|
HC TB TEST
|
Facility
|
IP
|
$24.00
|
|
|
Service Code
|
CPT 86580
|
| Hospital Charge Code |
30000069
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.56 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Aetna American Axle |
$15.60
|
| Rate for Payer: Aetna Commercial |
$20.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.60
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cofinity Commercial |
$16.80
|
| Rate for Payer: Cofinity Commercial |
$20.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.20
|
| Rate for Payer: Healthscope Commercial |
$21.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.40
|
| Rate for Payer: PHP Commercial |
$20.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.80
|
| Rate for Payer: Priority Health SBD |
$15.12
|
| Rate for Payer: UMR Bronson Commercial |
$10.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.00
|
|
|
HC TC 99M ABD PER STUDY
|
Facility
|
OP
|
$154.43
|
|
|
Service Code
|
HCPCS A9500
|
| Hospital Charge Code |
34300019
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$57.14 |
| Max. Negotiated Rate |
$153.60 |
| Rate for Payer: Aetna American Axle |
$100.38
|
| Rate for Payer: Aetna Commercial |
$131.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.38
|
| Rate for Payer: BCBS Complete |
$61.77
|
| Rate for Payer: BCBS Trust/PPO |
$153.60
|
| Rate for Payer: Cash Price |
$123.54
|
| Rate for Payer: Cash Price |
$123.54
|
| Rate for Payer: Cofinity Commercial |
$108.10
|
| Rate for Payer: Cofinity Commercial |
$132.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.54
|
| Rate for Payer: Healthscope Commercial |
$138.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$108.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$115.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$131.27
|
| Rate for Payer: PHP Commercial |
$131.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.10
|
| Rate for Payer: Priority Health SBD |
$97.29
|
| Rate for Payer: UMR Bronson Commercial |
$57.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$115.82
|
|
|
HC TC 99M ABD PER STUDY
|
Facility
|
IP
|
$154.43
|
|
|
Service Code
|
HCPCS A9500
|
| Hospital Charge Code |
34300019
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$67.95 |
| Max. Negotiated Rate |
$138.99 |
| Rate for Payer: Aetna American Axle |
$100.38
|
| Rate for Payer: Aetna Commercial |
$131.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.38
|
| Rate for Payer: Cash Price |
$123.54
|
| Rate for Payer: Cofinity Commercial |
$132.81
|
| Rate for Payer: Cofinity Commercial |
$108.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.54
|
| Rate for Payer: Healthscope Commercial |
$138.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$108.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$115.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$131.27
|
| Rate for Payer: PHP Commercial |
$131.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.10
|
| Rate for Payer: Priority Health SBD |
$97.29
|
| Rate for Payer: UMR Bronson Commercial |
$67.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$115.82
|
|
|
HC TC-99M AUTOL WBC DIAG PER DOSE
|
Facility
|
IP
|
$1,745.01
|
|
|
Service Code
|
HCPCS A9569
|
| Hospital Charge Code |
34300027
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$767.80 |
| Max. Negotiated Rate |
$1,570.51 |
| Rate for Payer: Aetna American Axle |
$1,134.26
|
| Rate for Payer: Aetna Commercial |
$1,483.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,134.26
|
| Rate for Payer: Cash Price |
$1,396.01
|
| Rate for Payer: Cofinity Commercial |
$1,221.51
|
| Rate for Payer: Cofinity Commercial |
$1,500.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,396.01
|
| Rate for Payer: Healthscope Commercial |
$1,570.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,221.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,308.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,483.26
|
| Rate for Payer: PHP Commercial |
$1,483.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,221.51
|
| Rate for Payer: Priority Health SBD |
$1,099.36
|
| Rate for Payer: UMR Bronson Commercial |
$767.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,308.76
