HC RO TREATMENT DEVICE INTERMED
|
Facility
|
OP
|
$159.00
|
|
Service Code
|
CPT 77333
|
Hospital Charge Code |
33300037
|
Hospital Revenue Code
|
333
|
Min. Negotiated Rate |
$17.69 |
Max. Negotiated Rate |
$979.00 |
Rate for Payer: Aetna American Axle |
$103.35
|
Rate for Payer: Aetna American Axle |
$332.16
|
Rate for Payer: Aetna Commercial |
$135.15
|
Rate for Payer: Aetna Commercial |
$434.37
|
Rate for Payer: Aetna Medicare |
$125.43
|
Rate for Payer: Aetna Medicare |
$125.43
|
Rate for Payer: Aetna New Business (MI Preferred) |
$103.35
|
Rate for Payer: Aetna New Business (MI Preferred) |
$332.16
|
Rate for Payer: Allen County Amish Medical Aid Commercial |
$150.76
|
Rate for Payer: Allen County Amish Medical Aid Commercial |
$150.76
|
Rate for Payer: Amish Plain Church Group Commercial |
$150.76
|
Rate for Payer: Amish Plain Church Group Commercial |
$150.76
|
Rate for Payer: BCBS Complete |
$69.28
|
Rate for Payer: BCBS Complete |
$69.28
|
Rate for Payer: BCBS MAPPO |
$120.61
|
Rate for Payer: BCBS MAPPO |
$120.61
|
Rate for Payer: BCBS Trust/PPO |
$17.69
|
Rate for Payer: BCBS Trust/PPO |
$17.69
|
Rate for Payer: BCN Medicare Advantage |
$120.61
|
Rate for Payer: BCN Medicare Advantage |
$120.61
|
Rate for Payer: Cash Price |
$127.20
|
Rate for Payer: Cash Price |
$127.20
|
Rate for Payer: Cash Price |
$408.82
|
Rate for Payer: Cash Price |
$408.82
|
Rate for Payer: Cash Price |
$408.82
|
Rate for Payer: Cash Price |
$127.20
|
Rate for Payer: Cofinity Commercial |
$439.48
|
Rate for Payer: Cofinity Commercial |
$111.30
|
Rate for Payer: Cofinity Commercial |
$136.74
|
Rate for Payer: Cofinity Commercial |
$357.71
|
Rate for Payer: Encore Health Key Benefits Commercial |
$408.82
|
Rate for Payer: Encore Health Key Benefits Commercial |
$127.20
|
Rate for Payer: Health Alliance Plan Medicare Advantage |
$120.61
|
Rate for Payer: Health Alliance Plan Medicare Advantage |
$120.61
|
Rate for Payer: Healthscope Commercial |
$459.92
|
Rate for Payer: Healthscope Commercial |
$143.10
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$357.71
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$111.30
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$119.25
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$383.26
|
Rate for Payer: Mclaren Medicaid |
$65.97
|
Rate for Payer: Mclaren Medicaid |
$65.97
|
Rate for Payer: Mclaren Medicare |
$120.61
|
Rate for Payer: Mclaren Medicare |
$120.61
|
Rate for Payer: Meridian Medicaid |
$69.28
|
Rate for Payer: Meridian Medicaid |
$69.28
|
Rate for Payer: Meridian Wellcare - Medicare Advantage |
$126.64
|
Rate for Payer: Meridian Wellcare - Medicare Advantage |
$126.64
|
Rate for Payer: MI Amish Medical Board Commercial |
$138.70
|
Rate for Payer: MI Amish Medical Board Commercial |
$138.70
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$434.37
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$135.15
|
Rate for Payer: PACE Medicare |
$114.58
|
Rate for Payer: PACE Medicare |
$114.58
|
Rate for Payer: PACE SWMI |
$120.61
|
Rate for Payer: PACE SWMI |
$120.61
|
Rate for Payer: PHP Commercial |
$135.15
|
Rate for Payer: PHP Commercial |
$434.37
|
Rate for Payer: PHP Medicare Advantage |
$120.61
|
Rate for Payer: PHP Medicare Advantage |
$120.61
|
Rate for Payer: Priority Health Choice Medicaid |
$65.97
|
Rate for Payer: Priority Health Choice Medicaid |
$65.97
|
Rate for Payer: Priority Health Cigna Priority Health |
$357.71
|
Rate for Payer: Priority Health Cigna Priority Health |
$111.30
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$379.68
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$379.68
|
Rate for Payer: Priority Health Medicare |
$120.61
|
Rate for Payer: Priority Health Medicare |
$120.61
|
Rate for Payer: Priority Health Narrow Network |
$303.74
|
Rate for Payer: Priority Health Narrow Network |
$303.74
|
Rate for Payer: Priority Health SBD |
$321.94
|
Rate for Payer: Priority Health SBD |
$100.17
|
Rate for Payer: Railroad Medicare Medicare |
$120.61
|
Rate for Payer: Railroad Medicare Medicare |
$120.61
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$148.04
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$148.04
|
Rate for Payer: UHC Core |
$979.00
|
Rate for Payer: UHC Core |
$979.00
|
Rate for Payer: UHC Dual Complete DSNP |
$120.61
|
Rate for Payer: UHC Dual Complete DSNP |
$120.61
|
Rate for Payer: UHC Exchange |
$134.58
|
Rate for Payer: UHC Exchange |
$134.58
|
Rate for Payer: UHC Medicare Advantage |
$124.23
|
Rate for Payer: UHC Medicare Advantage |
$124.23
|
Rate for Payer: UMR Bronson Commercial |
$58.83
|
Rate for Payer: UMR Bronson Commercial |
$189.08
|
Rate for Payer: VA VA |
$120.61
|
Rate for Payer: VA VA |
$120.61
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$119.25
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$383.26
|
|
HC RO TREATMENT DEVICE INTERMED
|
Facility
|
IP
|
$159.00
|
|
Service Code
|
CPT 77333
|
Hospital Charge Code |
33300037
|
Hospital Revenue Code
|
333
|
Min. Negotiated Rate |
$69.96 |
Max. Negotiated Rate |
$143.10 |
Rate for Payer: Aetna American Axle |
$103.35
|
Rate for Payer: Aetna American Axle |
$332.16
|
Rate for Payer: Aetna Commercial |
$434.37
|
Rate for Payer: Aetna Commercial |
$135.15
|
Rate for Payer: Aetna New Business (MI Preferred) |
$103.35
|
Rate for Payer: Aetna New Business (MI Preferred) |
$332.16
|
Rate for Payer: Cash Price |
$408.82
|
Rate for Payer: Cash Price |
$127.20
|
Rate for Payer: Cofinity Commercial |
$111.30
|
Rate for Payer: Cofinity Commercial |
$439.48
|
Rate for Payer: Cofinity Commercial |
$357.71
|
Rate for Payer: Cofinity Commercial |
$136.74
|
Rate for Payer: Encore Health Key Benefits Commercial |
$127.20
|
Rate for Payer: Encore Health Key Benefits Commercial |
$408.82
|
Rate for Payer: Healthscope Commercial |
$143.10
|
Rate for Payer: Healthscope Commercial |
$459.92
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$357.71
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$111.30
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$119.25
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$383.26
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$434.37
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$135.15
|
Rate for Payer: PHP Commercial |
$135.15
|
Rate for Payer: PHP Commercial |
$434.37
|
Rate for Payer: Priority Health Cigna Priority Health |
$111.30
|
Rate for Payer: Priority Health Cigna Priority Health |
$357.71
|
Rate for Payer: Priority Health SBD |
$100.17
|
Rate for Payer: Priority Health SBD |
$321.94
|
Rate for Payer: UMR Bronson Commercial |
$69.96
|
