|
HC LEUK LYMPHOMA IMMUNOPHEN TISSUE
|
Facility
|
OP
|
$53.28
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31100015
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$19.71 |
| Max. Negotiated Rate |
$47.95 |
| Rate for Payer: Aetna American Axle |
$34.63
|
| Rate for Payer: Aetna Commercial |
$45.29
|
| Rate for Payer: Aetna Medicare |
$26.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.63
|
| Rate for Payer: BCBS Complete |
$21.31
|
| Rate for Payer: BCBS Trust/PPO |
$41.88
|
| Rate for Payer: BCN Commercial |
$41.88
|
| Rate for Payer: Cash Price |
$42.62
|
| Rate for Payer: Cash Price |
$42.62
|
| Rate for Payer: Cofinity Advantage |
$37.30
|
| Rate for Payer: Cofinity Commercial |
$45.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.62
|
| Rate for Payer: Healthscope Commercial |
$47.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.96
|
| Rate for Payer: PHP Commercial |
$45.29
|
| Rate for Payer: Priority Health SBD |
$33.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.00
|
| Rate for Payer: UHC Core |
$33.00
|
| Rate for Payer: UHC Exchange |
$33.00
|
| Rate for Payer: UMR Bronson Commercial |
$19.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.96
|
|
|
HC LEUKOTRIENE E4, U
|
Facility
|
OP
|
$265.30
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
30100715
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.60 |
| Max. Negotiated Rate |
$238.77 |
| Rate for Payer: Aetna American Axle |
$172.44
|
| Rate for Payer: Aetna Commercial |
$225.50
|
| Rate for Payer: Aetna Medicare |
$25.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.11
|
| Rate for Payer: BCBS Complete |
$13.23
|
| Rate for Payer: BCBS MAPPO |
$24.09
|
| Rate for Payer: BCBS Trust/PPO |
$27.85
|
| Rate for Payer: BCN Commercial |
$27.85
|
| Rate for Payer: BCN Medicare Advantage |
$24.09
|
| Rate for Payer: Cash Price |
$212.24
|
| Rate for Payer: Cash Price |
$212.24
|
| Rate for Payer: Cofinity Advantage |
$185.71
|
| Rate for Payer: Cofinity Commercial |
$228.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.09
|
| Rate for Payer: Healthscope Commercial |
$238.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$185.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$198.97
|
| Rate for Payer: Mclaren Medicaid |
$24.09
|
| Rate for Payer: Mclaren Medicare |
$24.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.29
|
| Rate for Payer: Meridian Medicaid |
$25.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$26.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.50
|
| Rate for Payer: Nomi Health Commercial |
$36.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$198.97
|
| Rate for Payer: PACE Medicare |
$22.89
|
| Rate for Payer: PACE SWMI |
$24.09
|
| Rate for Payer: PHP Commercial |
$225.50
|
| Rate for Payer: PHP Medicare Advantage |
$24.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$24.09
|
| Rate for Payer: Priority Health Medicare |
$24.09
|
| Rate for Payer: Priority Health SBD |
$167.14
|
| Rate for Payer: Priority Health Tiered Network |
$19.27
|
| Rate for Payer: Railroad Medicare Medicare |
$24.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.14
|
| Rate for Payer: UHC Core |
$36.14
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$24.09
|
| Rate for Payer: UHC Exchange |
$36.14
|
| Rate for Payer: UHC Medicaid |
$12.60
|
| Rate for Payer: UHCCP Medicaid |
$12.60
|
| Rate for Payer: UMR Bronson Commercial |
$98.16
|
| Rate for Payer: VA VA |
$24.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$198.97
|
|
|
HC LEUKOTRIENE E4, U
|
Facility
|
IP
|
$265.30
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
30100715
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$116.73 |
| Max. Negotiated Rate |
$238.77 |
| Rate for Payer: Aetna American Axle |
$172.44
|
| Rate for Payer: Aetna Commercial |
$225.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.44
|
| Rate for Payer: Cash Price |
$212.24
|
| Rate for Payer: Cofinity Advantage |
$185.71
|
| Rate for Payer: Cofinity Commercial |
$228.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.24
|
| Rate for Payer: Healthscope Commercial |
$238.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$185.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$198.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$198.97
|
| Rate for Payer: PHP Commercial |
$225.50
|
| Rate for Payer: Priority Health SBD |
$167.14
|
| Rate for Payer: UMR Bronson Commercial |
$116.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$198.97
|
|
|
HC LEUPROLIDE ACETATE 3.75MG
|
Facility
|
OP
|
$1,051.76