|
|
|
HC TC-99M AUTOL WBC DIAG PER DOSE
|
Facility
|
OP
|
$1,745.01
|
|
|
Service Code
|
HCPCS A9569
|
| Hospital Charge Code |
34300027
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$3.89 |
| Max. Negotiated Rate |
$1,570.51 |
| Rate for Payer: Aetna American Axle |
$1,134.26
|
| Rate for Payer: Aetna Commercial |
$1,483.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,134.26
|
| Rate for Payer: BCBS Complete |
$698.00
|
| Rate for Payer: BCBS Trust/PPO |
$3.89
|
| Rate for Payer: Cash Price |
$1,396.01
|
| Rate for Payer: Cash Price |
$1,396.01
|
| Rate for Payer: Cofinity Commercial |
$1,221.51
|
| Rate for Payer: Cofinity Commercial |
$1,500.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,396.01
|
| Rate for Payer: Healthscope Commercial |
$1,570.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,221.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,308.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,483.26
|
| Rate for Payer: PHP Commercial |
$1,483.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,221.51
|
| Rate for Payer: Priority Health SBD |
$1,099.36
|
| Rate for Payer: UMR Bronson Commercial |
$645.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,308.76
|
|
|
HC TC99M DTPA AEROSOL <=75 MCI
|
Facility
|
OP
|
$131.39
|
|
|
Service Code
|
HCPCS A9567
|
| Hospital Charge Code |
34300030
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$48.61 |
| Max. Negotiated Rate |
$118.25 |
| Rate for Payer: Aetna American Axle |
$85.40
|
| Rate for Payer: Aetna Commercial |
$111.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.40
|
| Rate for Payer: BCBS Complete |
$52.56
|
| Rate for Payer: BCBS Trust/PPO |
$77.07
|
| Rate for Payer: Cash Price |
$105.11
|
| Rate for Payer: Cash Price |
$105.11
|
| Rate for Payer: Cofinity Commercial |
$113.00
|
| Rate for Payer: Cofinity Commercial |
$91.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.11
|
| Rate for Payer: Healthscope Commercial |
$118.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$91.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$111.68
|
| Rate for Payer: PHP Commercial |
$111.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.97
|
| Rate for Payer: Priority Health SBD |
$82.78
|
| Rate for Payer: UMR Bronson Commercial |
$48.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.54
|
|
|
HC TC99M DTPA AEROSOL <=75 MCI
|
Facility
|
IP
|
$131.39
|
|
|
Service Code
|
HCPCS A9567
|
| Hospital Charge Code |
34300030
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$57.81 |
| Max. Negotiated Rate |
$118.25 |
| Rate for Payer: Aetna American Axle |
$85.40
|
| Rate for Payer: Aetna Commercial |
$111.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.40
|
| Rate for Payer: Cash Price |
$105.11
|
| Rate for Payer: Cofinity Commercial |
$113.00
|
| Rate for Payer: Cofinity Commercial |
$91.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.11
|
| Rate for Payer: Healthscope Commercial |
$118.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$91.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$111.68
|
| Rate for Payer: PHP Commercial |
$111.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.97
|
| Rate for Payer: Priority Health SBD |
$82.78
|
| Rate for Payer: UMR Bronson Commercial |
$57.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.54
|
|
|
HC TC 99M MAA PER STUDY
|
Facility
|
OP
|
$124.80
|
|
|
Service Code
|
HCPCS A9540
|
| Hospital Charge Code |
34300017
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$46.18 |
| Max. Negotiated Rate |
$112.32 |
| Rate for Payer: Aetna American Axle |
$81.12
|
| Rate for Payer: Aetna Commercial |
$106.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.12
|
| Rate for Payer: BCBS Complete |
$49.92
|
| Rate for Payer: BCBS Trust/PPO |
$75.68
|
| Rate for Payer: Cash Price |
$99.84
|
| Rate for Payer: Cash Price |
$99.84
|
| Rate for Payer: Cofinity Commercial |
$107.33
|
| Rate for Payer: Cofinity Commercial |
$87.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.84
|
| Rate for Payer: Healthscope Commercial |
$112.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$87.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$106.08