Rate for Payer: UMR Bronson Commercial |
$224.85
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$383.26
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$119.25
|
|
HC RO TREATMENT DEVICE SIMPLE
|
Facility
|
OP
|
$339.00
|
|
Service Code
|
CPT 77332
|
Hospital Charge Code |
33300038
|
Hospital Revenue Code
|
333
|
Min. Negotiated Rate |
$38.64 |
Max. Negotiated Rate |
$979.00 |
Rate for Payer: Aetna American Axle |
$220.35
|
Rate for Payer: Aetna American Axle |
$263.87
|
Rate for Payer: Aetna Commercial |
$288.15
|
Rate for Payer: Aetna Commercial |
$345.07
|
Rate for Payer: Aetna Medicare |
$125.43
|
Rate for Payer: Aetna Medicare |
$125.43
|
Rate for Payer: Aetna New Business (MI Preferred) |
$220.35
|
Rate for Payer: Aetna New Business (MI Preferred) |
$263.87
|
Rate for Payer: Allen County Amish Medical Aid Commercial |
$150.76
|
Rate for Payer: Allen County Amish Medical Aid Commercial |
$150.76
|
Rate for Payer: Amish Plain Church Group Commercial |
$150.76
|
Rate for Payer: Amish Plain Church Group Commercial |
$150.76
|
Rate for Payer: BCBS Complete |
$69.28
|
Rate for Payer: BCBS Complete |
$69.28
|
Rate for Payer: BCBS MAPPO |
$120.61
|
Rate for Payer: BCBS MAPPO |
$120.61
|
Rate for Payer: BCBS Trust/PPO |
$100.89
|
Rate for Payer: BCBS Trust/PPO |
$100.89
|
Rate for Payer: BCN Medicare Advantage |
$120.61
|
Rate for Payer: BCN Medicare Advantage |
$120.61
|
Rate for Payer: Cash Price |
$324.77
|
Rate for Payer: Cash Price |
$324.77
|
Rate for Payer: Cash Price |
$271.20
|
Rate for Payer: Cash Price |
$271.20
|
Rate for Payer: Cash Price |
$271.20
|
Rate for Payer: Cash Price |
$324.77
|
Rate for Payer: Cofinity Commercial |
$237.30
|
Rate for Payer: Cofinity Commercial |
$349.13
|
Rate for Payer: Cofinity Commercial |
$284.17
|
Rate for Payer: Cofinity Commercial |
$291.54
|
Rate for Payer: Encore Health Key Benefits Commercial |
$324.77
|
Rate for Payer: Encore Health Key Benefits Commercial |
$271.20
|
Rate for Payer: Health Alliance Plan Medicare Advantage |
$120.61
|
Rate for Payer: Health Alliance Plan Medicare Advantage |
$120.61
|
Rate for Payer: Healthscope Commercial |
$365.36
|
Rate for Payer: Healthscope Commercial |
$305.10
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$237.30
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$284.17
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$304.47
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$254.25
|
Rate for Payer: Mclaren Medicaid |
$65.97
|
Rate for Payer: Mclaren Medicaid |
$65.97
|
Rate for Payer: Mclaren Medicare |
$120.61
|
Rate for Payer: Mclaren Medicare |
$120.61
|
Rate for Payer: Meridian Medicaid |
$69.28
|
Rate for Payer: Meridian Medicaid |
$69.28
|
Rate for Payer: Meridian Wellcare - Medicare Advantage |
$126.64
|
Rate for Payer: Meridian Wellcare - Medicare Advantage |
$126.64
|
Rate for Payer: MI Amish Medical Board Commercial |
$138.70
|
Rate for Payer: MI Amish Medical Board Commercial |
$138.70
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$345.07
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$288.15
|
Rate for Payer: PACE Medicare |
$114.58
|
Rate for Payer: PACE Medicare |
$114.58
|
Rate for Payer: PACE SWMI |
$120.61
|
Rate for Payer: PACE SWMI |
$120.61
|
Rate for Payer: PHP Commercial |
$288.15
|
Rate for Payer: PHP Commercial |
$345.07
|
Rate for Payer: PHP Medicare Advantage |
$120.61
|
Rate for Payer: PHP Medicare Advantage |
$120.61
|
Rate for Payer: Priority Health Choice Medicaid |
$65.97
|
Rate for Payer: Priority Health Choice Medicaid |
$65.97
|
Rate for Payer: Priority Health Cigna Priority Health |
$237.30
|
Rate for Payer: Priority Health Cigna Priority Health |
$284.17
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$379.68
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$379.68
|
Rate for Payer: Priority Health Medicare |
$120.61
|
Rate for Payer: Priority Health Medicare |
$120.61
|
Rate for Payer: Priority Health Narrow Network |
$303.74
|
Rate for Payer: Priority Health Narrow Network |
$303.74
|
Rate for Payer: Priority Health SBD |
$255.75
|
Rate for Payer: Priority Health SBD |
$213.57
|
Rate for Payer: Railroad Medicare Medicare |
$120.61
|
Rate for Payer: Railroad Medicare Medicare |
$120.61
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$42.50
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$42.50
|
Rate for Payer: UHC Core |
$979.00
|
Rate for Payer: UHC Core |
$979.00
|
Rate for Payer: UHC Dual Complete DSNP |
$120.61
|
Rate for Payer: UHC Dual Complete DSNP |
$120.61
|
Rate for Payer: UHC Exchange |
$38.64
|
Rate for Payer: UHC Exchange |
$38.64
|
Rate for Payer: UHC Medicare Advantage |
$124.23
|
Rate for Payer: UHC Medicare Advantage |
$124.23
|
Rate for Payer: UMR Bronson Commercial |
$150.21
|
Rate for Payer: UMR Bronson Commercial |
$125.43
|
Rate for Payer: VA VA |
$120.61
|
Rate for Payer: VA VA |
$120.61
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$254.25
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$304.47
|
|
HC RO TREATMENT DEVICE SIMPLE
|
Facility
|
IP
|
$339.00
|
|
Service Code
|
CPT 77332
|
Hospital Charge Code |
33300038
|
Hospital Revenue Code
|
333
|
Min. Negotiated Rate |
$149.16 |
Max. Negotiated Rate |
$305.10 |
Rate for Payer: Aetna American Axle |
$220.35
|
Rate for Payer: Aetna American Axle |
$263.87
|
Rate for Payer: Aetna Commercial |
$288.15
|
Rate for Payer: Aetna Commercial |
$345.07
|
Rate for Payer: Aetna New Business (MI Preferred) |
$263.87
|
Rate for Payer: Aetna New Business (MI Preferred) |
$220.35
|
Rate for Payer: Cash Price |
$271.20
|
Rate for Payer: Cash Price |
$324.77
|
Rate for Payer: Cofinity Commercial |
$349.13
|
Rate for Payer: Cofinity Commercial |
$291.54
|
Rate for Payer: Cofinity Commercial |
$284.17
|
Rate for Payer: Cofinity Commercial |
$237.30
|
Rate for Payer: Encore Health Key Benefits Commercial |
$324.77
|
Rate for Payer: Encore Health Key Benefits Commercial |
$271.20
|
Rate for Payer: Healthscope Commercial |
$365.36
|
Rate for Payer: Healthscope Commercial |
$305.10
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$284.17
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$237.30
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$304.47
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$254.25
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$288.15
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$345.07
|
Rate for Payer: PHP Commercial |
$288.15
|
Rate for Payer: PHP Commercial |
$345.07
|
Rate for Payer: Priority Health Cigna Priority Health |
$237.30
|
Rate for Payer: Priority Health Cigna Priority Health |
