|
HC SEQUENTIAL MATERNAL SCRN PART 1
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
CPT 84163
|
| Hospital Charge Code |
30100655
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$39.60 |
| Max. Negotiated Rate |
$81.00 |
| Rate for Payer: Aetna American Axle |
$58.50
|
| Rate for Payer: Aetna Commercial |
$76.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.50
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cofinity Commercial |
$63.00
|
| Rate for Payer: Cofinity Commercial |
$77.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.00
|
| Rate for Payer: Healthscope Commercial |
$81.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$63.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.50
|
| Rate for Payer: PHP Commercial |
$76.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.00
|
| Rate for Payer: Priority Health SBD |
$56.70
|
| Rate for Payer: UMR Bronson Commercial |
$39.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.50
|
|
|
HC SEQUENTIAL MATERNAL SCRN PART 2
|
Facility
|
OP
|
$237.60
|
|
|
Service Code
|
CPT 81511
|
| Hospital Charge Code |
30100656
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.53 |
| Max. Negotiated Rate |
$213.84 |
| Rate for Payer: Aetna American Axle |
$154.44
|
| Rate for Payer: Aetna Commercial |
$201.96
|
| Rate for Payer: Aetna Medicare |
$159.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$154.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$191.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$191.88
|
| Rate for Payer: BCBS Complete |
$88.17
|
| Rate for Payer: BCBS MAPPO |
$153.50
|
| Rate for Payer: BCBS Trust/PPO |
$138.05
|
| Rate for Payer: BCN Medicare Advantage |
$153.50
|
| Rate for Payer: Cash Price |
$190.08
|
| Rate for Payer: Cash Price |
$190.08
|
| Rate for Payer: Cofinity Commercial |
$166.32
|
| Rate for Payer: Cofinity Commercial |
$204.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$153.50
|
| Rate for Payer: Healthscope Commercial |
$213.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$166.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$178.20
|
| Rate for Payer: Mclaren Medicaid |
$83.96
|
| Rate for Payer: Mclaren Medicare |
$153.50
|
| Rate for Payer: Meridian Medicaid |
$88.17
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$161.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$176.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$201.96
|
| Rate for Payer: PACE Medicare |
$145.82
|
| Rate for Payer: PACE SWMI |
$153.50
|
| Rate for Payer: PHP Commercial |
$201.96
|
| Rate for Payer: PHP Medicare Advantage |
$153.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$83.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24.41
|
| Rate for Payer: Priority Health Medicare |
$153.50
|
| Rate for Payer: Priority Health Narrow Network |
$19.53
|
| Rate for Payer: Priority Health SBD |
$149.69
|
| Rate for Payer: Railroad Medicare Medicare |
$153.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$184.20
|
| Rate for Payer: UHC Core |
$184.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$153.50
|
| Rate for Payer: UHC Exchange |
$153.50
|
| Rate for Payer: UHC Medicare Advantage |
$158.10
|
| Rate for Payer: UMR Bronson Commercial |
$87.91
|
| Rate for Payer: VA VA |
$153.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$178.20
|
|
|
HC SEQUENTIAL MATERNAL SCRN PART 2
|
Facility
|
IP
|
$237.60
|
|
|
Service Code
|
CPT 81511
|
| Hospital Charge Code |
30100656
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$104.54 |
| Max. Negotiated Rate |
$213.84 |
| Rate for Payer: Aetna American Axle |
$154.44
|
| Rate for Payer: Aetna Commercial |
$201.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$154.44
|
| Rate for Payer: Cash Price |
$190.08
|
| Rate for Payer: Cofinity Commercial |
$166.32
|
| Rate for Payer: Cofinity Commercial |
$204.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.08
|
| Rate for Payer: Healthscope Commercial |
$213.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$166.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$178.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$201.96
|
| Rate for Payer: PHP Commercial |
$201.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.32
|
| Rate for Payer: Priority Health SBD |