|
| Rate for Payer: PHP Commercial |
$106.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.36
|
| Rate for Payer: Priority Health SBD |
$78.62
|
| Rate for Payer: UMR Bronson Commercial |
$46.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.60
|
|
|
HC TC 99M MAA PER STUDY
|
Facility
|
IP
|
$124.80
|
|
|
Service Code
|
HCPCS A9540
|
| Hospital Charge Code |
34300017
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$54.91 |
| Max. Negotiated Rate |
$112.32 |
| Rate for Payer: Aetna American Axle |
$81.12
|
| Rate for Payer: Aetna Commercial |
$106.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.12
|
| Rate for Payer: Cash Price |
$99.84
|
| Rate for Payer: Cofinity Commercial |
$107.33
|
| Rate for Payer: Cofinity Commercial |
$87.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.84
|
| Rate for Payer: Healthscope Commercial |
$112.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$87.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$106.08
|
| Rate for Payer: PHP Commercial |
$106.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.36
|
| Rate for Payer: Priority Health SBD |
$78.62
|
| Rate for Payer: UMR Bronson Commercial |
$54.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.60
|
|
|
HC TC 99M MDP PER STUDY
|
Facility
|
IP
|
$140.03
|
|
|
Service Code
|
HCPCS A9503
|
| Hospital Charge Code |
34300018
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$61.61 |
| Max. Negotiated Rate |
$126.03 |
| Rate for Payer: Aetna American Axle |
$91.02
|
| Rate for Payer: Aetna Commercial |
$119.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.02
|
| Rate for Payer: Cash Price |
$112.02
|
| Rate for Payer: Cofinity Commercial |
$98.02
|
| Rate for Payer: Cofinity Commercial |
$120.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.02
|
| Rate for Payer: Healthscope Commercial |
$126.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$98.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$119.03
|
| Rate for Payer: PHP Commercial |
$119.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.02
|
| Rate for Payer: Priority Health SBD |
$88.22
|
| Rate for Payer: UMR Bronson Commercial |
$61.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.02
|
|
|
HC TC 99M MDP PER STUDY
|
Facility
|
OP
|
$140.03
|
|
|
Service Code
|
HCPCS A9503
|
| Hospital Charge Code |
34300018
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$41.97 |
| Max. Negotiated Rate |
$126.03 |
| Rate for Payer: Aetna American Axle |
$91.02
|
| Rate for Payer: Aetna Commercial |
$119.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.02
|
| Rate for Payer: BCBS Complete |
$56.01
|
| Rate for Payer: BCBS Trust/PPO |
$41.97
|
| Rate for Payer: Cash Price |
$112.02
|
| Rate for Payer: Cash Price |
$112.02
|
| Rate for Payer: Cofinity Commercial |
$120.43
|
| Rate for Payer: Cofinity Commercial |
$98.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.02
|
| Rate for Payer: Healthscope Commercial |
$126.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$98.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$119.03
|
| Rate for Payer: PHP Commercial |
$119.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.02
|
| Rate for Payer: Priority Health SBD |
$88.22
|
| Rate for Payer: UMR Bronson Commercial |
$51.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.02
|
|
|
HC TC 99M PERTECHNETATE PER MCI
|
Facility
|
IP
|
$46.68
|
|
|
Service Code
|
HCPCS A9512
|
| Hospital Charge Code |
34300029
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$20.54 |
| Max. Negotiated Rate |
$42.01 |
| Rate for Payer: Aetna American Axle |
$30.34
|
| Rate for Payer: Aetna Commercial |
$39.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.34
|
| Rate for Payer: Cash Price |
$37.34
|
| Rate for Payer: Cofinity Commercial |
$32.68
|
| Rate for Payer: Cofinity Commercial |
$40.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.34
|
| Rate for Payer: Healthscope Commercial |
$42.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.68
|
| Rate for Payer: PHP Commercial |
$39.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.68
|
| Rate for Payer: Priority Health SBD |
$29.41
|
