|
HC I&D PILONIDAL CYST
|
Facility
|
IP
|
$931.90
|
|
|
Service Code
|
CPT 10080
|
| Hospital Charge Code |
45000097
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$410.04 |
| Max. Negotiated Rate |
$838.71 |
| Rate for Payer: Aetna American Axle |
$605.74
|
| Rate for Payer: Aetna Commercial |
$792.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$605.74
|
| Rate for Payer: Cash Price |
$745.52
|
| Rate for Payer: Cofinity Commercial |
$652.33
|
| Rate for Payer: Cofinity Commercial |
$801.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$652.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$745.52
|
| Rate for Payer: Healthscope Commercial |
$838.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$652.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$698.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$792.12
|
| Rate for Payer: PHP Commercial |
$792.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$605.74
|
| Rate for Payer: Priority Health SBD |
$587.10
|
| Rate for Payer: UMR Bronson Commercial |
$410.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$698.92
|
|
|
HC I&D PROCEDURE
|
Facility
|
IP
|
$490.15
|
|
| Hospital Charge Code |
45000045
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$215.67 |
| Max. Negotiated Rate |
$441.14 |
| Rate for Payer: Aetna American Axle |
$318.60
|
| Rate for Payer: Aetna Commercial |
$416.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$318.60
|
| Rate for Payer: Cash Price |
$392.12
|
| Rate for Payer: Cofinity Commercial |
$343.10
|
| Rate for Payer: Cofinity Commercial |
$421.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$343.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$392.12
|
| Rate for Payer: Healthscope Commercial |
$441.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$343.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$367.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$416.63
|
| Rate for Payer: PHP Commercial |
$416.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$318.60
|
| Rate for Payer: Priority Health SBD |
$308.79
|
| Rate for Payer: UMR Bronson Commercial |
$215.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$367.61
|
|
|
HC I&D PROCEDURE
|
Facility
|
OP
|
$490.15
|
|
| Hospital Charge Code |
45000045
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$181.36 |
| Max. Negotiated Rate |
$441.14 |
| Rate for Payer: Aetna American Axle |
$318.60
|
| Rate for Payer: Aetna Commercial |
$416.63
|
| Rate for Payer: Aetna Medicare |
$245.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$318.60
|
| Rate for Payer: BCBS Complete |
$196.06
|
| Rate for Payer: Cash Price |
$392.12
|
| Rate for Payer: Cofinity Commercial |
$343.10
|
| Rate for Payer: Cofinity Commercial |
$421.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$343.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$392.12
|
| Rate for Payer: Healthscope Commercial |
$441.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$343.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$367.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$416.63
|
| Rate for Payer: PHP Commercial |
$416.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$318.60
|
| Rate for Payer: Priority Health SBD |
$308.79
|
| Rate for Payer: UMR Bronson Commercial |
$181.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$367.61
|
|
|
HC I&D VULVA/PERINEAL ABSCESS
|
Facility
|
IP
|
$849.27
|
|
|
Service Code
|
CPT 56405
|
| Hospital Charge Code |
76100319
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$373.68 |
| Max. Negotiated Rate |
$764.34 |
| Rate for Payer: Aetna American Axle |
$552.03
|
| Rate for Payer: Aetna Commercial |
$721.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$552.03
|
| Rate for Payer: Cash Price |
$679.42
|
| Rate for Payer: Cofinity Commercial |
$594.49
|
| Rate for Payer: Cofinity Commercial |
$730.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$594.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$679.42
|
| Rate for Payer: Healthscope Commercial |
$764.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$594.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$636.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$721.88
|
| Rate for Payer: PHP Commercial |
$721.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$552.03
|
| Rate for Payer: Priority Health SBD |
$535.04
|
| Rate for Payer: UMR Bronson Commercial |
$373.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$636.95
|
|
|
HC I&D VULVA/PERINEAL ABSCESS
|
Facility
|
OP
|
$849.27
|
|
|
Service Code
|
CPT 56405
|
| Hospital Charge Code |
76100319
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$121.33 |