$149.69
|
| Rate for Payer: UMR Bronson Commercial |
$104.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$178.20
|
|
|
HC SERIAL LOOP EXPLANT
|
Facility
|
IP
|
$2,138.75
|
|
|
Service Code
|
CPT 33286
|
| Hospital Charge Code |
36100082
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$941.05 |
| Max. Negotiated Rate |
$1,924.88 |
| Rate for Payer: Aetna American Axle |
$1,390.19
|
| Rate for Payer: Aetna Commercial |
$1,817.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,390.19
|
| Rate for Payer: Cash Price |
$1,711.00
|
| Rate for Payer: Cofinity Commercial |
$1,497.12
|
| Rate for Payer: Cofinity Commercial |
$1,839.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,711.00
|
| Rate for Payer: Healthscope Commercial |
$1,924.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,497.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,604.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,817.94
|
| Rate for Payer: PHP Commercial |
$1,817.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,497.12
|
| Rate for Payer: Priority Health SBD |
$1,347.41
|
| Rate for Payer: UMR Bronson Commercial |
$941.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,604.06
|
|
|
HC SERIAL LOOP EXPLANT
|
Facility
|
OP
|
$2,138.75
|
|
|
Service Code
|
CPT 33286
|
| Hospital Charge Code |
36100082
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$82.52 |
| Max. Negotiated Rate |
$1,968.76 |
| Rate for Payer: Aetna American Axle |
$1,390.19
|
| Rate for Payer: Aetna Commercial |
$1,817.94
|
| Rate for Payer: Aetna Medicare |
$650.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,390.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$781.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$781.74
|
| Rate for Payer: BCBS Complete |
$359.22
|
| Rate for Payer: BCBS MAPPO |
$625.39
|
| Rate for Payer: BCBS Trust/PPO |
$649.26
|
| Rate for Payer: BCN Medicare Advantage |
$625.39
|
| Rate for Payer: Cash Price |
$1,711.00
|
| Rate for Payer: Cash Price |
$1,711.00
|
| Rate for Payer: Cofinity Commercial |
$1,839.32
|
| Rate for Payer: Cofinity Commercial |
$1,497.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,711.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$625.39
|
| Rate for Payer: Healthscope Commercial |
$1,924.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,497.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,604.06
|
| Rate for Payer: Mclaren Medicaid |
$342.09
|
| Rate for Payer: Mclaren Medicare |
$625.39
|
| Rate for Payer: Meridian Medicaid |
$359.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$656.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$719.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,817.94
|
| Rate for Payer: PACE Medicare |
$594.12
|
| Rate for Payer: PACE SWMI |
$625.39
|
| Rate for Payer: PHP Commercial |
$1,817.94
|
| Rate for Payer: PHP Medicare Advantage |
$625.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$342.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,497.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,968.76
|
| Rate for Payer: Priority Health Medicare |
$625.39
|
| Rate for Payer: Priority Health Narrow Network |
$1,575.01
|
| Rate for Payer: Priority Health SBD |
$1,347.41
|
| Rate for Payer: Railroad Medicare Medicare |
$625.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$90.77
|
| Rate for Payer: UHC Core |
$981.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$625.39
|
| Rate for Payer: UHC Exchange |
$82.52
|
| Rate for Payer: UHC Medicare Advantage |
$644.15
|
| Rate for Payer: UMR Bronson Commercial |
$791.34
|
| Rate for Payer: VA VA |
$625.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,604.06
|
|
|
HC SERIAL LOOP IMPLANT
|
Facility
|
IP
|
$4,077.63
|
|
|
Service Code
|
CPT 33285
|
| Hospital Charge Code |
36100081
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,794.16 |
| Max. Negotiated Rate |
$3,669.87 |
| Rate for Payer: Aetna American Axle |
$2,650.46
|
| Rate for Payer: Aetna Commercial |
$3,465.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,650.46
|
| Rate for Payer: Cash Price |
$3,262.10
|
| Rate for Payer: Cofinity Commercial |
$2,854.34
|
| Rate for Payer: Cofinity Commercial |
$3,506.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,262.10
|