| Rate for Payer: UMR Bronson Commercial |
$20.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.01
|
|
|
HC TC 99M PERTECHNETATE PER MCI
|
Facility
|
OP
|
$46.68
|
|
|
Service Code
|
HCPCS A9512
|
| Hospital Charge Code |
34300029
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$3.60 |
| Max. Negotiated Rate |
$42.01 |
| Rate for Payer: Aetna American Axle |
$30.34
|
| Rate for Payer: Aetna Commercial |
$39.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.34
|
| Rate for Payer: BCBS Complete |
$18.67
|
| Rate for Payer: BCBS Trust/PPO |
$3.60
|
| Rate for Payer: Cash Price |
$37.34
|
| Rate for Payer: Cash Price |
$37.34
|
| Rate for Payer: Cofinity Commercial |
$32.68
|
| Rate for Payer: Cofinity Commercial |
$40.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.34
|
| Rate for Payer: Healthscope Commercial |
$42.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.68
|
| Rate for Payer: PHP Commercial |
$39.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.68
|
| Rate for Payer: Priority Health SBD |
$29.41
|
| Rate for Payer: UMR Bronson Commercial |
$17.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.01
|
|
|
HC TC 99M PYROPHOSPHATE PER STUDY UP TO 25 MILLICURIES
|
Facility
|
OP
|
$231.54
|
|
|
Service Code
|
CPT A9538
|
| Hospital Charge Code |
34300037
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$41.40 |
| Max. Negotiated Rate |
$208.39 |
| Rate for Payer: Aetna American Axle |
$150.50
|
| Rate for Payer: Aetna Commercial |
$196.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$150.50
|
| Rate for Payer: BCBS Complete |
$92.62
|
| Rate for Payer: BCBS Trust/PPO |
$41.40
|
| Rate for Payer: Cash Price |
$185.23
|
| Rate for Payer: Cash Price |
$185.23
|
| Rate for Payer: Cofinity Commercial |
$199.12
|
| Rate for Payer: Cofinity Commercial |
$162.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$185.23
|
| Rate for Payer: Healthscope Commercial |
$208.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$162.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$173.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$196.81
|
| Rate for Payer: PHP Commercial |
$196.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.08
|
| Rate for Payer: Priority Health SBD |
$145.87
|
| Rate for Payer: UMR Bronson Commercial |
$85.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$173.66
|
|
|
HC TC 99M PYROPHOSPHATE PER STUDY UP TO 25 MILLICURIES
|
Facility
|
IP
|
$231.54
|
|
|
Service Code
|
CPT A9538
|
| Hospital Charge Code |
34300037
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$101.88 |
| Max. Negotiated Rate |
$208.39 |
| Rate for Payer: Aetna American Axle |
$150.50
|
| Rate for Payer: Aetna Commercial |
$196.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$150.50
|
| Rate for Payer: Cash Price |
$185.23
|
| Rate for Payer: Cofinity Commercial |
$162.08
|
| Rate for Payer: Cofinity Commercial |
$199.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$185.23
|
| Rate for Payer: Healthscope Commercial |
$208.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$162.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$173.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$196.81
|
| Rate for Payer: PHP Commercial |
$196.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.08
|
| Rate for Payer: Priority Health SBD |
$145.87
|
| Rate for Payer: UMR Bronson Commercial |
$101.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$173.66
|
|
|
HC TC 99M SULFUR COLLOID PER STUDY
|
Facility
|
IP
|
$245.38
|
|
|
Service Code
|
HCPCS A9541
|
| Hospital Charge Code |
34300020
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$107.97 |
| Max. Negotiated Rate |
$220.84 |
| Rate for Payer: Aetna American Axle |
$159.50
|
| Rate for Payer: Aetna Commercial |
$208.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.50
|
| Rate for Payer: Cash Price |
$196.30
|
| Rate for Payer: Cofinity Commercial |
$211.03
|
| Rate for Payer: Cofinity Commercial |
$171.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.30
|
| Rate for Payer: Healthscope Commercial |
$220.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$171.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$184.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$208.57
