SBD |
$28.84
|
| Rate for Payer: Railroad Medicare Medicare |
$11.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.98
|
| Rate for Payer: UHC Exchange |
$22.89
|
| Rate for Payer: UHC Medicare Advantage |
$11.98
|
| Rate for Payer: UHCCP Medicaid |
$6.42
|
| Rate for Payer: UMR Bronson Commercial |
$16.94
|
| Rate for Payer: VA VA |
$11.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.34
|
|
|
HC GI CONVERT G TO GJ TUBE W
|
Facility
|
IP
|
$1,796.43
|
|
|
Service Code
|
CPT 49446
|
| Hospital Charge Code |
36100228
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$790.43 |
| Max. Negotiated Rate |
$1,616.79 |
| Rate for Payer: Aetna American Axle |
$1,167.68
|
| Rate for Payer: Aetna Commercial |
$1,526.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,167.68
|
| Rate for Payer: Cash Price |
$1,437.14
|
| Rate for Payer: Cofinity Commercial |
$1,257.50
|
| Rate for Payer: Cofinity Commercial |
$1,544.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,257.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,437.14
|
| Rate for Payer: Healthscope Commercial |
$1,616.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,257.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,347.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,526.97
|
| Rate for Payer: PHP Commercial |
$1,526.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,167.68
|
| Rate for Payer: Priority Health SBD |
$1,131.75
|
| Rate for Payer: UMR Bronson Commercial |
$790.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,347.32
|
|