| Rate for Payer: Healthscope Commercial |
$3,669.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,854.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,058.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,465.99
|
| Rate for Payer: PHP Commercial |
$3,465.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,854.34
|
| Rate for Payer: Priority Health SBD |
$2,568.91
|
| Rate for Payer: UMR Bronson Commercial |
$1,794.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,058.22
|
|
|
HC SERIAL LOOP IMPLANT
|
Facility
|
OP
|
$4,077.63
|
|
|
Service Code
|
CPT 33285
|
| Hospital Charge Code |
36100081
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$84.15 |
| Max. Negotiated Rate |
$23,772.84 |
| Rate for Payer: Aetna American Axle |
$2,650.46
|
| Rate for Payer: Aetna Commercial |
$3,465.99
|
| Rate for Payer: Aetna Medicare |
$7,853.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,650.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,439.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,439.52
|
| Rate for Payer: BCBS Complete |
$4,337.65
|
| Rate for Payer: BCBS MAPPO |
$7,551.62
|
| Rate for Payer: BCBS Trust/PPO |
$6,468.20
|
| Rate for Payer: BCN Medicare Advantage |
$7,551.62
|
| Rate for Payer: Cash Price |
$3,262.10
|
| Rate for Payer: Cash Price |
$3,262.10
|
| Rate for Payer: Cofinity Commercial |
$3,506.76
|
| Rate for Payer: Cofinity Commercial |
$2,854.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,262.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,551.62
|
| Rate for Payer: Healthscope Commercial |
$3,669.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,854.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,058.22
|
| Rate for Payer: Mclaren Medicaid |
$4,130.74
|
| Rate for Payer: Mclaren Medicare |
$7,551.62
|
| Rate for Payer: Meridian Medicaid |
$4,337.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,929.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,684.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,465.99
|
| Rate for Payer: PACE Medicare |
$7,174.04
|
| Rate for Payer: PACE SWMI |
$7,551.62
|
| Rate for Payer: PHP Commercial |
$3,465.99
|
| Rate for Payer: PHP Medicare Advantage |
$7,551.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,130.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,854.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23,772.84
|
| Rate for Payer: Priority Health Medicare |
$7,551.62
|
| Rate for Payer: Priority Health Narrow Network |
$19,018.27
|
| Rate for Payer: Priority Health SBD |
$2,568.91
|
| Rate for Payer: Railroad Medicare Medicare |
$7,551.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$92.56
|
| Rate for Payer: UHC Core |
$13,752.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,551.62
|
| Rate for Payer: UHC Exchange |
$84.15
|
| Rate for Payer: UHC Medicare Advantage |
$7,778.17
|
| Rate for Payer: UMR Bronson Commercial |
$1,508.72
|
| Rate for Payer: VA VA |
$7,551.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,058.22
|
|
|
HC SERIAL LOOP RECORDER
|
Facility
|
IP
|
$10,245.90
|
|
|
Service Code
|
HCPCS C1764
|
| Hospital Charge Code |
27800025
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,508.20 |
| Max. Negotiated Rate |
$9,221.31 |
| Rate for Payer: Aetna American Axle |
$6,659.84
|
| Rate for Payer: Aetna Commercial |
$8,709.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,659.84
|
| Rate for Payer: Cash Price |
$8,196.72
|
| Rate for Payer: Cofinity Commercial |
$7,172.13
|
| Rate for Payer: Cofinity Commercial |
$8,811.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,196.72
|
| Rate for Payer: Healthscope Commercial |
$9,221.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7,172.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,684.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8,709.02
|
| Rate for Payer: PHP Commercial |
$8,709.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,172.13
|
| Rate for Payer: Priority Health SBD |
$6,454.92
|
| Rate for Payer: UMR Bronson Commercial |
$4,508.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,684.42
|
|
|
HC SERIAL LOOP RECORDER
|
Facility
|
OP
|
$10,245.90
|
|
|
Service Code
|
HCPCS C1764
|
| Hospital Charge Code |
27800025
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,790.98 |