| Max. Negotiated Rate |
$936.74 |
| Rate for Payer: Aetna American Axle |
$552.03
|
| Rate for Payer: Aetna Commercial |
$721.88
|
| Rate for Payer: Aetna Medicare |
$309.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$552.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$372.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$372.55
|
| Rate for Payer: BCBS Complete |
$167.74
|
| Rate for Payer: BCBS MAPPO |
$298.04
|
| Rate for Payer: BCBS Trust/PPO |
$327.46
|
| Rate for Payer: BCN Commercial |
$327.46
|
| Rate for Payer: BCN Medicare Advantage |
$298.04
|
| Rate for Payer: Cash Price |
$679.42
|
| Rate for Payer: Cash Price |
$679.42
|
| Rate for Payer: Cash Price |
$679.42
|
| Rate for Payer: Cofinity Commercial |
$730.37
|
| Rate for Payer: Cofinity Commercial |
$594.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$594.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$679.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$298.04
|
| Rate for Payer: Healthscope Commercial |
$764.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$594.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$636.95
|
| Rate for Payer: Mclaren Medicaid |
$159.75
|
| Rate for Payer: Mclaren Medicare |
$298.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$312.94
|
| Rate for Payer: Meridian Medicaid |
$167.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$342.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$721.88
|
| Rate for Payer: Nomi Health Commercial |
$625.88
|
| Rate for Payer: PACE Medicare |
$283.14
|
| Rate for Payer: PACE SWMI |
$298.04
|
| Rate for Payer: PHP Commercial |
$721.88
|
| Rate for Payer: PHP Medicare Advantage |
$298.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$159.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$552.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$936.74
|
| Rate for Payer: Priority Health Medicare |
$298.04
|
| Rate for Payer: Priority Health Narrow Network |
$749.39
|
| Rate for Payer: Priority Health SBD |
$535.04
|
| Rate for Payer: Railroad Medicare Medicare |
$298.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$133.46
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$298.04
|
| Rate for Payer: UHC Exchange |
$121.33
|
| Rate for Payer: UHC Medicare Advantage |
$298.04
|
| Rate for Payer: UHCCP Medicaid |
$159.75
|
| Rate for Payer: UMR Bronson Commercial |
$314.23
|
| Rate for Payer: VA VA |
$298.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$636.95
|
|
|
HC IFR MEASUREMENT
|
Facility
|
OP
|
$3,878.57
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
48100132
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$82.17 |
| Max. Negotiated Rate |
$3,490.71 |
| Rate for Payer: Aetna American Axle |
$2,521.07
|
| Rate for Payer: Aetna Commercial |
$3,296.78
|
| Rate for Payer: Aetna Medicare |
$159.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,521.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$191.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$191.62
|
| Rate for Payer: BCBS Complete |
$86.28
|
| Rate for Payer: BCBS MAPPO |
$153.30
|
| Rate for Payer: BCBS Trust/PPO |
$393.86
|
| Rate for Payer: BCN Commercial |
$393.86
|
| Rate for Payer: BCN Medicare Advantage |
$153.30
|
| Rate for Payer: Cash Price |
$3,102.86
|
| Rate for Payer: Cash Price |
$3,102.86
|
| Rate for Payer: Cash Price |
$3,102.86
|
| Rate for Payer: Cofinity Commercial |
$2,715.00
|
| Rate for Payer: Cofinity Commercial |
$3,335.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,715.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,102.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$153.30
|
| Rate for Payer: Healthscope Commercial |
$3,490.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,715.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,908.93
|
| Rate for Payer: Mclaren Medicaid |
$82.17
|
| Rate for Payer: Mclaren Medicare |
$153.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$160.96
|
| Rate for Payer: Meridian Medicaid |
$86.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$176.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,296.78
|
| Rate for Payer: Nomi Health Commercial |
$459.90
|
| Rate for Payer: PACE Medicare |
$145.64
|
| Rate for Payer: PACE SWMI |
$153.30
|
| Rate for Payer: PHP Commercial |
$3,296.78
|
| Rate for Payer: PHP Medicare Advantage |
$153.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,521.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$481.80
|
| Rate for Payer: Priority Health Medicare |
$153.30
|
| Rate for Payer: Priority Health Narrow Network |
$385.44
|
| Rate for Payer: Priority Health SBD |
$2,443.50
|
| Rate for Payer: Railroad Medicare Medicare |