|
|
|
Service Code
|
HCPCS J1950
|
| Hospital Charge Code |
63600142
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$389.15 |
| Max. Negotiated Rate |
$5,719.58 |
| Rate for Payer: Aetna American Axle |
$683.64
|
| Rate for Payer: Aetna Commercial |
$894.00
|
| Rate for Payer: Aetna Medicare |
$1,836.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$683.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,206.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,206.96
|
| Rate for Payer: BCBS Complete |
$969.65
|
| Rate for Payer: BCBS MAPPO |
$1,765.57
|
| Rate for Payer: BCBS Trust/PPO |
$5,719.58
|
| Rate for Payer: BCN Commercial |
$5,719.58
|
| Rate for Payer: BCN Medicare Advantage |
$1,765.57
|
| Rate for Payer: Cash Price |
$841.41
|
| Rate for Payer: Cash Price |
$841.41
|
| Rate for Payer: Cofinity Advantage |
$736.23
|
| Rate for Payer: Cofinity Commercial |
$904.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$841.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,765.57
|
| Rate for Payer: Healthscope Commercial |
$946.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$736.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$788.82
|
| Rate for Payer: Mclaren Medicaid |
$1,765.57
|
| Rate for Payer: Mclaren Medicare |
$1,765.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,853.85
|
| Rate for Payer: Meridian Medicaid |
$1,853.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,030.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,942.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$894.00
|
| Rate for Payer: Nomi Health Commercial |
$5,296.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$788.82
|
| Rate for Payer: PACE Medicare |
$1,677.29
|
| Rate for Payer: PACE SWMI |
$1,765.57
|
| Rate for Payer: PHP Commercial |
$894.00
|
| Rate for Payer: PHP Medicare Advantage |
$1,765.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$923.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,457.38
|
| Rate for Payer: Priority Health Medicare |
$1,765.57
|
| Rate for Payer: Priority Health SBD |
$662.61
|
| Rate for Payer: Priority Health Tiered Network |
$4,365.90
|
| Rate for Payer: Railroad Medicare Medicare |
$1,765.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,910.39
|
| Rate for Payer: UHC Core |
$2,910.39
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,765.57
|
| Rate for Payer: UHC Exchange |
$2,910.39
|
| Rate for Payer: UHC Medicaid |
$923.39
|
| Rate for Payer: UHCCP Medicaid |
$923.39
|
| Rate for Payer: UMR Bronson Commercial |
$389.15
|
| Rate for Payer: VA VA |
$1,765.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$788.82
|
|
|
HC LEUPROLIDE ACETATE 3.75MG
|
Facility
|
IP
|
$1,051.76
|
|
|
Service Code
|
HCPCS J1950
|
| Hospital Charge Code |
63600142
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$462.77 |
| Max. Negotiated Rate |
$946.58 |
| Rate for Payer: Aetna American Axle |
$683.64
|
| Rate for Payer: Aetna Commercial |
$894.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$683.64
|
| Rate for Payer: Cash Price |
$841.41
|
| Rate for Payer: Cofinity Advantage |
$736.23
|
| Rate for Payer: Cofinity Commercial |
$904.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$841.41
|
| Rate for Payer: Healthscope Commercial |
$946.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$736.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$788.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$894.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$788.82
|
| Rate for Payer: PHP Commercial |
$894.00
|
| Rate for Payer: Priority Health SBD |
$662.61
|
| Rate for Payer: UMR Bronson Commercial |
$462.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$788.82
|
|
|
HC LEUPROLIDE ACETATE SUSPNSION/ 7.5MG
|
Facility
|
IP
|
$470.26
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
63600147
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$206.91 |
| Max. Negotiated Rate |
$423.23 |
| Rate for Payer: Aetna American Axle |
$305.67
|
| Rate for Payer: Aetna Commercial |
$399.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$305.67
|
| Rate for Payer: Cash Price |
$376.21
|
| Rate for Payer: Cofinity Advantage |
$329.18
|
| Rate for Payer: Cofinity Commercial |
$404.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$376.21
|
| Rate for Payer: Healthscope Commercial |
$423.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$329.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$352.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$399.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$352.69