| Max. Negotiated Rate |
$9,221.31 |
| Rate for Payer: Aetna American Axle |
$6,659.84
|
| Rate for Payer: Aetna Commercial |
$8,709.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,659.84
|
| Rate for Payer: BCBS Complete |
$4,098.36
|
| Rate for Payer: Cash Price |
$8,196.72
|
| Rate for Payer: Cofinity Commercial |
$7,172.13
|
| Rate for Payer: Cofinity Commercial |
$8,811.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,196.72
|
| Rate for Payer: Healthscope Commercial |
$9,221.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7,172.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,684.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8,709.02
|
| Rate for Payer: PHP Commercial |
$8,709.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,172.13
|
| Rate for Payer: Priority Health SBD |
$6,454.92
|
| Rate for Payer: UMR Bronson Commercial |
$3,790.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,684.42
|
|
|
HC SEROTONIN HIAA BLOOD
|
Facility
|
IP
|
$65.28
|
|
|
Service Code
|
CPT 84260
|
| Hospital Charge Code |
30100421
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.72 |
| Max. Negotiated Rate |
$58.75 |
| Rate for Payer: Aetna American Axle |
$42.43
|
| Rate for Payer: Aetna Commercial |
$55.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.43
|
| Rate for Payer: Cash Price |
$52.22
|
| Rate for Payer: Cofinity Commercial |
$45.70
|
| Rate for Payer: Cofinity Commercial |
$56.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.22
|
| Rate for Payer: Healthscope Commercial |
$58.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$55.49
|
| Rate for Payer: PHP Commercial |
$55.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.70
|
| Rate for Payer: Priority Health SBD |
$41.13
|
| Rate for Payer: UMR Bronson Commercial |
$28.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.96
|
|
|
HC SEROTONIN HIAA BLOOD
|
Facility
|
OP
|
$65.28
|
|
|
Service Code
|
CPT 84260
|
| Hospital Charge Code |
30100421
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.75 |
| Max. Negotiated Rate |
$58.75 |
| Rate for Payer: Aetna American Axle |
$42.43
|
| Rate for Payer: Aetna Commercial |
$55.49
|
| Rate for Payer: Aetna Medicare |
$32.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38.72
|
| Rate for Payer: BCBS Complete |
$17.79
|
| Rate for Payer: BCBS MAPPO |
$30.98
|
| Rate for Payer: BCBS Trust/PPO |
$27.87
|
| Rate for Payer: BCN Medicare Advantage |
$30.98
|
| Rate for Payer: Cash Price |
$52.22
|
| Rate for Payer: Cash Price |
$52.22
|
| Rate for Payer: Cofinity Commercial |
$45.70
|
| Rate for Payer: Cofinity Commercial |
$56.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.98
|
| Rate for Payer: Healthscope Commercial |
$58.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.96
|
| Rate for Payer: Mclaren Medicaid |
$16.95
|
| Rate for Payer: Mclaren Medicare |
$30.98
|
| Rate for Payer: Meridian Medicaid |
$17.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$32.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$55.49
|
| Rate for Payer: PACE Medicare |
$29.43
|
| Rate for Payer: PACE SWMI |
$30.98
|
| Rate for Payer: PHP Commercial |
$55.49
|
| Rate for Payer: PHP Medicare Advantage |
$30.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.94
|
| Rate for Payer: Priority Health Medicare |
$30.98
|
| Rate for Payer: Priority Health Narrow Network |
$16.75
|
| Rate for Payer: Priority Health SBD |
$41.13
|
| Rate for Payer: Railroad Medicare Medicare |
$30.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.18
|
| Rate for Payer: UHC Core |
$51.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.98
|
| Rate for Payer: UHC Exchange |
$30.98
|
| Rate for Payer: UHC Medicare Advantage |
$31.91
|
| Rate for Payer: UMR Bronson Commercial |
$24.15
|
| Rate for Payer: VA VA |
$30.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.96
|
|
|
HC SEROTONIN RELEASE ASSAY
|
Facility
|
IP
|
$338.64
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
30200393
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$149.00 |
| Max. Negotiated Rate |
$304.78 |
| Rate for Payer: Aetna American Axle |
$220.12
|
| Rate for Payer: Aetna Commercial |
$287.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$220.12
|
| Rate for Payer: Cash Price |