$284.17
|
Rate for Payer: Priority Health SBD |
$213.57
|
Rate for Payer: Priority Health SBD |
$255.75
|
Rate for Payer: UMR Bronson Commercial |
$178.62
|
Rate for Payer: UMR Bronson Commercial |
$149.16
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$254.25
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$304.47
|
|
HC RO TRTMNT >1 MEV COMPLEX
|
Facility
|
OP
|
$859.00
|
|
Service Code
|
CPT 77412
|
Hospital Charge Code |
33300049
|
Hospital Revenue Code
|
333
|
Min. Negotiated Rate |
$130.67 |
Max. Negotiated Rate |
$979.00 |
Rate for Payer: Aetna American Axle |
$558.35
|
Rate for Payer: Aetna American Axle |
$446.86
|
Rate for Payer: Aetna Commercial |
$584.36
|
Rate for Payer: Aetna Commercial |
$730.15
|
Rate for Payer: Aetna Medicare |
$248.44
|
Rate for Payer: Aetna Medicare |
$248.44
|
Rate for Payer: Aetna New Business (MI Preferred) |
$558.35
|
Rate for Payer: Aetna New Business (MI Preferred) |
$446.86
|
Rate for Payer: Allen County Amish Medical Aid Commercial |
$298.60
|
Rate for Payer: Allen County Amish Medical Aid Commercial |
$298.60
|
Rate for Payer: Amish Plain Church Group Commercial |
$298.60
|
Rate for Payer: Amish Plain Church Group Commercial |
$298.60
|
Rate for Payer: BCBS Complete |
$137.21
|
Rate for Payer: BCBS Complete |
$137.21
|
Rate for Payer: BCBS MAPPO |
$238.88
|
Rate for Payer: BCBS MAPPO |
$238.88
|
Rate for Payer: BCBS Trust/PPO |
$243.66
|
Rate for Payer: BCBS Trust/PPO |
$243.66
|
Rate for Payer: BCN Medicare Advantage |
$238.88
|
Rate for Payer: BCN Medicare Advantage |
$238.88
|
Rate for Payer: Cash Price |
$549.98
|
Rate for Payer: Cash Price |
$687.20
|
Rate for Payer: Cash Price |
$549.98
|
Rate for Payer: Cash Price |
$549.98
|
Rate for Payer: Cash Price |
$687.20
|
Rate for Payer: Cash Price |
$687.20
|
Rate for Payer: Cofinity Commercial |
$591.23
|
Rate for Payer: Cofinity Commercial |
$601.30
|
Rate for Payer: Cofinity Commercial |
$738.74
|
Rate for Payer: Cofinity Commercial |
$481.24
|
Rate for Payer: Encore Health Key Benefits Commercial |
$687.20
|
Rate for Payer: Encore Health Key Benefits Commercial |
$549.98
|
Rate for Payer: Health Alliance Plan Medicare Advantage |
$238.88
|
Rate for Payer: Health Alliance Plan Medicare Advantage |
$238.88
|
Rate for Payer: Healthscope Commercial |
$773.10
|
Rate for Payer: Healthscope Commercial |
$618.73
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$481.24
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$601.30
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$644.25
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$515.61
|
Rate for Payer: Mclaren Medicaid |
$130.67
|
Rate for Payer: Mclaren Medicaid |
$130.67
|
Rate for Payer: Mclaren Medicare |
$238.88
|
Rate for Payer: Mclaren Medicare |
$238.88
|
Rate for Payer: Meridian Medicaid |
$137.21
|
Rate for Payer: Meridian Medicaid |
$137.21
|
Rate for Payer: Meridian Wellcare - Medicare Advantage |
$250.82
|
Rate for Payer: Meridian Wellcare - Medicare Advantage |
$250.82
|
Rate for Payer: MI Amish Medical Board Commercial |
$274.71
|
Rate for Payer: MI Amish Medical Board Commercial |
$274.71
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$730.15
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$584.36
|
Rate for Payer: PACE Medicare |
$226.94
|
Rate for Payer: PACE Medicare |
$226.94
|
Rate for Payer: PACE SWMI |
$238.88
|
Rate for Payer: PACE SWMI |
$238.88
|
Rate for Payer: PHP Commercial |
$584.36
|
Rate for Payer: PHP Commercial |
$730.15
|
Rate for Payer: PHP Medicare Advantage |
$238.88
|
Rate for Payer: PHP Medicare Advantage |
$238.88
|
Rate for Payer: Priority Health Choice Medicaid |
$130.67
|
Rate for Payer: Priority Health Choice Medicaid |
$130.67
|
Rate for Payer: Priority Health Cigna Priority Health |
$601.30
|
Rate for Payer: Priority Health Cigna Priority Health |
$481.24
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$752.03
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$752.03
|
Rate for Payer: Priority Health Medicare |
$238.88
|
Rate for Payer: Priority Health Medicare |
$238.88
|
Rate for Payer: Priority Health Narrow Network |
$601.62
|
Rate for Payer: Priority Health Narrow Network |
$601.62
|
Rate for Payer: Priority Health SBD |
$541.17
|
Rate for Payer: Priority Health SBD |
$433.11
|
Rate for Payer: Railroad Medicare Medicare |
$238.88
|
Rate for Payer: Railroad Medicare Medicare |
$238.88
|
Rate for Payer: UHC Core |
$979.00
|
Rate for Payer: UHC Core |
$979.00
|
Rate for Payer: UHC Dual Complete DSNP |
$238.88
|
Rate for Payer: UHC Dual Complete DSNP |
$238.88
|
Rate for Payer: UHC Medicare Advantage |
$246.05
|
Rate for Payer: UHC Medicare Advantage |
$246.05
|
Rate for Payer: UMR Bronson Commercial |
$317.83
|
Rate for Payer: UMR Bronson Commercial |
$254.37
|
Rate for Payer: VA VA |
$238.88
|
Rate for Payer: VA VA |
$238.88
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$515.61
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$644.25
|
|
HC RO TRTMNT >1 MEV COMPLEX
|
Facility
|
IP
|
$687.48
|
|
Service Code
|
CPT 77412
|
Hospital Charge Code |
33300049
|
Hospital Revenue Code
|
333
|
Min. Negotiated Rate |
$302.49 |
Max. Negotiated Rate |
$618.73 |
Rate for Payer: Aetna American Axle |
$446.86
|
Rate for Payer: Aetna American Axle |
$558.35
|
Rate for Payer: Aetna Commercial |
$730.15
|
Rate for Payer: Aetna Commercial |
$584.36
|
Rate for Payer: Aetna New Business (MI Preferred) |
$446.86
|
Rate for Payer: Aetna New Business (MI Preferred) |
$558.35
|
Rate for Payer: Cash Price |
$549.98
|
Rate for Payer: Cash Price |
$687.20
|
Rate for Payer: Cofinity Commercial |
$591.23
|
Rate for Payer: Cofinity Commercial |
$481.24
|
Rate for Payer: Cofinity Commercial |
$601.30
|
Rate for Payer: Cofinity Commercial |
$738.74
|
Rate for Payer: Encore Health Key Benefits Commercial |
$549.98
|
Rate for Payer: Encore Health Key Benefits Commercial |
$687.20
|
Rate for Payer: Healthscope Commercial |
$773.10
|
Rate for Payer: Healthscope Commercial |
$618.73
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$601.30
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$481.24
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$515.61
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$644.25
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$730.15
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$584.36
|
Rate for Payer: PHP Commercial |
$584.36
|
Rate for Payer: PHP Commercial |
$730.15
|
Rate for Payer: Priority Health Cigna Priority Health |
$481.24
|
Rate for Payer: Priority Health Cigna Priority Health |
$601.30
|
Rate for Payer: Priority Health SBD |