|
| Rate for Payer: PHP Commercial |
$208.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.77
|
| Rate for Payer: Priority Health SBD |
$154.59
|
| Rate for Payer: UMR Bronson Commercial |
$107.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$184.04
|
|
|
HC TC 99M SULFUR COLLOID PER STUDY
|
Facility
|
OP
|
$245.38
|
|
|
Service Code
|
HCPCS A9541
|
| Hospital Charge Code |
34300020
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$90.79 |
| Max. Negotiated Rate |
$220.84 |
| Rate for Payer: Aetna American Axle |
$159.50
|
| Rate for Payer: Aetna Commercial |
$208.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.50
|
| Rate for Payer: BCBS Complete |
$98.15
|
| Rate for Payer: BCBS Trust/PPO |
$98.05
|
| Rate for Payer: Cash Price |
$196.30
|
| Rate for Payer: Cash Price |
$196.30
|
| Rate for Payer: Cofinity Commercial |
$171.77
|
| Rate for Payer: Cofinity Commercial |
$211.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.30
|
| Rate for Payer: Healthscope Commercial |
$220.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$171.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$184.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$208.57
|
| Rate for Payer: PHP Commercial |
$208.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.77
|
| Rate for Payer: Priority Health SBD |
$154.59
|
| Rate for Payer: UMR Bronson Commercial |
$90.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$184.04
|
|
|
HC T CELL ACUTE LYMPH LEUK
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
31000133
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Aetna American Axle |
$22.75
|
| Rate for Payer: Aetna Commercial |
$29.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.75
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cofinity Commercial |
$24.50
|
| Rate for Payer: Cofinity Commercial |
$30.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.00
|
| Rate for Payer: Healthscope Commercial |
$31.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.75
|
| Rate for Payer: PHP Commercial |
$29.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.50
|
| Rate for Payer: Priority Health SBD |
$22.05
|
| Rate for Payer: UMR Bronson Commercial |
$15.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.25
|
|
|
HC T CELL ACUTE LYMPH LEUK
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
31000133
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$11.72 |
| Max. Negotiated Rate |
$35.33 |
| Rate for Payer: Aetna American Axle |
$22.75
|
| Rate for Payer: Aetna Commercial |
$29.75
|
| Rate for Payer: Aetna Medicare |
$22.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.78
|
| Rate for Payer: BCBS Complete |
$12.30
|
| Rate for Payer: BCBS MAPPO |
$21.42
|
| Rate for Payer: BCBS Trust/PPO |
$19.27
|
| Rate for Payer: BCN Medicare Advantage |
$21.42
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cofinity Commercial |
$24.50
|
| Rate for Payer: Cofinity Commercial |
$30.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.42
|
| Rate for Payer: Healthscope Commercial |
$31.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.25
|
| Rate for Payer: Mclaren Medicaid |
$11.72
|
| Rate for Payer: Mclaren Medicare |
$21.42
|
| Rate for Payer: Meridian Medicaid |
$12.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$22.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.75
|
| Rate for Payer: PACE Medicare |
$20.35
|
| Rate for Payer: PACE SWMI |
$21.42
|
| Rate for Payer: PHP Commercial |
$29.75
|
| Rate for Payer: PHP Medicare Advantage |
$21.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.86
|
| Rate for Payer: Priority Health Medicare |
$21.42
|
| Rate for Payer: Priority Health Narrow Network |
$15.89
|
| Rate for Payer: Priority Health SBD |
$22.05
|
| Rate for Payer: Railroad Medicare Medicare |
$21.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.70
|
| Rate for Payer: UHC Core |
$35.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.42
|
| Rate for Payer: UHC Exchange |
$21.42
|
| Rate for Payer: UHC Medicare Advantage |
$22.06
|
| Rate for Payer: UMR Bronson Commercial |
$12.95
|
| Rate for Payer: VA VA |