$270.91
|
| Rate for Payer: Cofinity Commercial |
$237.05
|
| Rate for Payer: Cofinity Commercial |
$291.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.91
|
| Rate for Payer: Healthscope Commercial |
$304.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$237.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$253.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$287.84
|
| Rate for Payer: PHP Commercial |
$287.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.05
|
| Rate for Payer: Priority Health SBD |
$213.34
|
| Rate for Payer: UMR Bronson Commercial |
$149.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$253.98
|
|
|
HC SEROTONIN RELEASE ASSAY
|
Facility
|
OP
|
$338.64
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
30200393
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.05 |
| Max. Negotiated Rate |
$304.78 |
| Rate for Payer: Aetna American Axle |
$220.12
|
| Rate for Payer: Aetna Commercial |
$287.84
|
| Rate for Payer: Aetna Medicare |
$19.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$220.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.96
|
| Rate for Payer: BCBS Complete |
$10.55
|
| Rate for Payer: BCBS MAPPO |
$18.37
|
| Rate for Payer: BCBS Trust/PPO |
$16.52
|
| Rate for Payer: BCN Medicare Advantage |
$18.37
|
| Rate for Payer: Cash Price |
$270.91
|
| Rate for Payer: Cash Price |
$270.91
|
| Rate for Payer: Cofinity Commercial |
$237.05
|
| Rate for Payer: Cofinity Commercial |
$291.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.37
|
| Rate for Payer: Healthscope Commercial |
$304.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$237.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$253.98
|
| Rate for Payer: Mclaren Medicaid |
$10.05
|
| Rate for Payer: Mclaren Medicare |
$18.37
|
| Rate for Payer: Meridian Medicaid |
$10.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$287.84
|
| Rate for Payer: PACE Medicare |
$17.45
|
| Rate for Payer: PACE SWMI |
$18.37
|
| Rate for Payer: PHP Commercial |
$287.84
|
| Rate for Payer: PHP Medicare Advantage |
$18.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.59
|
| Rate for Payer: Priority Health Medicare |
$18.37
|
| Rate for Payer: Priority Health Narrow Network |
$15.67
|
| Rate for Payer: Priority Health SBD |
$213.34
|
| Rate for Payer: Railroad Medicare Medicare |
$18.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.04
|
| Rate for Payer: UHC Core |
$30.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.37
|
| Rate for Payer: UHC Exchange |
$18.37
|
| Rate for Payer: UHC Medicare Advantage |
$18.92
|
| Rate for Payer: UMR Bronson Commercial |
$125.30
|
| Rate for Payer: VA VA |
$18.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$253.98
|
|
|
HC SEROTONIN RELEASE ASSAY LOVENOX
|
Facility
|
IP
|
$103.02
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
30200131
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$45.33 |
| Max. Negotiated Rate |
$92.72 |
| Rate for Payer: Aetna American Axle |
$66.96
|
| Rate for Payer: Aetna Commercial |
$87.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.96
|
| Rate for Payer: Cash Price |
$82.42
|
| Rate for Payer: Cofinity Commercial |
$72.11
|
| Rate for Payer: Cofinity Commercial |
$88.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.42
|
| Rate for Payer: Healthscope Commercial |
$92.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$72.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$87.57
|
| Rate for Payer: PHP Commercial |
$87.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.11
|
| Rate for Payer: Priority Health SBD |
$64.90
|
| Rate for Payer: UMR Bronson Commercial |
$45.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.26
|
|
|
HC SEROTONIN RELEASE ASSAY LOVENOX
|
Facility
|
OP
|
$103.02
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
30200131
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.05 |
| Max. Negotiated Rate |
$92.72 |
| Rate for Payer: Aetna American Axle |
$66.96
|
| Rate for Payer: Aetna Commercial |
$87.57
|
| Rate for Payer: Aetna Medicare |
$19.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.96
|
| Rate for Payer: BCBS Complete |
$10.55
|
| Rate for Payer: BCBS MAPPO |
$18.37
|
| Rate for Payer: BCBS Trust/PPO |
$16.52
|
| Rate for Payer: BCN Medicare Advantage |