|
| Rate for Payer: PHP Commercial |
$399.72
|
| Rate for Payer: Priority Health SBD |
$296.26
|
| Rate for Payer: UMR Bronson Commercial |
$206.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$352.69
|
|
|
HC LEUPROLIDE ACETATE SUSPNSION/ 7.5MG
|
Facility
|
OP
|
$470.26
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
63600147
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$92.15 |
| Max. Negotiated Rate |
$574.27 |
| Rate for Payer: Aetna American Axle |
$305.67
|
| Rate for Payer: Aetna Commercial |
$399.72
|
| Rate for Payer: Aetna Medicare |
$183.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$305.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$220.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$220.25
|
| Rate for Payer: BCBS Complete |
$96.77
|
| Rate for Payer: BCBS MAPPO |
$176.20
|
| Rate for Payer: BCBS Trust/PPO |
$574.27
|
| Rate for Payer: BCN Commercial |
$574.27
|
| Rate for Payer: BCN Medicare Advantage |
$176.20
|
| Rate for Payer: Cash Price |
$376.21
|
| Rate for Payer: Cash Price |
$376.21
|
| Rate for Payer: Cofinity Advantage |
$329.18
|
| Rate for Payer: Cofinity Commercial |
$404.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$376.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$176.20
|
| Rate for Payer: Healthscope Commercial |
$423.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$329.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$352.69
|
| Rate for Payer: Mclaren Medicaid |
$176.20
|
| Rate for Payer: Mclaren Medicare |
$176.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$185.01
|
| Rate for Payer: Meridian Medicaid |
$185.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$202.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$193.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$399.72
|
| Rate for Payer: Nomi Health Commercial |
$528.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$352.69
|
| Rate for Payer: PACE Medicare |
$167.39
|
| Rate for Payer: PACE SWMI |
$176.20
|
| Rate for Payer: PHP Commercial |
$399.72
|
| Rate for Payer: PHP Medicare Advantage |
$176.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$92.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$556.52
|
| Rate for Payer: Priority Health Medicare |
$176.20
|
| Rate for Payer: Priority Health SBD |
$296.26
|
| Rate for Payer: Priority Health Tiered Network |
$445.22
|
| Rate for Payer: Railroad Medicare Medicare |
$176.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$281.79
|
| Rate for Payer: UHC Core |
$281.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$176.20
|
| Rate for Payer: UHC Exchange |
$281.79
|
| Rate for Payer: UHC Medicaid |
$92.15
|
| Rate for Payer: UHCCP Medicaid |
$92.15
|
| Rate for Payer: UMR Bronson Commercial |
$174.00
|
| Rate for Payer: VA VA |
$176.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$352.69
|
|
|
HC LEVEL 0.5 INIT 30 MIN
|
Facility
|
OP
|
$939.78
|
|
| Hospital Charge Code |
36000060
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$347.72 |
| Max. Negotiated Rate |
$845.80 |
| Rate for Payer: Aetna American Axle |
$610.86
|
| Rate for Payer: Aetna Commercial |
$798.81
|
| Rate for Payer: Aetna Medicare |
$469.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$610.86
|
| Rate for Payer: BCBS Complete |
$375.91
|
| Rate for Payer: Cash Price |
$751.82
|
| Rate for Payer: Cofinity Advantage |
$657.85
|
| Rate for Payer: Cofinity Commercial |
$808.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$751.82
|
| Rate for Payer: Healthscope Commercial |
$845.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$657.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$704.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$751.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$798.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$704.84
|
| Rate for Payer: PHP Commercial |
$798.81
|
| Rate for Payer: Priority Health SBD |
$592.06
|
| Rate for Payer: UMR Bronson Commercial |
$347.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$704.84
|
|
|
HC LEVEL 0.5 INIT 30 MIN
|
Facility
|
IP
|
$939.78
|
|
| Hospital Charge Code |
36000060
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$413.50 |
| Max. Negotiated Rate |
$845.80 |
| Rate for Payer: Aetna American Axle |
$610.86
|
| Rate for Payer: Aetna Commercial |
$798.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$610.86
|
| Rate for Payer: Cash Price |
$751.82
|
| Rate for Payer: Cofinity Advantage |
$657.85
|
| Rate for Payer: Cofinity Commercial |
$808.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$751.82