$153.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$431.52
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$153.30
|
| Rate for Payer: UHC Exchange |
$292.97
|
| Rate for Payer: UHC Medicare Advantage |
$153.30
|
| Rate for Payer: UHCCP Medicaid |
$82.17
|
| Rate for Payer: UMR Bronson Commercial |
$1,435.07
|
| Rate for Payer: VA VA |
$153.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,908.93
|
|
|
HC IFR MEASUREMENT
|
Facility
|
IP
|
$3,878.57
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
48100132
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,706.57 |
| Max. Negotiated Rate |
$3,490.71 |
| Rate for Payer: Aetna American Axle |
$2,521.07
|
| Rate for Payer: Aetna Commercial |
$3,296.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,521.07
|
| Rate for Payer: Cash Price |
$3,102.86
|
| Rate for Payer: Cofinity Commercial |
$2,715.00
|
| Rate for Payer: Cofinity Commercial |
$3,335.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,715.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,102.86
|
| Rate for Payer: Healthscope Commercial |
$3,490.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,715.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,908.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,296.78
|
| Rate for Payer: PHP Commercial |
$3,296.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,521.07
|
| Rate for Payer: Priority Health SBD |
$2,443.50
|
| Rate for Payer: UMR Bronson Commercial |
$1,706.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,908.93
|
|
|
HC IGG SUBCLASS 1-4
|
Facility
|
IP
|
$13.46
|
|
|
Service Code
|
CPT 82787
|
| Hospital Charge Code |
30100214
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.92 |
| Max. Negotiated Rate |
$12.11 |
| Rate for Payer: Aetna American Axle |
$8.75
|
| Rate for Payer: Aetna Commercial |
$11.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.75
|
| Rate for Payer: Cash Price |
$10.77
|
| Rate for Payer: Cofinity Commercial |
$11.58
|
| Rate for Payer: Cofinity Commercial |
$9.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.77
|
| Rate for Payer: Healthscope Commercial |
$12.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.44
|
| Rate for Payer: PHP Commercial |
$11.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.75
|
| Rate for Payer: Priority Health SBD |
$8.48
|
| Rate for Payer: UMR Bronson Commercial |
$5.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.10
|
|
|
HC IGG SUBCLASS 1-4
|
Facility
|
OP
|
$13.46
|
|
|
Service Code
|
CPT 82787
|
| Hospital Charge Code |
30100214
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.30 |
| Max. Negotiated Rate |
$12.11 |
| Rate for Payer: Mclaren Medicare |
$8.02
|
| Rate for Payer: Aetna American Axle |
$8.75
|
| Rate for Payer: Aetna Commercial |
$11.44
|
| Rate for Payer: Aetna Medicare |
$8.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.02
|
| Rate for Payer: BCBS Complete |
$4.51
|
| Rate for Payer: BCBS MAPPO |
$8.02
|
| Rate for Payer: BCBS Trust/PPO |
$7.73
|
| Rate for Payer: BCN Commercial |
$7.73
|
| Rate for Payer: BCN Medicare Advantage |
$8.02
|
| Rate for Payer: Cash Price |
$10.77
|
| Rate for Payer: Cash Price |
$10.77
|
| Rate for Payer: Cofinity Commercial |
$9.42
|
| Rate for Payer: Cofinity Commercial |
$11.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.02
|
| Rate for Payer: Healthscope Commercial |
$12.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.10
|
| Rate for Payer: Mclaren Medicaid |
$4.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.42
|
| Rate for Payer: Meridian Medicaid |
$4.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.44
|
| Rate for Payer: Nomi Health Commercial |
$12.03
|
| Rate for Payer: PACE Medicare |
$7.62
|
| Rate for Payer: PACE SWMI |
$8.02
|
| Rate for Payer: PHP Commercial |
$11.44
|
| Rate for Payer: PHP Medicare Advantage |
$8.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.02
|
| Rate for Payer: Priority Health Medicare |
$8.02
|
| Rate for Payer: Priority Health Narrow Network |
$6.42
|
| Rate for Payer: Priority Health SBD |
$8.48
|
| Rate for Payer: Railroad Medicare Medicare |
$8.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.02
|
| Rate for Payer: UHC Exchange |
$8.02
|
| Rate for Payer: UHC Medicare Advantage |
$8.02
|
| Rate for Payer: UHCCP Medicaid |
$4.30
|
| Rate for Payer: UMR Bronson Commercial |
$4.98
|
| Rate for Payer: VA VA |
$8.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.10
|
|
|
HC IGG SYNTHESIS RATE CSF
|
Facility
|
IP
|
$20.81
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
30100212
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.16 |
| Max. Negotiated Rate |
$18.73 |