$18.37
|
| Rate for Payer: Cash Price |
$82.42
|
| Rate for Payer: Cash Price |
$82.42
|
| Rate for Payer: Cofinity Commercial |
$88.60
|
| Rate for Payer: Cofinity Commercial |
$72.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.37
|
| Rate for Payer: Healthscope Commercial |
$92.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$72.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.26
|
| Rate for Payer: Mclaren Medicaid |
$10.05
|
| Rate for Payer: Mclaren Medicare |
$18.37
|
| Rate for Payer: Meridian Medicaid |
$10.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$87.57
|
| Rate for Payer: PACE Medicare |
$17.45
|
| Rate for Payer: PACE SWMI |
$18.37
|
| Rate for Payer: PHP Commercial |
$87.57
|
| Rate for Payer: PHP Medicare Advantage |
$18.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.59
|
| Rate for Payer: Priority Health Medicare |
$18.37
|
| Rate for Payer: Priority Health Narrow Network |
$15.67
|
| Rate for Payer: Priority Health SBD |
$64.90
|
| Rate for Payer: Railroad Medicare Medicare |
$18.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.04
|
| Rate for Payer: UHC Core |
$30.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.37
|
| Rate for Payer: UHC Exchange |
$18.37
|
| Rate for Payer: UHC Medicare Advantage |
$18.92
|
| Rate for Payer: UMR Bronson Commercial |
$38.12
|
| Rate for Payer: VA VA |
$18.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.26
|
|
|
HC SEROTONIN RELEASE ASSAY PORCINE
|
Facility
|
IP
|
$399.84
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
30200132
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$175.93 |
| Max. Negotiated Rate |
$359.86 |
| Rate for Payer: Aetna American Axle |
$259.90
|
| Rate for Payer: Aetna Commercial |
$339.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$259.90
|
| Rate for Payer: Cash Price |
$319.87
|
| Rate for Payer: Cofinity Commercial |
$279.89
|
| Rate for Payer: Cofinity Commercial |
$343.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$319.87
|
| Rate for Payer: Healthscope Commercial |
$359.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$279.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$299.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$339.86
|
| Rate for Payer: PHP Commercial |
$339.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$279.89
|
| Rate for Payer: Priority Health SBD |
$251.90
|
| Rate for Payer: UMR Bronson Commercial |
$175.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$299.88
|
|
|
HC SEROTONIN RELEASE ASSAY PORCINE
|
Facility
|
OP
|
$399.84
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
30200132
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.05 |
| Max. Negotiated Rate |
$359.86 |
| Rate for Payer: Aetna American Axle |
$259.90
|
| Rate for Payer: Aetna Commercial |
$339.86
|
| Rate for Payer: Aetna Medicare |
$19.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$259.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.96
|
| Rate for Payer: BCBS Complete |
$10.55
|
| Rate for Payer: BCBS MAPPO |
$18.37
|
| Rate for Payer: BCBS Trust/PPO |
$16.52
|
| Rate for Payer: BCN Medicare Advantage |
$18.37
|
| Rate for Payer: Cash Price |
$319.87
|
| Rate for Payer: Cash Price |
$319.87
|
| Rate for Payer: Cofinity Commercial |
$279.89
|
| Rate for Payer: Cofinity Commercial |
$343.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$319.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.37
|
| Rate for Payer: Healthscope Commercial |
$359.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$279.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$299.88
|
| Rate for Payer: Mclaren Medicaid |
$10.05
|
| Rate for Payer: Mclaren Medicare |
$18.37
|
| Rate for Payer: Meridian Medicaid |
$10.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$339.86
|
| Rate for Payer: PACE Medicare |
$17.45
|
| Rate for Payer: PACE SWMI |
$18.37
|
| Rate for Payer: PHP Commercial |
$339.86
|
| Rate for Payer: PHP Medicare Advantage |
$18.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$279.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.59
|
| Rate for Payer: Priority Health Medicare |
$18.37
|
| Rate for Payer: Priority Health Narrow Network |
$15.67
|
| Rate for Payer: Priority Health SBD |
$251.90
|