$21.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.25
|
|
|
HC T CELL ACUTE LYMPH LEUK CMPT1
|
Facility
|
OP
|
$116.28
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
31000040
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$28.00 |
| Max. Negotiated Rate |
$104.65 |
| Rate for Payer: Aetna American Axle |
$75.58
|
| Rate for Payer: Aetna Commercial |
$98.84
|
| Rate for Payer: Aetna Medicare |
$53.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$63.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$63.99
|
| Rate for Payer: BCBS Complete |
$29.40
|
| Rate for Payer: BCBS MAPPO |
$51.19
|
| Rate for Payer: BCBS Trust/PPO |
$46.03
|
| Rate for Payer: BCN Medicare Advantage |
$51.19
|
| Rate for Payer: Cash Price |
$93.02
|
| Rate for Payer: Cash Price |
$93.02
|
| Rate for Payer: Cofinity Commercial |
$81.40
|
| Rate for Payer: Cofinity Commercial |
$100.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.19
|
| Rate for Payer: Healthscope Commercial |
$104.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$81.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.21
|
| Rate for Payer: Mclaren Medicaid |
$28.00
|
| Rate for Payer: Mclaren Medicare |
$51.19
|
| Rate for Payer: Meridian Medicaid |
$29.40
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$53.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$98.84
|
| Rate for Payer: PACE Medicare |
$48.63
|
| Rate for Payer: PACE SWMI |
$51.19
|
| Rate for Payer: PHP Commercial |
$98.84
|
| Rate for Payer: PHP Medicare Advantage |
$51.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$28.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55.09
|
| Rate for Payer: Priority Health Medicare |
$51.19
|
| Rate for Payer: Priority Health Narrow Network |
$44.07
|
| Rate for Payer: Priority Health SBD |
$73.26
|
| Rate for Payer: Railroad Medicare Medicare |
$51.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.43
|
| Rate for Payer: UHC Core |
$66.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.19
|
| Rate for Payer: UHC Exchange |
$51.19
|
| Rate for Payer: UHC Medicare Advantage |
$52.73
|
| Rate for Payer: UMR Bronson Commercial |
$43.02
|
| Rate for Payer: VA VA |
$51.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.21
|
|
|
HC T CELL ACUTE LYMPH LEUK CMPT1
|
Facility
|
IP
|
$116.28
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
31000040
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$51.16 |
| Max. Negotiated Rate |
$104.65 |
| Rate for Payer: Aetna American Axle |
$75.58
|
| Rate for Payer: Aetna Commercial |
$98.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.58
|
| Rate for Payer: Cash Price |
$93.02
|
| Rate for Payer: Cofinity Commercial |
$100.00
|
| Rate for Payer: Cofinity Commercial |
$81.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.02
|
| Rate for Payer: Healthscope Commercial |
$104.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$81.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$98.84
|
| Rate for Payer: PHP Commercial |
$98.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.40
|
| Rate for Payer: Priority Health SBD |
$73.26
|
| Rate for Payer: UMR Bronson Commercial |
$51.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.21
|
|
|
HC T CELL ACUTE LYMPH LEUK CMPT2
|
Facility
|
IP
|
$103.02
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
31000029
|
|
Hospital Revenue Code
|
310
|
| 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 T CELL ACUTE LYMPH LEUK CMPT2
|
Facility
|
OP
|
$103.02
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
31000029
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$11.72 |
| 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 |
$22.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.78
|
| Rate for Payer: BCBS Complete |
$12.30
|
| Rate for Payer: BCBS MAPPO |
$21.42
|
| Rate for Payer: BCBS Trust/PPO |
$19.27
|
| Rate for Payer: BCN Medicare Advantage |
$21.42
|
| Rate for Payer: Cash Price |
$82.42
|
| 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: Health Alliance Plan Medicare Advantage |
$21.42
|
| 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: Mclaren Medicaid |
$11.72
|