| Rate for Payer: Aetna American Axle |
$13.53
|
| Rate for Payer: Aetna Commercial |
$17.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.53
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$14.57
|
| Rate for Payer: Cofinity Commercial |
$17.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Healthscope Commercial |
$18.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: PHP Commercial |
$17.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: Priority Health SBD |
$13.11
|
| Rate for Payer: UMR Bronson Commercial |
$9.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.61
|
|
|
HC IGG SYNTHESIS RATE CSF
|
Facility
|
OP
|
$20.81
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
30100212
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.98 |
| Max. Negotiated Rate |
$18.73 |
| Rate for Payer: Aetna American Axle |
$13.53
|
| Rate for Payer: Aetna Commercial |
$17.69
|
| Rate for Payer: Aetna Medicare |
$9.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.62
|
| Rate for Payer: BCBS Complete |
$5.23
|
| Rate for Payer: BCBS MAPPO |
$9.30
|
| Rate for Payer: BCBS Trust/PPO |
$8.97
|
| Rate for Payer: BCN Commercial |
$8.97
|
| Rate for Payer: BCN Medicare Advantage |
$9.30
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$17.90
|
| Rate for Payer: Cofinity Commercial |
$14.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.30
|
| Rate for Payer: Healthscope Commercial |
$18.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.61
|
| Rate for Payer: Mclaren Medicaid |
$4.98
|
| Rate for Payer: Mclaren Medicare |
$9.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.76
|
| Rate for Payer: Meridian Medicaid |
$5.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: Nomi Health Commercial |
$13.95
|
| Rate for Payer: PACE Medicare |
$8.84
|
| Rate for Payer: PACE SWMI |
$9.30
|
| Rate for Payer: PHP Commercial |
$17.69
|
| Rate for Payer: PHP Medicare Advantage |
$9.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.57
|
| Rate for Payer: Priority Health Medicare |
$9.30
|
| Rate for Payer: Priority Health Narrow Network |
$7.66
|
| Rate for Payer: Priority Health SBD |
$13.11
|
| Rate for Payer: Railroad Medicare Medicare |
$9.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.30
|
| Rate for Payer: UHC Exchange |
$9.30
|
| Rate for Payer: UHC Medicare Advantage |
$9.30
|
| Rate for Payer: UHCCP Medicaid |
$4.98
|
| Rate for Payer: UMR Bronson Commercial |
$7.70
|
| Rate for Payer: VA VA |
$9.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.61
|
|
|
HC IGG SYNTHESIS RATE CSF ALBUMIN
|
Facility
|
IP
|
$16.65
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
30100074
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.33 |
| Max. Negotiated Rate |
$14.98 |
| Rate for Payer: Aetna American Axle |
$10.82
|
| Rate for Payer: Aetna Commercial |
$14.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.82
|
| Rate for Payer: Cash Price |
$13.32
|
| Rate for Payer: Cofinity Commercial |
$11.66
|
| Rate for Payer: Cofinity Commercial |
$14.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.32
|
| Rate for Payer: Healthscope Commercial |
$14.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.15
|
| Rate for Payer: PHP Commercial |
$14.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.82
|
| Rate for Payer: Priority Health SBD |
$10.49
|
| Rate for Payer: UMR Bronson Commercial |
$7.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.49
|
|
|
HC IGG SYNTHESIS RATE CSF ALBUMIN
|
Facility
|
OP
|
$16.65
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
30100074
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.17 |
| Max. Negotiated Rate |
$962.80 |
| Rate for Payer: Aetna American Axle |
$10.82
|
| Rate for Payer: Aetna Commercial |
$14.15
|
| Rate for Payer: Aetna Medicare |
$8.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.72
|
| Rate for Payer: BCBS Complete |
$4.38
|
| Rate for Payer: BCBS MAPPO |
$7.78
|
| Rate for Payer: BCBS Trust/PPO |
$7.50
|
| Rate for Payer: BCN Commercial |
$7.50
|
| Rate for Payer: BCN Medicare Advantage |
$7.78
|
| Rate for Payer: Cash Price |
$13.32
|
| Rate for Payer: Cash Price |
$13.32
|
| Rate for Payer: Cofinity Commercial |
$14.32
|
| Rate for Payer: Cofinity Commercial |
$11.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.78
|
| Rate for Payer: Healthscope Commercial |
$14.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.49
|
| Rate for Payer: Mclaren Medicaid |
$4.17
|
| Rate for Payer: Mclaren Medicare |
$7.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.17
|
| Rate for Payer: Meridian Medicaid |
$4.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.15
|
| Rate for Payer: Nomi Health Commercial |
$11.67