$433.11
|
Rate for Payer: Priority Health SBD |
$541.17
|
Rate for Payer: UMR Bronson Commercial |
$302.49
|
Rate for Payer: UMR Bronson Commercial |
$377.96
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$515.61
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$644.25
|
|
HC RO TRTMNT > 1 MEV INTERMEDIATE
|
Facility
|
IP
|
$413.27
|
|
Service Code
|
CPT 77407
|
Hospital Charge Code |
33300052
|
Hospital Revenue Code
|
333
|
Min. Negotiated Rate |
$181.84 |
Max. Negotiated Rate |
$371.94 |
Rate for Payer: Aetna American Axle |
$268.63
|
Rate for Payer: Aetna Commercial |
$351.28
|
Rate for Payer: Aetna New Business (MI Preferred) |
$268.63
|
Rate for Payer: Cash Price |
$330.62
|
Rate for Payer: Cofinity Commercial |
$289.29
|
Rate for Payer: Cofinity Commercial |
$355.41
|
Rate for Payer: Encore Health Key Benefits Commercial |
$330.62
|
Rate for Payer: Healthscope Commercial |
$371.94
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$289.29
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$309.95
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$351.28
|
Rate for Payer: PHP Commercial |
$351.28
|
Rate for Payer: Priority Health Cigna Priority Health |
$289.29
|
Rate for Payer: Priority Health SBD |
$260.36
|
Rate for Payer: UMR Bronson Commercial |
$181.84
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$309.95
|
|
HC RO TRTMNT > 1 MEV INTERMEDIATE
|
Facility
|
OP
|
$413.27
|
|
Service Code
|
CPT 77407
|
Hospital Charge Code |
33300052
|
Hospital Revenue Code
|
333
|
Min. Negotiated Rate |
$130.67 |
Max. Negotiated Rate |
$979.00 |
Rate for Payer: Aetna American Axle |
$268.63
|
Rate for Payer: Aetna Commercial |
$351.28
|
Rate for Payer: Aetna Medicare |
$248.44
|
Rate for Payer: Aetna New Business (MI Preferred) |
$268.63
|
Rate for Payer: Allen County Amish Medical Aid Commercial |
$298.60
|
Rate for Payer: Amish Plain Church Group Commercial |
$298.60
|
Rate for Payer: BCBS Complete |
$137.21
|
Rate for Payer: BCBS MAPPO |
$238.88
|
Rate for Payer: BCBS Trust/PPO |
$138.33
|
Rate for Payer: BCN Medicare Advantage |
$238.88
|
Rate for Payer: Cash Price |
$330.62
|
Rate for Payer: Cash Price |
$330.62
|
Rate for Payer: Cash Price |
$330.62
|
Rate for Payer: Cofinity Commercial |
$355.41
|
Rate for Payer: Cofinity Commercial |
$289.29
|
Rate for Payer: Encore Health Key Benefits Commercial |
$330.62
|
Rate for Payer: Health Alliance Plan Medicare Advantage |
$238.88
|
Rate for Payer: Healthscope Commercial |
$371.94
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$289.29
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$309.95
|
Rate for Payer: Mclaren Medicaid |
$130.67
|
Rate for Payer: Mclaren Medicare |
$238.88
|
Rate for Payer: Meridian Medicaid |
$137.21
|
Rate for Payer: Meridian Wellcare - Medicare Advantage |
$250.82
|
Rate for Payer: MI Amish Medical Board Commercial |
$274.71
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$351.28
|
Rate for Payer: PACE Medicare |
$226.94
|
Rate for Payer: PACE SWMI |
$238.88
|
Rate for Payer: PHP Commercial |
$351.28
|
Rate for Payer: PHP Medicare Advantage |
$238.88
|
Rate for Payer: Priority Health Choice Medicaid |
$130.67
|
Rate for Payer: Priority Health Cigna Priority Health |
$289.29
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$752.03
|
Rate for Payer: Priority Health Medicare |
$238.88
|
Rate for Payer: Priority Health Narrow Network |
$601.62
|
Rate for Payer: Priority Health SBD |
$260.36
|
Rate for Payer: Railroad Medicare Medicare |
$238.88
|
Rate for Payer: UHC Core |
$979.00
|
Rate for Payer: UHC Dual Complete DSNP |
$238.88
|
Rate for Payer: UHC Medicare Advantage |
$246.05
|
Rate for Payer: UMR Bronson Commercial |
$152.91
|
Rate for Payer: VA VA |
$238.88
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$309.95
|
|
HC RO TRTMNT >1 MEV SIMPLE
|
Facility
|
IP
|
$859.00
|
|
Service Code
|
CPT 77402
|
Hospital Charge Code |
33300048
|
Hospital Revenue Code
|
333
|
Min. Negotiated Rate |
$377.96 |
Max. Negotiated Rate |
$773.10 |
Rate for Payer: Aetna American Axle |
$558.35
|
Rate for Payer: Aetna American Axle |
$147.36
|
Rate for Payer: Aetna Commercial |
$730.15
|
Rate for Payer: Aetna Commercial |
$192.70
|
Rate for Payer: Aetna New Business (MI Preferred) |
$558.35
|
Rate for Payer: Aetna New Business (MI Preferred) |
$147.36
|
Rate for Payer: Cash Price |
$181.37
|
Rate for Payer: Cash Price |
$687.20
|
Rate for Payer: Cofinity Commercial |
$194.97
|
Rate for Payer: Cofinity Commercial |
$158.70
|
Rate for Payer: Cofinity Commercial |
$601.30
|
Rate for Payer: Cofinity Commercial |
$738.74
|
Rate for Payer: Encore Health Key Benefits Commercial |
$181.37
|
Rate for Payer: Encore Health Key Benefits Commercial |
$687.20
|
Rate for Payer: Healthscope Commercial |
$773.10
|
Rate for Payer: Healthscope Commercial |
$204.04
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$158.70
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$601.30
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$644.25
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$170.03
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$730.15
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$192.70
|
Rate for Payer: PHP Commercial |
$192.70
|
Rate for Payer: PHP Commercial |
$730.15
|
Rate for Payer: Priority Health Cigna Priority Health |
$601.30
|
Rate for Payer: Priority Health Cigna Priority Health |
$158.70
|
Rate for Payer: Priority Health SBD |
$541.17
|
Rate for Payer: Priority Health SBD |
$142.83
|
Rate for Payer: UMR Bronson Commercial |
$99.75
|
Rate for Payer: UMR Bronson Commercial |
$377.96
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$170.03
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$644.25
|
|
HC RO TRTMNT >1 MEV SIMPLE
|
Facility
|
OP
|
$226.71
|
|
Service Code
|
CPT 77402
|
Hospital Charge Code |
33300048
|
Hospital Revenue Code
|
333
|
Min. Negotiated Rate |
$58.30 |
Max. Negotiated Rate |
$979.00 |
Rate for Payer: Aetna American Axle |
$147.36
|
Rate for Payer: Aetna American Axle |
$558.35
|
Rate for Payer: Aetna Commercial |
$192.70
|
Rate for Payer: Aetna Commercial |
$730.15
|
Rate for Payer: Aetna Medicare |
$110.85
|
Rate for Payer: Aetna Medicare |
$110.85
|
Rate for Payer: Aetna New Business (MI Preferred) |
$558.35
|
Rate for Payer: Aetna New Business (MI Preferred) |
$147.36
|
Rate for Payer: Allen County Amish Medical Aid Commercial |
$133.24
|
Rate for Payer: Allen County Amish Medical Aid Commercial |
$133.24
|
Rate for Payer: Amish Plain Church Group Commercial |
$133.24
|
Rate for Payer: Amish Plain Church Group Commercial |