|
| Rate for Payer: Healthscope Commercial |
$845.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$657.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$704.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$798.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$704.84
|
| Rate for Payer: PHP Commercial |
$798.81
|
| Rate for Payer: Priority Health SBD |
$592.06
|
| Rate for Payer: UMR Bronson Commercial |
$413.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$704.84
|
|
|
HC LEVEL 0.5 SUBSQ 15 MIN
|
Facility
|
IP
|
$270.72
|
|
| Hospital Charge Code |
36000061
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$119.12 |
| Max. Negotiated Rate |
$243.65 |
| Rate for Payer: Aetna American Axle |
$175.97
|
| Rate for Payer: Aetna Commercial |
$230.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.97
|
| Rate for Payer: Cash Price |
$216.58
|
| Rate for Payer: Cofinity Advantage |
$189.50
|
| Rate for Payer: Cofinity Commercial |
$232.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.58
|
| Rate for Payer: Healthscope Commercial |
$243.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$189.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$203.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$203.04
|
| Rate for Payer: PHP Commercial |
$230.11
|
| Rate for Payer: Priority Health SBD |
$170.55
|
| Rate for Payer: UMR Bronson Commercial |
$119.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$203.04
|
|
|
HC LEVEL 0.5 SUBSQ 15 MIN
|
Facility
|
OP
|
$270.72
|
|
| Hospital Charge Code |
36000061
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$100.17 |
| Max. Negotiated Rate |
$243.65 |
| Rate for Payer: Aetna American Axle |
$175.97
|
| Rate for Payer: Aetna Commercial |
$230.11
|
| Rate for Payer: Aetna Medicare |
$135.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.97
|
| Rate for Payer: BCBS Complete |
$108.29
|
| Rate for Payer: Cash Price |
$216.58
|
| Rate for Payer: Cofinity Advantage |
$189.50
|
| Rate for Payer: Cofinity Commercial |
$232.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.58
|
| Rate for Payer: Healthscope Commercial |
$243.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$189.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$203.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$216.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$203.04
|
| Rate for Payer: PHP Commercial |
$230.11
|
| Rate for Payer: Priority Health SBD |
$170.55
|
| Rate for Payer: UMR Bronson Commercial |
$100.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$203.04
|
|
|
HC LEVEL 1 INIT 30 MIN
|
Facility
|
IP
|
$2,074.72
|
|
| Hospital Charge Code |
36000062
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$912.88 |
| Max. Negotiated Rate |
$1,867.25 |
| Rate for Payer: Aetna American Axle |
$1,348.57
|
| Rate for Payer: Aetna Commercial |
$1,763.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,348.57
|
| Rate for Payer: Cash Price |
$1,659.78
|
| Rate for Payer: Cofinity Advantage |
$1,452.30
|
| Rate for Payer: Cofinity Commercial |
$1,784.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,659.78
|
| Rate for Payer: Healthscope Commercial |
$1,867.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,452.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,556.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,763.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,556.04
|
| Rate for Payer: PHP Commercial |
$1,763.51
|
| Rate for Payer: Priority Health SBD |
$1,307.07
|
| Rate for Payer: UMR Bronson Commercial |
$912.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,556.04
|
|
|
HC LEVEL 1 INIT 30 MIN
|
Facility
|
OP
|
$2,074.72
|
|
| Hospital Charge Code |
36000062
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$767.65 |
| Max. Negotiated Rate |
$1,867.25 |
| Rate for Payer: Aetna American Axle |
$1,348.57
|
| Rate for Payer: Aetna Commercial |
$1,763.51
|
| Rate for Payer: Aetna Medicare |
$1,037.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,348.57
|
| Rate for Payer: BCBS Complete |
$829.89
|
| Rate for Payer: Cash Price |
$1,659.78
|
| Rate for Payer: Cofinity Advantage |
$1,452.30
|
| Rate for Payer: Cofinity Commercial |
$1,784.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,659.78
|
| Rate for Payer: Healthscope Commercial |
$1,867.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,452.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,556.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,659.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,763.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,556.04