| Rate for Payer: Railroad Medicare Medicare |
$18.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.04
|
| Rate for Payer: UHC Core |
$30.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.37
|
| Rate for Payer: UHC Exchange |
$18.37
|
| Rate for Payer: UHC Medicare Advantage |
$18.92
|
| Rate for Payer: UMR Bronson Commercial |
$147.94
|
| Rate for Payer: VA VA |
$18.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$299.88
|
|
|
HC SERUM FREE LIGHT CHAIN
|
Facility
|
OP
|
$75.90
|
|
|
Service Code
|
CPT 83521
|
| Hospital Charge Code |
30100305
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.45 |
| Max. Negotiated Rate |
$68.31 |
| Rate for Payer: Aetna American Axle |
$49.34
|
| Rate for Payer: Aetna Commercial |
$64.52
|
| Rate for Payer: Aetna Medicare |
$17.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.59
|
| Rate for Payer: BCBS Complete |
$9.92
|
| Rate for Payer: BCBS MAPPO |
$17.27
|
| Rate for Payer: BCBS Trust/PPO |
$15.53
|
| Rate for Payer: BCN Medicare Advantage |
$17.27
|
| Rate for Payer: Cash Price |
$60.72
|
| Rate for Payer: Cash Price |
$60.72
|
| Rate for Payer: Cofinity Commercial |
$53.13
|
| Rate for Payer: Cofinity Commercial |
$65.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.27
|
| Rate for Payer: Healthscope Commercial |
$68.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$53.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.92
|
| Rate for Payer: Mclaren Medicaid |
$9.45
|
| Rate for Payer: Mclaren Medicare |
$17.27
|
| Rate for Payer: Meridian Medicaid |
$9.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$64.52
|
| Rate for Payer: PACE Medicare |
$16.41
|
| Rate for Payer: PACE SWMI |
$17.27
|
| Rate for Payer: PHP Commercial |
$64.52
|
| Rate for Payer: PHP Medicare Advantage |
$17.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.27
|
| Rate for Payer: Priority Health Medicare |
$17.27
|
| Rate for Payer: Priority Health Narrow Network |
$13.82
|
| Rate for Payer: Priority Health SBD |
$47.82
|
| Rate for Payer: Railroad Medicare Medicare |
$17.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.72
|
| Rate for Payer: UHC Core |
$20.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.27
|
| Rate for Payer: UHC Exchange |
$17.27
|
| Rate for Payer: UHC Medicare Advantage |
$17.79
|
| Rate for Payer: UMR Bronson Commercial |
$28.08
|
| Rate for Payer: VA VA |
$17.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.92
|
|
|
HC SERUM FREE LIGHT CHAIN
|
Facility
|
IP
|
$75.90
|
|
|
Service Code
|
CPT 83521
|
| Hospital Charge Code |
30100305
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.40 |
| Max. Negotiated Rate |
$68.31 |
| Rate for Payer: Aetna American Axle |
$49.34
|
| Rate for Payer: Aetna Commercial |
$64.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.34
|
| Rate for Payer: Cash Price |
$60.72
|
| Rate for Payer: Cofinity Commercial |
$65.27
|
| Rate for Payer: Cofinity Commercial |
$53.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.72
|
| Rate for Payer: Healthscope Commercial |
$68.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$53.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$64.52
|
| Rate for Payer: PHP Commercial |
$64.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.13
|
| Rate for Payer: Priority Health SBD |
$47.82
|
| Rate for Payer: UMR Bronson Commercial |
$33.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.92
|
|
|
HC SERUM FREE LIGHT CHAIN CMPT
|
Facility
|
OP
|
$75.90
|
|
|
Service Code
|
CPT 83521
|
| Hospital Charge Code |
30100306
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.45 |
| Max. Negotiated Rate |
$68.31 |
| Rate for Payer: Aetna American Axle |
$49.34
|
| Rate for Payer: Aetna Commercial |
$64.52
|
| Rate for Payer: Aetna Medicare |
$17.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.59
|
| Rate for Payer: BCBS Complete |
$9.92
|
| Rate for Payer: BCBS MAPPO |
$17.27
|
| Rate for Payer: BCBS Trust/PPO |
$15.53
|
| Rate for Payer: BCN Medicare Advantage |
$17.27
|
| Rate for Payer: Cash Price |
$60.72
|
| Rate for Payer: Cash Price |
$60.72
|
| Rate for Payer: Cofinity Commercial |
$65.27
|
| Rate for Payer: Cofinity Commercial |
$53.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.27
|
| Rate for Payer: Healthscope Commercial |