$133.24
|
Rate for Payer: BCBS Complete |
$61.23
|
Rate for Payer: BCBS Complete |
$61.23
|
Rate for Payer: BCBS MAPPO |
$106.59
|
Rate for Payer: BCBS MAPPO |
$106.59
|
Rate for Payer: BCBS Trust/PPO |
$138.33
|
Rate for Payer: BCBS Trust/PPO |
$138.33
|
Rate for Payer: BCN Medicare Advantage |
$106.59
|
Rate for Payer: BCN Medicare Advantage |
$106.59
|
Rate for Payer: Cash Price |
$687.20
|
Rate for Payer: Cash Price |
$181.37
|
Rate for Payer: Cash Price |
$687.20
|
Rate for Payer: Cash Price |
$181.37
|
Rate for Payer: Cash Price |
$181.37
|
Rate for Payer: Cash Price |
$687.20
|
Rate for Payer: Cofinity Commercial |
$158.70
|
Rate for Payer: Cofinity Commercial |
$194.97
|
Rate for Payer: Cofinity Commercial |
$738.74
|
Rate for Payer: Cofinity Commercial |
$601.30
|
Rate for Payer: Encore Health Key Benefits Commercial |
$181.37
|
Rate for Payer: Encore Health Key Benefits Commercial |
$687.20
|
Rate for Payer: Health Alliance Plan Medicare Advantage |
$106.59
|
Rate for Payer: Health Alliance Plan Medicare Advantage |
$106.59
|
Rate for Payer: Healthscope Commercial |
$204.04
|
Rate for Payer: Healthscope Commercial |
$773.10
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$601.30
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$158.70
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$170.03
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$644.25
|
Rate for Payer: Mclaren Medicaid |
$58.30
|
Rate for Payer: Mclaren Medicaid |
$58.30
|
Rate for Payer: Mclaren Medicare |
$106.59
|
Rate for Payer: Mclaren Medicare |
$106.59
|
Rate for Payer: Meridian Medicaid |
$61.23
|
Rate for Payer: Meridian Medicaid |
$61.23
|
Rate for Payer: Meridian Wellcare - Medicare Advantage |
$111.92
|
Rate for Payer: Meridian Wellcare - Medicare Advantage |
$111.92
|
Rate for Payer: MI Amish Medical Board Commercial |
$122.58
|
Rate for Payer: MI Amish Medical Board Commercial |
$122.58
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$192.70
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$730.15
|
Rate for Payer: PACE Medicare |
$101.26
|
Rate for Payer: PACE Medicare |
$101.26
|
Rate for Payer: PACE SWMI |
$106.59
|
Rate for Payer: PACE SWMI |
$106.59
|
Rate for Payer: PHP Commercial |
$192.70
|
Rate for Payer: PHP Commercial |
$730.15
|
Rate for Payer: PHP Medicare Advantage |
$106.59
|
Rate for Payer: PHP Medicare Advantage |
$106.59
|
Rate for Payer: Priority Health Choice Medicaid |
$58.30
|
Rate for Payer: Priority Health Choice Medicaid |
$58.30
|
Rate for Payer: Priority Health Cigna Priority Health |
$601.30
|
Rate for Payer: Priority Health Cigna Priority Health |
$158.70
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$335.54
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$335.54
|
Rate for Payer: Priority Health Medicare |
$106.59
|
Rate for Payer: Priority Health Medicare |
$106.59
|
Rate for Payer: Priority Health Narrow Network |
$268.43
|
Rate for Payer: Priority Health Narrow Network |
$268.43
|
Rate for Payer: Priority Health SBD |
$541.17
|
Rate for Payer: Priority Health SBD |
$142.83
|
Rate for Payer: Railroad Medicare Medicare |
$106.59
|
Rate for Payer: Railroad Medicare Medicare |
$106.59
|
Rate for Payer: UHC Core |
$979.00
|
Rate for Payer: UHC Core |
$979.00
|
Rate for Payer: UHC Dual Complete DSNP |
$106.59
|
Rate for Payer: UHC Dual Complete DSNP |
$106.59
|
Rate for Payer: UHC Medicare Advantage |
$109.79
|
Rate for Payer: UHC Medicare Advantage |
$109.79
|
Rate for Payer: UMR Bronson Commercial |
$317.83
|
Rate for Payer: UMR Bronson Commercial |
$83.88
|
Rate for Payer: VA VA |
$106.59
|
Rate for Payer: VA VA |
$106.59
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$170.03
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$644.25
|
|
HC ROUGH MARSH ELDER IGE
|
Facility
|
IP
|
$24.89
|
|
Service Code
|
CPT 86003
|
Hospital Charge Code |
30200058
|
Hospital Revenue Code
|
302
|
Min. Negotiated Rate |
$10.95 |
Max. Negotiated Rate |
$22.40 |
Rate for Payer: Aetna American Axle |
$16.18
|
Rate for Payer: Aetna Commercial |
$21.16
|
Rate for Payer: Aetna New Business (MI Preferred) |
$16.18
|
Rate for Payer: Cash Price |
$19.91
|
Rate for Payer: Cofinity Commercial |
$17.42
|
Rate for Payer: Cofinity Commercial |
$21.41
|
Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
Rate for Payer: Healthscope Commercial |
$22.40
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.42
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.67
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
Rate for Payer: PHP Commercial |
$21.16
|
Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
Rate for Payer: Priority Health SBD |
$15.68
|
Rate for Payer: UMR Bronson Commercial |
$10.95
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.67
|
|
HC ROUGH MARSH ELDER IGE
|
Facility
|
OP
|
$24.89
|
|
Service Code
|
CPT 86003
|
Hospital Charge Code |
30200058
|
Hospital Revenue Code
|
302
|
Min. Negotiated Rate |
$2.86 |
Max. Negotiated Rate |
$22.40 |
Rate for Payer: Aetna American Axle |
$16.18
|
Rate for Payer: Aetna Commercial |
$21.16
|
Rate for Payer: Aetna Medicare |
$5.43
|
Rate for Payer: Aetna New Business (MI Preferred) |
$16.18
|
Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
Rate for Payer: BCBS Complete |
$3.00
|
Rate for Payer: BCBS MAPPO |
$5.22
|
Rate for Payer: BCBS Trust/PPO |
$4.70
|
Rate for Payer: BCN Medicare Advantage |
$5.22
|
Rate for Payer: Cash Price |
$19.91
|
Rate for Payer: Cash Price |
$19.91
|
Rate for Payer: Cofinity Commercial |
$17.42
|
Rate for Payer: Cofinity Commercial |
$21.41
|
Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
Rate for Payer: Healthscope Commercial |
$22.40
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.42
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.67
|
Rate for Payer: Mclaren Medicaid |
$2.86
|
Rate for Payer: Mclaren Medicare |
$5.22
|
Rate for Payer: Meridian Medicaid |
$3.00
|
Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.48
|
Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
Rate for Payer: PACE Medicare |
$4.96
|
Rate for Payer: PACE SWMI |
$5.22
|
Rate for Payer: PHP Commercial |
$21.16
|
Rate for Payer: PHP Medicare Advantage |
$5.22
|
Rate for Payer: Priority Health Choice Medicaid |
$2.86
|
Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7.16
|
Rate for Payer: Priority Health Medicare |
$5.22
|
Rate for Payer: Priority Health Narrow Network |
$5.73
|
Rate for Payer: Priority Health SBD |
$15.68
|
Rate for Payer: Railroad Medicare Medicare |
$5.22
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$6.26
|
Rate for Payer: UHC Core |