|
| Rate for Payer: PHP Commercial |
$1,763.51
|
| Rate for Payer: Priority Health SBD |
$1,307.07
|
| Rate for Payer: UMR Bronson Commercial |
$767.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,556.04
|
|
|
HC LEVEL 1 SUBSQ 15 MIN
|
Facility
|
OP
|
$412.97
|
|
| Hospital Charge Code |
36000063
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$152.80 |
| Max. Negotiated Rate |
$371.67 |
| Rate for Payer: Aetna American Axle |
$268.43
|
| Rate for Payer: Aetna Commercial |
$351.02
|
| Rate for Payer: Aetna Medicare |
$206.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$268.43
|
| Rate for Payer: BCBS Complete |
$165.19
|
| Rate for Payer: Cash Price |
$330.38
|
| Rate for Payer: Cofinity Advantage |
$289.08
|
| Rate for Payer: Cofinity Commercial |
$355.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$330.38
|
| Rate for Payer: Healthscope Commercial |
$371.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$289.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$309.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$330.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$351.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$309.73
|
| Rate for Payer: PHP Commercial |
$351.02
|
| Rate for Payer: Priority Health SBD |
$260.17
|
| Rate for Payer: UMR Bronson Commercial |
$152.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$309.73
|
|
|
HC LEVEL 1 SUBSQ 15 MIN
|
Facility
|
IP
|
$412.97
|
|
| Hospital Charge Code |
36000063
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$181.71 |
| Max. Negotiated Rate |
$371.67 |
| Rate for Payer: Aetna American Axle |
$268.43
|
| Rate for Payer: Aetna Commercial |
$351.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$268.43
|
| Rate for Payer: Cash Price |
$330.38
|
| Rate for Payer: Cofinity Advantage |
$289.08
|
| Rate for Payer: Cofinity Commercial |
$355.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$330.38
|
| Rate for Payer: Healthscope Commercial |
$371.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$289.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$309.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$351.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$309.73
|
| Rate for Payer: PHP Commercial |
$351.02
|
| Rate for Payer: Priority Health SBD |
$260.17
|
| Rate for Payer: UMR Bronson Commercial |
$181.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$309.73
|
|
|
HC LEVEL 2 INIT 30 MIN
|
Facility
|
OP
|
$3,226.85
|
|
| Hospital Charge Code |
36000064
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,193.93 |
| Max. Negotiated Rate |
$2,904.16 |
| Rate for Payer: Aetna American Axle |
$2,097.45
|
| Rate for Payer: Aetna Commercial |
$2,742.82
|
| Rate for Payer: Aetna Medicare |
$1,613.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,097.45
|
| Rate for Payer: BCBS Complete |
$1,290.74
|
| Rate for Payer: Cash Price |
$2,581.48
|
| Rate for Payer: Cofinity Advantage |
$2,258.80
|
| Rate for Payer: Cofinity Commercial |
$2,775.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,581.48
|
| Rate for Payer: Healthscope Commercial |
$2,904.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,258.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,420.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,581.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,742.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,420.14
|
| Rate for Payer: PHP Commercial |
$2,742.82
|
| Rate for Payer: Priority Health SBD |
$2,032.92
|
| Rate for Payer: UMR Bronson Commercial |
$1,193.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,420.14
|
|
|
HC LEVEL 2 INIT 30 MIN
|
Facility
|
IP
|
$3,226.85
|
|
| Hospital Charge Code |
36000064
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,419.81 |
| Max. Negotiated Rate |
$2,904.16 |
| Rate for Payer: Aetna American Axle |
$2,097.45
|
| Rate for Payer: Aetna Commercial |
$2,742.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,097.45
|
| Rate for Payer: Cash Price |
$2,581.48
|
| Rate for Payer: Cofinity Advantage |
$2,258.80
|
| Rate for Payer: Cofinity Commercial |
$2,775.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,581.48
|
| Rate for Payer: Healthscope Commercial |
$2,904.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,258.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,420.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,742.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,420.14
|
| Rate for Payer: PHP Commercial |
$2,742.82
|