|
| Rate for Payer: PACE Medicare |
$7.39
|
| Rate for Payer: PACE SWMI |
$7.78
|
| Rate for Payer: PHP Commercial |
$14.15
|
| Rate for Payer: PHP Medicare Advantage |
$7.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7.78
|
| Rate for Payer: Priority Health Medicare |
$7.78
|
| Rate for Payer: Priority Health Narrow Network |
$6.22
|
| Rate for Payer: Priority Health SBD |
$10.49
|
| Rate for Payer: Railroad Medicare Medicare |
$7.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.34
|
| Rate for Payer: UHC Core |
$962.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.78
|
| Rate for Payer: UHC Exchange |
$7.78
|
| Rate for Payer: UHC Medicare Advantage |
$7.78
|
| Rate for Payer: UHCCP Medicaid |
$4.17
|
| Rate for Payer: UMR Bronson Commercial |
$6.16
|
| Rate for Payer: VA VA |
$7.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.49
|
|
|
HC IGG SYNTHESIS RATE CSF-IGG
|
Facility
|
IP
|
$20.81
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
30100210
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.16 |
| Max. Negotiated Rate |
$18.73 |
| Rate for Payer: Aetna American Axle |
$13.53
|
| Rate for Payer: Aetna Commercial |
$17.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.53
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$14.57
|
| Rate for Payer: Cofinity Commercial |
$17.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Healthscope Commercial |
$18.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: PHP Commercial |
$17.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: Priority Health SBD |
$13.11
|
| Rate for Payer: UMR Bronson Commercial |
$9.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.61
|
|
|
HC IGG SYNTHESIS RATE CSF-IGG
|
Facility
|
OP
|
$20.81
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
30100210
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.98 |
| Max. Negotiated Rate |
$18.73 |
| Rate for Payer: Mclaren Medicare |
$9.30
|
| Rate for Payer: Aetna American Axle |
$13.53
|
| Rate for Payer: Aetna Commercial |
$17.69
|
| Rate for Payer: Aetna Medicare |
$9.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.62
|
| Rate for Payer: BCBS Complete |
$5.23
|
| Rate for Payer: BCBS MAPPO |
$9.30
|
| Rate for Payer: BCBS Trust/PPO |
$8.97
|
| Rate for Payer: BCN Commercial |
$8.97
|
| Rate for Payer: BCN Medicare Advantage |
$9.30
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$17.90
|
| Rate for Payer: Cofinity Commercial |
$14.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.30
|
| Rate for Payer: Healthscope Commercial |
$18.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.61
|
| Rate for Payer: Mclaren Medicaid |
$4.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.76
|
| Rate for Payer: Meridian Medicaid |
$5.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: Nomi Health Commercial |
$13.95
|
| Rate for Payer: PACE Medicare |
$8.84
|
| Rate for Payer: PACE SWMI |
$9.30
|
| Rate for Payer: PHP Commercial |
$17.69
|
| Rate for Payer: PHP Medicare Advantage |
$9.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.57
|
| Rate for Payer: Priority Health Medicare |
$9.30
|
| Rate for Payer: Priority Health Narrow Network |
$7.66
|
| Rate for Payer: Priority Health SBD |
$13.11
|
| Rate for Payer: Railroad Medicare Medicare |
$9.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.30
|
| Rate for Payer: UHC Exchange |
$9.30
|
| Rate for Payer: UHC Medicare Advantage |
$9.30
|
| Rate for Payer: UHCCP Medicaid |
$4.98
|
| Rate for Payer: UMR Bronson Commercial |
$7.70
|
| Rate for Payer: VA VA |
$9.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.61
|
|
|
HC IGG SYNTHESIS RATE CSF-PROTEIN
|
Facility
|
OP
|
$10.40
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
30100073
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.65 |
| Max. Negotiated Rate |
$2,938.27 |
| Rate for Payer: UHC Medicare Advantage |
$4.95
|
| Rate for Payer: UHCCP Medicaid |
$2.65
|
| Rate for Payer: UMR Bronson Commercial |
$3.85
|
| Rate for Payer: VA VA |
$4.95
|
| Rate for Payer: Aetna American Axle |
$6.76
|
| Rate for Payer: Aetna Commercial |
$8.84
|
| Rate for Payer: Aetna Medicare |
$5.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.19
|
| Rate for Payer: BCBS Complete |
$2.79
|
| Rate for Payer: BCBS MAPPO |
$4.95
|
| Rate for Payer: BCN Medicare Advantage |
$4.95
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Cofinity Commercial |
$8.94
|
| Rate for Payer: Cofinity Commercial |
$7.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.95
|
| Rate for Payer: Healthscope Commercial |
$9.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.80
|
| Rate for Payer: Mclaren Medicaid |
$2.65
|
| Rate for Payer: Mclaren Medicare |