$68.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$53.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.92
|
| Rate for Payer: Mclaren Medicaid |
$9.45
|
| Rate for Payer: Mclaren Medicare |
$17.27
|
| Rate for Payer: Meridian Medicaid |
$9.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$64.52
|
| Rate for Payer: PACE Medicare |
$16.41
|
| Rate for Payer: PACE SWMI |
$17.27
|
| Rate for Payer: PHP Commercial |
$64.52
|
| Rate for Payer: PHP Medicare Advantage |
$17.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.27
|
| Rate for Payer: Priority Health Medicare |
$17.27
|
| Rate for Payer: Priority Health Narrow Network |
$13.82
|
| Rate for Payer: Priority Health SBD |
$47.82
|
| Rate for Payer: Railroad Medicare Medicare |
$17.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.72
|
| Rate for Payer: UHC Core |
$20.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.27
|
| Rate for Payer: UHC Exchange |
$17.27
|
| Rate for Payer: UHC Medicare Advantage |
$17.79
|
| Rate for Payer: UMR Bronson Commercial |
$28.08
|
| Rate for Payer: VA VA |
$17.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.92
|
|
|
HC SERUM FREE LIGHT CHAIN CMPT
|
Facility
|
IP
|
$75.90
|
|
|
Service Code
|
CPT 83521
|
| Hospital Charge Code |
30100306
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.40 |
| Max. Negotiated Rate |
$68.31 |
| Rate for Payer: Aetna American Axle |
$49.34
|
| Rate for Payer: Aetna Commercial |
$64.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.34
|
| Rate for Payer: Cash Price |
$60.72
|
| Rate for Payer: Cofinity Commercial |
$53.13
|
| Rate for Payer: Cofinity Commercial |
$65.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.72
|
| Rate for Payer: Healthscope Commercial |
$68.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$53.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$64.52
|
| Rate for Payer: PHP Commercial |
$64.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.13
|
| Rate for Payer: Priority Health SBD |
$47.82
|
| Rate for Payer: UMR Bronson Commercial |
$33.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.92
|
|
|
HC SESAME SEED IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200101
|
|
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 SESAME SEED IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200101
|
|
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 |
$21.41
|
| Rate for Payer: Cofinity Commercial |
$17.42
|
| 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 SETUP 1
|
Facility
|
IP
|
$32.88
|
|
| Hospital Charge Code |
27000145
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.47 |
| Max. Negotiated Rate |
$29.59 |
| Rate for Payer: Aetna American Axle |
$21.37
|
| Rate for Payer: Aetna Commercial |
$27.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.37
|
| Rate for Payer: Cash Price |
$26.30
|
| Rate for Payer: Cofinity Commercial |
$23.02
|
| Rate for Payer: Cofinity Commercial |
$28.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.30
|
| Rate for Payer: Healthscope Commercial |
$29.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$27.95
|
| Rate for Payer: PHP Commercial |
$27.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.02
|
| Rate for Payer: Priority Health SBD |
$20.71
|
| Rate for Payer: UMR Bronson Commercial |
$14.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.66
|
|
|
HC SETUP 1
|
Facility
|
OP
|
$32.88
|
|
| Hospital Charge Code |
27000145
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.17 |
| Max. Negotiated Rate |
$29.59 |
| Rate for Payer: Aetna American Axle |
$21.37
|
| Rate for Payer: Aetna Commercial |
$27.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.37
|
| Rate for Payer: BCBS Complete |
$13.15
|
| Rate for Payer: Cash Price |
$26.30
|
| Rate for Payer: Cofinity Commercial |
$23.02
|
| Rate for Payer: Cofinity Commercial |
$28.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.30
|
| Rate for Payer: Healthscope Commercial |
$29.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$27.95
|
| Rate for Payer: PHP Commercial |
$27.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.02
|
| Rate for Payer: Priority Health SBD |
$20.71
|
| Rate for Payer: UMR Bronson Commercial |
$12.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.66
|
|