| Rate for Payer: Priority Health SBD |
$2,032.92
|
| Rate for Payer: UMR Bronson Commercial |
$1,419.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,420.14
|
|
|
HC LEVEL 2 SUBSQ 15 MIN
|
Facility
|
OP
|
$1,237.94
|
|
| Hospital Charge Code |
36000065
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$458.04 |
| Max. Negotiated Rate |
$1,114.15 |
| Rate for Payer: Aetna American Axle |
$804.66
|
| Rate for Payer: Aetna Commercial |
$1,052.25
|
| Rate for Payer: Aetna Medicare |
$618.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$804.66
|
| Rate for Payer: BCBS Complete |
$495.18
|
| Rate for Payer: Cash Price |
$990.35
|
| Rate for Payer: Cofinity Advantage |
$866.56
|
| Rate for Payer: Cofinity Commercial |
$1,064.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$990.35
|
| Rate for Payer: Healthscope Commercial |
$1,114.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$866.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$928.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$990.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,052.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$928.46
|
| Rate for Payer: PHP Commercial |
$1,052.25
|
| Rate for Payer: Priority Health SBD |
$779.90
|
| Rate for Payer: UMR Bronson Commercial |
$458.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$928.46
|
|
|
HC LEVEL 2 SUBSQ 15 MIN
|
Facility
|
IP
|
$1,237.94
|
|
| Hospital Charge Code |
36000065
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$544.69 |
| Max. Negotiated Rate |
$1,114.15 |
| Rate for Payer: Aetna American Axle |
$804.66
|
| Rate for Payer: Aetna Commercial |
$1,052.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$804.66
|
| Rate for Payer: Cash Price |
$990.35
|
| Rate for Payer: Cofinity Advantage |
$866.56
|
| Rate for Payer: Cofinity Commercial |
$1,064.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$990.35
|
| Rate for Payer: Healthscope Commercial |
$1,114.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$866.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$928.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,052.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$928.46
|
| Rate for Payer: PHP Commercial |
$1,052.25
|
| Rate for Payer: Priority Health SBD |
$779.90
|
| Rate for Payer: UMR Bronson Commercial |
$544.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$928.46
|
|
|
HC LEVEL 3 INIT 30 MIN
|
Facility
|
IP
|
$3,827.33
|
|
| Hospital Charge Code |
36000066
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,684.03 |
| Max. Negotiated Rate |
$3,444.60 |
| Rate for Payer: Aetna American Axle |
$2,487.76
|
| Rate for Payer: Aetna Commercial |
$3,253.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,487.76
|
| Rate for Payer: Cash Price |
$3,061.86
|
| Rate for Payer: Cofinity Advantage |
$2,679.13
|
| Rate for Payer: Cofinity Commercial |
$3,291.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,061.86
|
| Rate for Payer: Healthscope Commercial |
$3,444.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,679.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,870.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,253.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,870.50
|
| Rate for Payer: PHP Commercial |
$3,253.23
|
| Rate for Payer: Priority Health SBD |
$2,411.22
|
| Rate for Payer: UMR Bronson Commercial |
$1,684.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,870.50
|
|
|
HC LEVEL 3 INIT 30 MIN
|
Facility
|
OP
|
$3,827.33
|
|
| Hospital Charge Code |
36000066
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,416.11 |
| Max. Negotiated Rate |
$3,444.60 |
| Rate for Payer: Aetna American Axle |
$2,487.76
|
| Rate for Payer: Aetna Commercial |
$3,253.23
|
| Rate for Payer: Aetna Medicare |
$1,913.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,487.76
|
| Rate for Payer: BCBS Complete |
$1,530.93
|
| Rate for Payer: Cash Price |
$3,061.86
|
| Rate for Payer: Cofinity Advantage |
$2,679.13
|
| Rate for Payer: Cofinity Commercial |
$3,291.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,061.86
|
| Rate for Payer: Healthscope Commercial |
$3,444.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,679.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,870.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,061.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,253.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,870.50
|
| Rate for Payer: PHP Commercial |
$3,253.23
|
| Rate for Payer: Priority Health SBD |
$2,411.22
|
| Rate for Payer: UMR Bronson Commercial |