$4.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.20
|
| Rate for Payer: Meridian Medicaid |
$2.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.84
|
| Rate for Payer: Nomi Health Commercial |
$7.42
|
| Rate for Payer: PACE Medicare |
$4.70
|
| Rate for Payer: PACE SWMI |
$4.95
|
| Rate for Payer: PHP Commercial |
$8.84
|
| Rate for Payer: PHP Medicare Advantage |
$4.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.09
|
| Rate for Payer: Priority Health Medicare |
$4.95
|
| Rate for Payer: Priority Health Narrow Network |
$4.07
|
| Rate for Payer: Priority Health SBD |
$6.55
|
| Rate for Payer: Railroad Medicare Medicare |
$4.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.94
|
| Rate for Payer: UHC Core |
$2,938.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.95
|
| Rate for Payer: UHC Exchange |
$4.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.80
|
|
|
HC IGG SYNTHESIS RATE CSF-PROTEIN
|
Facility
|
IP
|
$10.40
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
30100073
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.58 |
| Max. Negotiated Rate |
$9.36 |
| Rate for Payer: Aetna American Axle |
$6.76
|
| Rate for Payer: Aetna Commercial |
$8.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.76
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Cofinity Commercial |
$7.28
|
| Rate for Payer: Cofinity Commercial |
$8.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.32
|
| Rate for Payer: Healthscope Commercial |
$9.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.84
|
| Rate for Payer: PHP Commercial |
$8.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.76
|
| Rate for Payer: Priority Health SBD |
$6.55
|
| Rate for Payer: UMR Bronson Commercial |
$4.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.80
|
|
|
HC IGH IN BCLL
|
Facility
|
OP
|
$481.76
|
|
|
Service Code
|
CPT 81263
|
| Hospital Charge Code |
31000146
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$157.86 |
| Max. Negotiated Rate |
$883.56 |
| Rate for Payer: Aetna American Axle |
$313.14
|
| Rate for Payer: Aetna Commercial |
$409.50
|
| Rate for Payer: Aetna Medicare |
$306.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$313.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$368.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$368.15
|
| Rate for Payer: BCBS Complete |
$165.76
|
| Rate for Payer: BCBS MAPPO |
$294.52
|
| Rate for Payer: BCBS Trust/PPO |
$283.76
|
| Rate for Payer: BCN Commercial |
$283.76
|
| Rate for Payer: BCN Medicare Advantage |
$294.52
|
| Rate for Payer: Cash Price |
$385.41
|
| Rate for Payer: Cash Price |
$385.41
|
| Rate for Payer: Cofinity Commercial |
$414.31
|
| Rate for Payer: Cofinity Commercial |
$337.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$337.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$385.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$294.52
|
| Rate for Payer: Healthscope Commercial |
$433.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$337.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$361.32
|
| Rate for Payer: Mclaren Medicaid |
$157.86
|
| Rate for Payer: Mclaren Medicare |
$294.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$309.25
|
| Rate for Payer: Meridian Medicaid |
$165.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$338.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$409.50
|
| Rate for Payer: Nomi Health Commercial |
$883.56
|
| Rate for Payer: PACE Medicare |
$279.79
|
| Rate for Payer: PACE SWMI |
$294.52
|
| Rate for Payer: PHP Commercial |
$409.50
|
| Rate for Payer: PHP Medicare Advantage |
$294.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$157.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$313.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$303.00
|
| Rate for Payer: Priority Health Medicare |
$294.52
|
| Rate for Payer: Priority Health Narrow Network |
$242.40
|
| Rate for Payer: Priority Health SBD |
$303.51
|
| Rate for Payer: Railroad Medicare Medicare |
$294.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$353.42
|
| Rate for Payer: UHC Core |
$361.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$294.52
|
| Rate for Payer: UHC Exchange |
$294.52
|
| Rate for Payer: UHC Medicare Advantage |
$294.52
|
| Rate for Payer: UHCCP Medicaid |
$157.86
|
| Rate for Payer: UMR Bronson Commercial |
$178.25
|
| Rate for Payer: VA VA |
$294.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$361.32
|
|
|
HC IGH IN BCLL
|
Facility
|
IP
|
$481.76
|
|
|
Service Code
|
CPT 81263
|
| Hospital Charge Code |
31000146
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$211.97 |
| Max. Negotiated Rate |
$433.58 |