$8.60
|
Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
Rate for Payer: UHC Exchange |
$5.22
|
Rate for Payer: UHC Medicare Advantage |
$5.38
|
Rate for Payer: UMR Bronson Commercial |
$9.21
|
Rate for Payer: VA VA |
$5.22
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.67
|
|
HC RPR (SYPHILIS SEROLOGY) SERUM
|
Facility
|
OP
|
$25.50
|
|
Service Code
|
CPT 86592
|
Hospital Charge Code |
30200213
|
Hospital Revenue Code
|
302
|
Min. Negotiated Rate |
$2.34 |
Max. Negotiated Rate |
$22.95 |
Rate for Payer: Aetna American Axle |
$16.58
|
Rate for Payer: Aetna Commercial |
$21.68
|
Rate for Payer: Aetna Medicare |
$4.44
|
Rate for Payer: Aetna New Business (MI Preferred) |
$16.58
|
Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.34
|
Rate for Payer: Amish Plain Church Group Commercial |
$5.34
|
Rate for Payer: BCBS Complete |
$2.45
|
Rate for Payer: BCBS MAPPO |
$4.27
|
Rate for Payer: BCBS Trust/PPO |
$3.84
|
Rate for Payer: BCN Medicare Advantage |
$4.27
|
Rate for Payer: Cash Price |
$20.40
|
Rate for Payer: Cash Price |
$20.40
|
Rate for Payer: Cofinity Commercial |
$21.93
|
Rate for Payer: Cofinity Commercial |
$17.85
|
Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.27
|
Rate for Payer: Healthscope Commercial |
$22.95
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.85
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.12
|
Rate for Payer: Mclaren Medicaid |
$2.34
|
Rate for Payer: Mclaren Medicare |
$4.27
|
Rate for Payer: Meridian Medicaid |
$2.45
|
Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4.48
|
Rate for Payer: MI Amish Medical Board Commercial |
$4.91
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.68
|
Rate for Payer: PACE Medicare |
$4.06
|
Rate for Payer: PACE SWMI |
$4.27
|
Rate for Payer: PHP Commercial |
$21.68
|
Rate for Payer: PHP Medicare Advantage |
$4.27
|
Rate for Payer: Priority Health Choice Medicaid |
$2.34
|
Rate for Payer: Priority Health Cigna Priority Health |
$17.85
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.86
|
Rate for Payer: Priority Health Medicare |
$4.27
|
Rate for Payer: Priority Health Narrow Network |
$4.69
|
Rate for Payer: Priority Health SBD |
$16.06
|
Rate for Payer: Railroad Medicare Medicare |
$4.27
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$5.12
|
Rate for Payer: UHC Core |
$7.04
|
Rate for Payer: UHC Dual Complete DSNP |
$4.27
|
Rate for Payer: UHC Exchange |
$4.27
|
Rate for Payer: UHC Medicare Advantage |
$4.40
|
Rate for Payer: UMR Bronson Commercial |
$9.44
|
Rate for Payer: VA VA |
$4.27
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.12
|
|
HC RPR (SYPHILIS SEROLOGY) SERUM
|
Facility
|
IP
|
$25.50
|
|
Service Code
|
CPT 86592
|
Hospital Charge Code |
30200213
|
Hospital Revenue Code
|
302
|
Min. Negotiated Rate |
$11.22 |
Max. Negotiated Rate |
$22.95 |
Rate for Payer: Aetna American Axle |
$16.58
|
Rate for Payer: Aetna Commercial |
$21.68
|
Rate for Payer: Aetna New Business (MI Preferred) |
$16.58
|
Rate for Payer: Cash Price |
$20.40
|
Rate for Payer: Cofinity Commercial |
$17.85
|
Rate for Payer: Cofinity Commercial |
$21.93
|
Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
Rate for Payer: Healthscope Commercial |
$22.95
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.85
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.12
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.68
|
Rate for Payer: PHP Commercial |
$21.68
|
Rate for Payer: Priority Health Cigna Priority Health |
$17.85
|
Rate for Payer: Priority Health SBD |
$16.06
|
Rate for Payer: UMR Bronson Commercial |
$11.22
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.12
|
|
HC RPR TITER
|
Facility
|
IP
|
$25.50
|
|
Service Code
|
CPT 86593
|
Hospital Charge Code |
30200425
|
Hospital Revenue Code
|
302
|
Min. Negotiated Rate |
$11.22 |
Max. Negotiated Rate |
$22.95 |
Rate for Payer: Aetna American Axle |
$16.58
|
Rate for Payer: Aetna Commercial |
$21.68
|
Rate for Payer: Aetna New Business (MI Preferred) |
$16.58
|
Rate for Payer: Cash Price |
$20.40
|
Rate for Payer: Cofinity Commercial |
$17.85
|
Rate for Payer: Cofinity Commercial |
$21.93
|
Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
Rate for Payer: Healthscope Commercial |
$22.95
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.85
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.12
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.68
|
Rate for Payer: PHP Commercial |
$21.68
|
Rate for Payer: Priority Health Cigna Priority Health |
$17.85
|
Rate for Payer: Priority Health SBD |
$16.06
|
Rate for Payer: UMR Bronson Commercial |
$11.22
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.12
|
|
HC RPR TITER
|
Facility
|
OP
|
$25.50
|
|
Service Code
|
CPT 86593
|
Hospital Charge Code |
30200425
|
Hospital Revenue Code
|
302
|
Min. Negotiated Rate |
$2.41 |
Max. Negotiated Rate |
$22.95 |
Rate for Payer: Aetna American Axle |
$16.58
|
Rate for Payer: Aetna Commercial |
$21.68
|
Rate for Payer: Aetna Medicare |
$4.58
|
Rate for Payer: Aetna New Business (MI Preferred) |
$16.58
|
Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.50
|
Rate for Payer: Amish Plain Church Group Commercial |
$5.50
|
Rate for Payer: BCBS Complete |
$2.53
|
Rate for Payer: BCBS MAPPO |
$4.40
|
Rate for Payer: BCBS Trust/PPO |
$3.96
|
Rate for Payer: BCN Medicare Advantage |
$4.40
|
Rate for Payer: Cash Price |
$20.40
|
Rate for Payer: Cash Price |
$20.40
|
Rate for Payer: Cofinity Commercial |
$21.93
|
Rate for Payer: Cofinity Commercial |
$17.85
|
Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.40
|
Rate for Payer: Healthscope Commercial |
$22.95
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.85
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.12
|
Rate for Payer: Mclaren Medicaid |
$2.41
|
Rate for Payer: Mclaren Medicare |
$4.40
|
Rate for Payer: Meridian Medicaid |
$2.53
|
Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4.62
|
Rate for Payer: MI Amish Medical Board Commercial |
$5.06
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.68
|
Rate for Payer: PACE Medicare |
$4.18
|
Rate for Payer: PACE SWMI |
$4.40
|
Rate for Payer: PHP Commercial |
$21.68
|
Rate for Payer: PHP Medicare Advantage |
$4.40
|
Rate for Payer: Priority Health Choice Medicaid |
$2.41
|
Rate for Payer: Priority Health Cigna Priority Health |
$17.85
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6.04
|
Rate for Payer: Priority Health Medicare |
$4.40
|
Rate for Payer: Priority Health Narrow Network |
$4.83
|
Rate for Payer: Priority Health SBD |
$16.06
|
Rate for Payer: Railroad Medicare Medicare |
$4.40