$1,416.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,870.50
|
|
|
HC LEVEL 3 SUBSQ 15 MIN
|
Facility
|
IP
|
$1,487.89
|
|
| Hospital Charge Code |
36000067
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$654.67 |
| Max. Negotiated Rate |
$1,339.10 |
| Rate for Payer: Aetna American Axle |
$967.13
|
| Rate for Payer: Aetna Commercial |
$1,264.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$967.13
|
| Rate for Payer: Cash Price |
$1,190.31
|
| Rate for Payer: Cofinity Advantage |
$1,041.52
|
| Rate for Payer: Cofinity Commercial |
$1,279.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,190.31
|
| Rate for Payer: Healthscope Commercial |
$1,339.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,041.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,115.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,264.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,115.92
|
| Rate for Payer: PHP Commercial |
$1,264.71
|
| Rate for Payer: Priority Health SBD |
$937.37
|
| Rate for Payer: UMR Bronson Commercial |
$654.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,115.92
|
|
|
HC LEVEL 3 SUBSQ 15 MIN
|
Facility
|
OP
|
$1,487.89
|
|
| Hospital Charge Code |
36000067
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$550.52 |
| Max. Negotiated Rate |
$1,339.10 |
| Rate for Payer: Aetna American Axle |
$967.13
|
| Rate for Payer: Aetna Commercial |
$1,264.71
|
| Rate for Payer: Aetna Medicare |
$743.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$967.13
|
| Rate for Payer: BCBS Complete |
$595.16
|
| Rate for Payer: Cash Price |
$1,190.31
|
| Rate for Payer: Cofinity Advantage |
$1,041.52
|
| Rate for Payer: Cofinity Commercial |
$1,279.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,190.31
|
| Rate for Payer: Healthscope Commercial |
$1,339.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,041.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,115.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,190.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,264.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,115.92
|
| Rate for Payer: PHP Commercial |
$1,264.71
|
| Rate for Payer: Priority Health SBD |
$937.37
|
| Rate for Payer: UMR Bronson Commercial |
$550.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,115.92
|
|
|
HC LEVEL 4 INIT 30 MIN
|
Facility
|
OP
|
$4,556.50
|
|
| Hospital Charge Code |
36000068
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,685.90 |
| Max. Negotiated Rate |
$4,100.85 |
| Rate for Payer: Aetna American Axle |
$2,961.72
|
| Rate for Payer: Aetna Commercial |
$3,873.03
|
| Rate for Payer: Aetna Medicare |
$2,278.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,961.72
|
| Rate for Payer: BCBS Complete |
$1,822.60
|
| Rate for Payer: Cash Price |
$3,645.20
|
| Rate for Payer: Cofinity Advantage |
$3,189.55
|
| Rate for Payer: Cofinity Commercial |
$3,918.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,645.20
|
| Rate for Payer: Healthscope Commercial |
$4,100.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,189.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,417.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,645.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,873.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,417.38
|
| Rate for Payer: PHP Commercial |
$3,873.03
|
| Rate for Payer: Priority Health SBD |
$2,870.59
|
| Rate for Payer: UMR Bronson Commercial |
$1,685.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,417.38
|
|
|
HC LEVEL 4 INIT 30 MIN
|
Facility
|
IP
|
$4,556.50
|
|
| Hospital Charge Code |
36000068
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,004.86 |
| Max. Negotiated Rate |
$4,100.85 |
| Rate for Payer: Aetna American Axle |
$2,961.72
|
| Rate for Payer: Aetna Commercial |
$3,873.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,961.72
|
| Rate for Payer: Cash Price |
$3,645.20
|
| Rate for Payer: Cofinity Advantage |
$3,189.55
|
| Rate for Payer: Cofinity Commercial |
$3,918.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,645.20
|
| Rate for Payer: Healthscope Commercial |
$4,100.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,189.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,417.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,873.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,417.38
|
| Rate for Payer: PHP Commercial |
$3,873.03
|
| Rate for Payer: Priority Health SBD |
$2,870.59
|
| Rate for Payer: UMR Bronson Commercial |
$2,004.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,417.38
|
|