| Rate for Payer: Aetna American Axle |
$313.14
|
| Rate for Payer: Aetna Commercial |
$409.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$313.14
|
| Rate for Payer: Cash Price |
$385.41
|
| Rate for Payer: Cofinity Commercial |
$337.23
|
| Rate for Payer: Cofinity Commercial |
$414.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$337.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$385.41
|
| Rate for Payer: Healthscope Commercial |
$433.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$337.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$361.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$409.50
|
| Rate for Payer: PHP Commercial |
$409.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$313.14
|
| Rate for Payer: Priority Health SBD |
$303.51
|
| Rate for Payer: UMR Bronson Commercial |
$211.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$361.32
|
|
|
HC ILEOSCOPY
|
Facility
|
OP
|
$2,308.81
|
|
| Hospital Charge Code |
36000055
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$854.26 |
| Max. Negotiated Rate |
$2,077.93 |
| Rate for Payer: Aetna American Axle |
$1,500.73
|
| Rate for Payer: Aetna Commercial |
$1,962.49
|
| Rate for Payer: Aetna Medicare |
$1,154.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,500.73
|
| Rate for Payer: BCBS Complete |
$923.52
|
| Rate for Payer: Cash Price |
$1,847.05
|
| Rate for Payer: Cofinity Commercial |
$1,616.17
|
| Rate for Payer: Cofinity Commercial |
$1,985.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,616.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,847.05
|
| Rate for Payer: Healthscope Commercial |
$2,077.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,616.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,731.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,962.49
|
| Rate for Payer: PHP Commercial |
$1,962.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,500.73
|
| Rate for Payer: Priority Health SBD |
$1,454.55
|
| Rate for Payer: UMR Bronson Commercial |
$854.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,731.61
|
|
|
HC ILEOSCOPY
|
Facility
|
IP
|
$2,308.81
|
|
| Hospital Charge Code |
36000055
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,015.88 |
| Max. Negotiated Rate |
$2,077.93 |
| Rate for Payer: Aetna American Axle |
$1,500.73
|
| Rate for Payer: Aetna Commercial |
$1,962.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,500.73
|
| Rate for Payer: Cash Price |
$1,847.05
|
| Rate for Payer: Cofinity Commercial |
$1,616.17
|
| Rate for Payer: Cofinity Commercial |
$1,985.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,616.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,847.05
|
| Rate for Payer: Healthscope Commercial |
$2,077.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,616.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,731.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,962.49
|
| Rate for Payer: PHP Commercial |
$1,962.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,500.73
|
| Rate for Payer: Priority Health SBD |
$1,454.55
|
| Rate for Payer: UMR Bronson Commercial |
$1,015.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,731.61
|
|
|
HC ILIAC ANGIOGRAPHY W/HEART CATH
|
Facility
|
OP
|
$2,755.73
|
|
|
Service Code
|
HCPCS G0278
|
| Hospital Charge Code |
48100053
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$13.18 |
| Max. Negotiated Rate |
$2,480.16 |
| Rate for Payer: Aetna American Axle |
$1,791.22
|
| Rate for Payer: Aetna Commercial |
$2,342.37
|
| Rate for Payer: Aetna Medicare |
$1,377.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,791.22
|
| Rate for Payer: BCBS Complete |
$1,102.29
|
| Rate for Payer: BCBS Trust/PPO |
$27.36
|
| Rate for Payer: BCN Commercial |
$27.36
|
| Rate for Payer: Cash Price |
$2,204.58
|
| Rate for Payer: Cash Price |
$2,204.58
|
| Rate for Payer: Cofinity Commercial |
$1,929.01
|
| Rate for Payer: Cofinity Commercial |
$2,369.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,929.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,204.58
|
| Rate for Payer: Healthscope Commercial |
$2,480.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,929.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,066.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,342.37
|
| Rate for Payer: PHP Commercial |
$2,342.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,791.22
|
| Rate for Payer: Priority Health SBD |
$1,736.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.50
|
| Rate for Payer: UHC Exchange |
$13.18
|
| Rate for Payer: UMR Bronson Commercial |
$1,019.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,066.80
|
|
|
HC ILIAC ANGIOGRAPHY W/HEART CATH