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$5.28
|
Rate for Payer: UHC Core |
$7.26
|
Rate for Payer: UHC Dual Complete DSNP |
$4.40
|
Rate for Payer: UHC Exchange |
$4.40
|
Rate for Payer: UHC Medicare Advantage |
$4.53
|
Rate for Payer: UMR Bronson Commercial |
$9.44
|
Rate for Payer: VA VA |
$4.40
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.12
|
|
HC RSV DNA/RNA AMP PROBE
|
Facility
|
IP
|
$76.50
|
|
Service Code
|
CPT 87634
|
Hospital Charge Code |
30600315
|
Hospital Revenue Code
|
306
|
Min. Negotiated Rate |
$33.66 |
Max. Negotiated Rate |
$68.85 |
Rate for Payer: Aetna American Axle |
$49.72
|
Rate for Payer: Aetna Commercial |
$65.02
|
Rate for Payer: Aetna New Business (MI Preferred) |
$49.72
|
Rate for Payer: Cash Price |
$61.20
|
Rate for Payer: Cofinity Commercial |
$53.55
|
Rate for Payer: Cofinity Commercial |
$65.79
|
Rate for Payer: Encore Health Key Benefits Commercial |
$61.20
|
Rate for Payer: Healthscope Commercial |
$68.85
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$53.55
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.38
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.02
|
Rate for Payer: PHP Commercial |
$65.02
|
Rate for Payer: Priority Health Cigna Priority Health |
$53.55
|
Rate for Payer: Priority Health SBD |
$48.20
|
Rate for Payer: UMR Bronson Commercial |
$33.66
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.38
|
|
HC RSV DNA/RNA AMP PROBE
|
Facility
|
OP
|
$76.50
|
|
Service Code
|
CPT 87634
|
Hospital Charge Code |
30600315
|
Hospital Revenue Code
|
306
|
Min. Negotiated Rate |
$28.30 |
Max. Negotiated Rate |
$103.99 |
Rate for Payer: Aetna American Axle |
$49.72
|
Rate for Payer: Aetna Commercial |
$65.02
|
Rate for Payer: Aetna Medicare |
$73.01
|
Rate for Payer: Aetna New Business (MI Preferred) |
$49.72
|
Rate for Payer: Allen County Amish Medical Aid Commercial |
$87.75
|
Rate for Payer: Amish Plain Church Group Commercial |
$87.75
|
Rate for Payer: BCBS Complete |
$40.32
|
Rate for Payer: BCBS MAPPO |
$70.20
|
Rate for Payer: BCBS Trust/PPO |
$63.13
|
Rate for Payer: BCN Medicare Advantage |
$70.20
|
Rate for Payer: Cash Price |
$61.20
|
Rate for Payer: Cash Price |
$61.20
|
Rate for Payer: Cofinity Commercial |
$53.55
|
Rate for Payer: Cofinity Commercial |
$65.79
|
Rate for Payer: Encore Health Key Benefits Commercial |
$61.20
|
Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.20
|
Rate for Payer: Healthscope Commercial |
$68.85
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$53.55
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.38
|
Rate for Payer: Mclaren Medicaid |
$38.40
|
Rate for Payer: Mclaren Medicare |
$70.20
|
Rate for Payer: Meridian Medicaid |
$40.32
|
Rate for Payer: Meridian Wellcare - Medicare Advantage |
$73.71
|
Rate for Payer: MI Amish Medical Board Commercial |
$80.73
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.02
|
Rate for Payer: PACE Medicare |
$66.69
|
Rate for Payer: PACE SWMI |
$70.20
|
Rate for Payer: PHP Commercial |
$65.02
|
Rate for Payer: PHP Medicare Advantage |
$70.20
|
Rate for Payer: Priority Health Choice Medicaid |
$38.40
|
Rate for Payer: Priority Health Cigna Priority Health |
$53.55
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$96.29
|
Rate for Payer: Priority Health Medicare |
$70.20
|
Rate for Payer: Priority Health Narrow Network |
$77.03
|
Rate for Payer: Priority Health SBD |
$48.20
|
Rate for Payer: Railroad Medicare Medicare |
$70.20
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$84.24
|
Rate for Payer: UHC Core |
$103.99
|
Rate for Payer: UHC Dual Complete DSNP |
$70.20
|
Rate for Payer: UHC Exchange |
$70.20
|
Rate for Payer: UHC Medicare Advantage |
$72.31
|
Rate for Payer: UMR Bronson Commercial |
$28.30
|
Rate for Payer: VA VA |
$70.20
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.38
|
|
HC RSV MONOCLONAL ANTB SEASONAL 0.5ML IM
|
Facility
|
OP
|
$1,277.00
|
|
Service Code
|
CPT 90380
|
Hospital Charge Code |
63600232
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$451.44 |
Max. Negotiated Rate |
$1,601.39 |
Rate for Payer: Aetna American Axle |
$830.05
|
Rate for Payer: Aetna Commercial |
$1,085.45
|
Rate for Payer: Aetna New Business (MI Preferred) |
$830.05
|
Rate for Payer: BCBS Complete |
$510.80
|
Rate for Payer: BCBS Trust/PPO |
$1,601.39
|
Rate for Payer: Cash Price |
$1,021.60
|
Rate for Payer: Cash Price |
$1,021.60
|
Rate for Payer: Cofinity Commercial |
$1,098.22
|
Rate for Payer: Cofinity Commercial |
$893.90
|
Rate for Payer: Encore Health Key Benefits Commercial |
$1,021.60
|
Rate for Payer: Healthscope Commercial |
$1,149.30
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$893.90
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$957.75
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,085.45
|
Rate for Payer: PHP Commercial |
$1,085.45
|
Rate for Payer: Priority Health Cigna Priority Health |
$893.90
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$564.30
|
Rate for Payer: Priority Health Narrow Network |
$451.44
|
Rate for Payer: Priority Health SBD |
$804.51
|
Rate for Payer: UMR Bronson Commercial |
$472.49
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$957.75
|
|
HC RSV MONOCLONAL ANTB SEASONAL 0.5ML IM
|
Facility
|
IP
|
$1,277.00
|
|
Service Code
|
CPT 90380
|
Hospital Charge Code |
63600232
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$561.88 |
Max. Negotiated Rate |
$1,149.30 |
Rate for Payer: Aetna American Axle |
$830.05
|
Rate for Payer: Aetna Commercial |
$1,085.45
|
Rate for Payer: Aetna New Business (MI Preferred) |
$830.05
|
Rate for Payer: Cash Price |
$1,021.60
|
Rate for Payer: Cofinity Commercial |
$1,098.22
|
Rate for Payer: Cofinity Commercial |
$893.90
|
Rate for Payer: Encore Health Key Benefits Commercial |
$1,021.60
|
Rate for Payer: Healthscope Commercial |
$1,149.30
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$893.90
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$957.75
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,085.45
|
Rate for Payer: PHP Commercial |
$1,085.45
|
Rate for Payer: Priority Health Cigna Priority Health |
$893.90
|
Rate for Payer: Priority Health SBD |
$804.51
|
Rate for Payer: UMR Bronson Commercial |
$561.88
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$957.75
|
|
HC RSV MONOCLONAL ANTB SEASONAL 1 ML IM
|
Facility
|
IP
|
$1,277.00
|
|
Service Code
|
CPT 90381
|
Hospital Charge Code |
63600233
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$561.88 |
Max. Negotiated Rate |
$1,149.30 |
Rate for Payer: Aetna American Axle |
$830.05
|
Rate for Payer: Aetna Commercial |