| Rate for Payer: Mclaren Medicare |
$21.42
|
| Rate for Payer: Meridian Medicaid |
$12.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$22.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$87.57
|
| Rate for Payer: PACE Medicare |
$20.35
|
| Rate for Payer: PACE SWMI |
$21.42
|
| Rate for Payer: PHP Commercial |
$87.57
|
| Rate for Payer: PHP Medicare Advantage |
$21.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.86
|
| Rate for Payer: Priority Health Medicare |
$21.42
|
| Rate for Payer: Priority Health Narrow Network |
$15.89
|
| Rate for Payer: Priority Health SBD |
$64.90
|
| Rate for Payer: Railroad Medicare Medicare |
$21.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.70
|
| Rate for Payer: UHC Core |
$35.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.42
|
| Rate for Payer: UHC Exchange |
$21.42
|
| Rate for Payer: UHC Medicare Advantage |
$22.06
|
| Rate for Payer: UMR Bronson Commercial |
$38.12
|
| Rate for Payer: VA VA |
$21.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.26
|
|
|
HC T CELL ACUTE LYMPH LEUK FISH
|
Facility
|
IP
|
$83.00
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
31000039
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$36.52 |
| Max. Negotiated Rate |
$74.70 |
| Rate for Payer: Aetna American Axle |
$53.95
|
| Rate for Payer: Aetna Commercial |
$70.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.95
|
| Rate for Payer: Cash Price |
$66.40
|
| Rate for Payer: Cofinity Commercial |
$58.10
|
| Rate for Payer: Cofinity Commercial |
$71.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.40
|
| Rate for Payer: Healthscope Commercial |
$74.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$58.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$70.55
|
| Rate for Payer: PHP Commercial |
$70.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.10
|
| Rate for Payer: Priority Health SBD |
$52.29
|
| Rate for Payer: UMR Bronson Commercial |
$36.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.25
|
|
|
HC T CELL ACUTE LYMPH LEUK FISH
|
Facility
|
OP
|
$83.00
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
31000039
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$28.00 |
| Max. Negotiated Rate |
$74.70 |
| Rate for Payer: Aetna American Axle |
$53.95
|
| Rate for Payer: Aetna Commercial |
$70.55
|
| Rate for Payer: Aetna Medicare |
$53.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$63.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$63.99
|
| Rate for Payer: BCBS Complete |
$29.40
|
| Rate for Payer: BCBS MAPPO |
$51.19
|
| Rate for Payer: BCBS Trust/PPO |
$46.03
|
| Rate for Payer: BCN Medicare Advantage |
$51.19
|
| Rate for Payer: Cash Price |
$66.40
|
| Rate for Payer: Cash Price |
$66.40
|
| Rate for Payer: Cofinity Commercial |
$58.10
|
| Rate for Payer: Cofinity Commercial |
$71.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.19
|
| Rate for Payer: Healthscope Commercial |
$74.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$58.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.25
|
| Rate for Payer: Mclaren Medicaid |
$28.00
|
| Rate for Payer: Mclaren Medicare |
$51.19
|
| Rate for Payer: Meridian Medicaid |
$29.40
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$53.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$70.55
|
| Rate for Payer: PACE Medicare |
$48.63
|
| Rate for Payer: PACE SWMI |
$51.19
|
| Rate for Payer: PHP Commercial |
$70.55
|
| Rate for Payer: PHP Medicare Advantage |
$51.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$28.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55.09
|
| Rate for Payer: Priority Health Medicare |
$51.19
|
| Rate for Payer: Priority Health Narrow Network |
$44.07
|
| Rate for Payer: Priority Health SBD |
$52.29
|
| Rate for Payer: Railroad Medicare Medicare |
$51.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.43
|
| Rate for Payer: UHC Core |
$66.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.19
|
| Rate for Payer: UHC Exchange |
$51.19
|
| Rate for Payer: UHC Medicare Advantage |
$52.73
|
| Rate for Payer: UMR Bronson Commercial |
$30.71
|
| Rate for Payer: VA VA |
$51.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.25
|
|