|
Facility
|
IP
|
$2,755.73
|
|
|
Service Code
|
HCPCS G0278
|
| Hospital Charge Code |
48100053
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,212.52 |
| Max. Negotiated Rate |
$2,480.16 |
| Rate for Payer: Aetna American Axle |
$1,791.22
|
| Rate for Payer: Aetna Commercial |
$2,342.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,791.22
|
| Rate for Payer: Cash Price |
$2,204.58
|
| Rate for Payer: Cofinity Commercial |
$1,929.01
|
| Rate for Payer: Cofinity Commercial |
$2,369.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,929.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,204.58
|
| Rate for Payer: Healthscope Commercial |
$2,480.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,929.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,066.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,342.37
|
| Rate for Payer: PHP Commercial |
$2,342.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,791.22
|
| Rate for Payer: Priority Health SBD |
$1,736.11
|
| Rate for Payer: UMR Bronson Commercial |
$1,212.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,066.80
|
|
|
HC IMFLUOR 1ST AB STAIN (BILL ONLY)
|
Facility
|
IP
|
$139.38
|
|
|
Service Code
|
CPT 88346
|
| Hospital Charge Code |
31000086
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$61.33 |
| Max. Negotiated Rate |
$125.44 |
| Rate for Payer: Aetna American Axle |
$90.60
|
| Rate for Payer: Aetna Commercial |
$118.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.60
|
| Rate for Payer: Cash Price |
$111.50
|
| Rate for Payer: Cofinity Commercial |
$119.87
|
| Rate for Payer: Cofinity Commercial |
$97.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$97.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$111.50
|
| Rate for Payer: Healthscope Commercial |
$125.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$97.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$104.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$118.47
|
| Rate for Payer: PHP Commercial |
$118.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.60
|
| Rate for Payer: Priority Health SBD |
$87.81
|
| Rate for Payer: UMR Bronson Commercial |
$61.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$104.54
|
|
|
HC IMFLUOR 1ST AB STAIN (BILL ONLY)
|
Facility
|
OP
|
$139.38
|
|
|
Service Code
|
CPT 88346
|
| Hospital Charge Code |
31000086
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$51.57 |
| Max. Negotiated Rate |
$527.71 |
| Rate for Payer: Aetna American Axle |
$90.60
|
| Rate for Payer: Aetna Commercial |
$118.47
|
| Rate for Payer: Aetna Medicare |
$174.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$209.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$209.88
|
| Rate for Payer: BCBS Complete |
$94.49
|
| Rate for Payer: BCBS MAPPO |
$167.90
|
| Rate for Payer: BCBS Trust/PPO |
$177.54
|
| Rate for Payer: BCN Commercial |
$177.54
|
| Rate for Payer: BCN Medicare Advantage |
$167.90
|
| Rate for Payer: Cash Price |
$111.50
|
| Rate for Payer: Cash Price |
$111.50
|
| Rate for Payer: Cofinity Commercial |
$97.57
|
| Rate for Payer: Cofinity Commercial |
$119.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$97.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$111.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$167.90
|
| Rate for Payer: Healthscope Commercial |
$125.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$97.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$104.54
|
| Rate for Payer: Mclaren Medicaid |
$89.99
|
| Rate for Payer: Mclaren Medicare |
$167.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$176.30
|
| Rate for Payer: Meridian Medicaid |
$94.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$193.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$118.47
|
| Rate for Payer: Nomi Health Commercial |
$503.70
|
| Rate for Payer: PACE Medicare |
$159.50
|
| Rate for Payer: PACE SWMI |
$167.90
|
| Rate for Payer: PHP Commercial |
$118.47
|
| Rate for Payer: PHP Medicare Advantage |
$167.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$527.71
|
| Rate for Payer: Priority Health Medicare |
$167.90
|
| Rate for Payer: Priority Health Narrow Network |
$422.17
|
| Rate for Payer: Priority Health SBD |
$87.81
|
| Rate for Payer: Railroad Medicare Medicare |
$167.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$150.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$167.90
|
| Rate for Payer: UHC Exchange |
$136.65
|
| Rate for Payer: UHC Medicare Advantage |
$167.90
|
| Rate for Payer: UHCCP Medicaid |
$89.99
|
| Rate for Payer: UMR Bronson Commercial |
$51.57
|
| Rate for Payer: VA VA |
$167.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$104.54
|
|