$1,085.45
|
Rate for Payer: Aetna New Business (MI Preferred) |
$830.05
|
Rate for Payer: Cash Price |
$1,021.60
|
Rate for Payer: Cofinity Commercial |
$1,098.22
|
Rate for Payer: Cofinity Commercial |
$893.90
|
Rate for Payer: Encore Health Key Benefits Commercial |
$1,021.60
|
Rate for Payer: Healthscope Commercial |
$1,149.30
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$893.90
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$957.75
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,085.45
|
Rate for Payer: PHP Commercial |
$1,085.45
|
Rate for Payer: Priority Health Cigna Priority Health |
$893.90
|
Rate for Payer: Priority Health SBD |
$804.51
|
Rate for Payer: UMR Bronson Commercial |
$561.88
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$957.75
|
|
HC RSV MONOCLONAL ANTB SEASONAL 1 ML IM
|
Facility
|
OP
|
$1,277.00
|
|
Service Code
|
CPT 90381
|
Hospital Charge Code |
63600233
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$451.44 |
Max. Negotiated Rate |
$1,601.39 |
Rate for Payer: Aetna American Axle |
$830.05
|
Rate for Payer: Aetna Commercial |
$1,085.45
|
Rate for Payer: Aetna New Business (MI Preferred) |
$830.05
|
Rate for Payer: BCBS Complete |
$510.80
|
Rate for Payer: BCBS Trust/PPO |
$1,601.39
|
Rate for Payer: Cash Price |
$1,021.60
|
Rate for Payer: Cash Price |
$1,021.60
|
Rate for Payer: Cofinity Commercial |
$893.90
|
Rate for Payer: Cofinity Commercial |
$1,098.22
|
Rate for Payer: Encore Health Key Benefits Commercial |
$1,021.60
|
Rate for Payer: Healthscope Commercial |
$1,149.30
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$893.90
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$957.75
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,085.45
|
Rate for Payer: PHP Commercial |
$1,085.45
|
Rate for Payer: Priority Health Cigna Priority Health |
$893.90
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$564.30
|
Rate for Payer: Priority Health Narrow Network |
$451.44
|
Rate for Payer: Priority Health SBD |
$804.51
|
Rate for Payer: UMR Bronson Commercial |
$472.49
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$957.75
|
|
HC RT ANGLE BALL COR CANN
|
Facility
|
OP
|
$69.30
|
|
Hospital Charge Code |
27000268
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$25.64 |
Max. Negotiated Rate |
$62.37 |
Rate for Payer: Aetna American Axle |
$45.04
|
Rate for Payer: Aetna Commercial |
$58.90
|
Rate for Payer: Aetna New Business (MI Preferred) |
$45.04
|
Rate for Payer: BCBS Complete |
$27.72
|
Rate for Payer: Cash Price |
$55.44
|
Rate for Payer: Cofinity Commercial |
$48.51
|
Rate for Payer: Cofinity Commercial |
$59.60
|
Rate for Payer: Encore Health Key Benefits Commercial |
$55.44
|
Rate for Payer: Healthscope Commercial |
$62.37
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.51
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.98
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$58.90
|
Rate for Payer: PHP Commercial |
$58.90
|
Rate for Payer: Priority Health Cigna Priority Health |
$48.51
|
Rate for Payer: Priority Health SBD |
$43.66
|
Rate for Payer: UMR Bronson Commercial |
$25.64
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.98
|
|
HC RT ANGLE BALL COR CANN
|
Facility
|
IP
|
$69.30
|
|
Hospital Charge Code |
27000268
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$30.49 |
Max. Negotiated Rate |
$62.37 |
Rate for Payer: Aetna American Axle |
$45.04
|
Rate for Payer: Aetna Commercial |
$58.90
|
Rate for Payer: Aetna New Business (MI Preferred) |
$45.04
|
Rate for Payer: Cash Price |
$55.44
|
Rate for Payer: Cofinity Commercial |
$48.51
|
Rate for Payer: Cofinity Commercial |
$59.60
|
Rate for Payer: Encore Health Key Benefits Commercial |
$55.44
|
Rate for Payer: Healthscope Commercial |
$62.37
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.51
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.98
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$58.90
|
Rate for Payer: PHP Commercial |
$58.90
|
Rate for Payer: Priority Health Cigna Priority Health |
$48.51
|
Rate for Payer: Priority Health SBD |
$43.66
|
Rate for Payer: UMR Bronson Commercial |
$30.49
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.98
|
|
HC RUBELLA ANTIBODY IGC
|
Facility
|
OP
|
$40.80
|
|
Service Code
|
CPT 86762
|
Hospital Charge Code |
30200315
|
Hospital Revenue Code
|
302
|
Min. Negotiated Rate |
$7.87 |
Max. Negotiated Rate |
$36.72 |
Rate for Payer: Aetna American Axle |
$26.52
|
Rate for Payer: Aetna Commercial |
$34.68
|
Rate for Payer: Aetna Medicare |
$14.97
|
Rate for Payer: Aetna New Business (MI Preferred) |
$26.52
|
Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.99
|
Rate for Payer: Amish Plain Church Group Commercial |
$17.99
|
Rate for Payer: BCBS Complete |
$8.27
|
Rate for Payer: BCBS MAPPO |
$14.39
|
Rate for Payer: BCBS Trust/PPO |
$12.94
|
Rate for Payer: BCN Medicare Advantage |
$14.39
|
Rate for Payer: Cash Price |
$32.64
|
Rate for Payer: Cash Price |
$32.64
|
Rate for Payer: Cofinity Commercial |
$35.09
|
Rate for Payer: Cofinity Commercial |
$28.56
|
Rate for Payer: Encore Health Key Benefits Commercial |
$32.64
|
Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.39
|
Rate for Payer: Healthscope Commercial |
$36.72
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.56
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.60
|
Rate for Payer: Mclaren Medicaid |
$7.87
|
Rate for Payer: Mclaren Medicare |
$14.39
|
Rate for Payer: Meridian Medicaid |
$8.27
|
Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15.11
|
Rate for Payer: MI Amish Medical Board Commercial |
$16.55
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.68
|
Rate for Payer: PACE Medicare |
$13.67
|
Rate for Payer: PACE SWMI |
$14.39
|
Rate for Payer: PHP Commercial |
$34.68
|
Rate for Payer: PHP Medicare Advantage |
$14.39
|
Rate for Payer: Priority Health Choice Medicaid |
$7.87
|
Rate for Payer: Priority Health Cigna Priority Health |
$28.56
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.88
|
Rate for Payer: Priority Health Medicare |
$14.39
|
Rate for Payer: Priority Health Narrow Network |
$15.10
|
Rate for Payer: Priority Health SBD |
$25.70
|
Rate for Payer: Railroad Medicare Medicare |
$14.39
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$17.27
|
Rate for Payer: UHC Core |
$23.75
|
Rate for Payer: UHC Dual Complete DSNP |
$14.39
|
Rate for Payer: UHC Exchange |
$14.39
|
Rate for Payer: UHC Medicare Advantage |
$14.82
|
Rate for Payer: UMR Bronson Commercial |
$15.10
|
Rate for Payer: VA VA |
$14.39
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.60
|
|