|
HC THERASKIN PER SQ CM (13 SQ CM)
|
Facility
|
OP
|
$180.52
|
|
|
Service Code
|
CPT Q4121
|
| Hospital Charge Code |
63600064
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.12 |
| Max. Negotiated Rate |
$162.47 |
| Rate for Payer: Aetna American Axle |
$117.34
|
| Rate for Payer: Aetna Commercial |
$153.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.34
|
| Rate for Payer: BCBS Complete |
$72.21
|
| Rate for Payer: BCBS Trust/PPO |
$37.12
|
| Rate for Payer: Cash Price |
$144.42
|
| Rate for Payer: Cash Price |
$144.42
|
| Rate for Payer: Cofinity Commercial |
$155.25
|
| Rate for Payer: Cofinity Commercial |
$126.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.42
|
| Rate for Payer: Healthscope Commercial |
$162.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$126.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$153.44
|
| Rate for Payer: PHP Commercial |
$153.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.36
|
| Rate for Payer: Priority Health SBD |
$113.73
|
| Rate for Payer: UMR Bronson Commercial |
$66.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.39
|
|
|
HC THERASKIN PER SQ CM (39 SQ CM)
|
Facility
|
OP
|
$82.89
|
|
|
Service Code
|
CPT Q4121
|
| Hospital Charge Code |
63600065
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.67 |
| Max. Negotiated Rate |
$74.60 |
| Rate for Payer: Aetna American Axle |
$53.88
|
| Rate for Payer: Aetna Commercial |
$70.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.88
|
| Rate for Payer: BCBS Complete |
$33.16
|
| Rate for Payer: BCBS Trust/PPO |
$37.12
|
| Rate for Payer: Cash Price |
$66.31
|
| Rate for Payer: Cash Price |
$66.31
|
| Rate for Payer: Cofinity Commercial |
$58.02
|
| Rate for Payer: Cofinity Commercial |
$71.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.31
|
| Rate for Payer: Healthscope Commercial |
$74.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$58.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$70.46
|
| Rate for Payer: PHP Commercial |
$70.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.02
|
| Rate for Payer: Priority Health SBD |
$52.22
|
| Rate for Payer: UMR Bronson Commercial |
$30.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.17
|
|
|
HC THERASKIN PER SQ CM (39 SQ CM)
|
Facility
|
IP
|
$82.89
|
|
|
Service Code
|
CPT Q4121
|
| Hospital Charge Code |
63600065
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.47 |
| Max. Negotiated Rate |
$74.60 |
| Rate for Payer: Aetna American Axle |
$53.88
|
| Rate for Payer: Aetna Commercial |
$70.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.88
|
| Rate for Payer: Cash Price |
$66.31
|
| Rate for Payer: Cofinity Commercial |
$58.02
|
| Rate for Payer: Cofinity Commercial |
$71.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.31
|
| Rate for Payer: Healthscope Commercial |
$74.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$58.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$70.46
|
| Rate for Payer: PHP Commercial |
$70.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.02
|
| Rate for Payer: Priority Health SBD |
$52.22
|
| Rate for Payer: UMR Bronson Commercial |
$36.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.17
|
|
|
HC THERASKIN PER SQ CM (6 SQ CM)
|
Facility
|
IP
|
$412.78
|
|
|
Service Code
|
HCPCS Q4121
|
| Hospital Charge Code |
63600127
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$181.62 |
| Max. Negotiated Rate |
$371.50 |
| Rate for Payer: Aetna American Axle |
$268.31
|
| Rate for Payer: Aetna Commercial |
$350.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$268.31
|
| Rate for Payer: Cash Price |
$330.22
|
| Rate for Payer: Cofinity Commercial |
$288.95
|
| Rate for Payer: Cofinity Commercial |
$354.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$330.22
|
| Rate for Payer: Healthscope Commercial |
$371.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$288.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$309.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$350.86
|
| Rate for Payer: PHP Commercial |
$350.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$288.95
|
| Rate for Payer: Priority Health SBD |
$260.05
|
| Rate for Payer: UMR Bronson Commercial |
$181.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$309.58
|
|
|
HC THERASKIN PER SQ CM (6 SQ CM)
|
Facility
|
OP
|
$412.78
|
|
|
Service Code
|
HCPCS Q4121
|
| Hospital Charge Code |
63600127
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.12 |
| Max. Negotiated Rate |
$371.50 |
| Rate for Payer: Aetna American Axle |
$268.31
|
| Rate for Payer: Aetna Commercial |
$350.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$268.31
|
| Rate for Payer: BCBS Complete |
$165.11
|
| Rate for Payer: BCBS Trust/PPO |
$37.12
|
| Rate for Payer: Cash Price |
$330.22
|
| Rate for Payer: Cash Price |
$330.22
|
| Rate for Payer: Cofinity Commercial |
$288.95
|
| Rate for Payer: Cofinity Commercial |
$354.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$330.22
|
| Rate for Payer: Healthscope Commercial |
$371.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$288.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$309.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$350.86
|
| Rate for Payer: PHP Commercial |
$350.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$288.95
|
| Rate for Payer: Priority Health SBD |
$260.05
|
| Rate for Payer: UMR Bronson Commercial |
$152.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$309.58
|
|
|
HC THER PROC STRGTH/END RESP 15M
|
Facility
|
IP
|
$85.96
|
|
|
Service Code
|
HCPCS G0237
|
| Hospital Charge Code |
41000047
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$37.82 |
| Max. Negotiated Rate |
$77.36 |
| Rate for Payer: Aetna American Axle |
$55.87
|
| Rate for Payer: Aetna Commercial |
$73.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.87
|
| Rate for Payer: Cash Price |
$68.77
|
| Rate for Payer: Cofinity Commercial |
$73.93
|
| Rate for Payer: Cofinity Commercial |
$60.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.77
|
| Rate for Payer: Healthscope Commercial |
$77.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$60.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$73.07
|
| Rate for Payer: PHP Commercial |
$73.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.17
|
| Rate for Payer: Priority Health SBD |
$54.15
|
| Rate for Payer: UMR Bronson Commercial |
$37.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.47
|
|
|
HC THER PROC STRGTH/END RESP 15M
|
Facility
|
OP
|
$85.96
|
|
|
Service Code
|
HCPCS G0237
|
| Hospital Charge Code |
41000047
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$11.13 |
| Max. Negotiated Rate |
$294.00 |
| Rate for Payer: Aetna American Axle |
$55.87
|
| Rate for Payer: Aetna Commercial |
$73.07
|
| Rate for Payer: Aetna Medicare |
$27.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33.09
|
| Rate for Payer: BCBS Complete |
$15.20
|
| Rate for Payer: BCBS MAPPO |
$26.47
|
| Rate for Payer: BCBS Trust/PPO |
$11.25
|
| Rate for Payer: BCN Medicare Advantage |
$26.47
|
| Rate for Payer: Cash Price |
$68.77
|
| Rate for Payer: Cash Price |
$68.77
|
| Rate for Payer: Cash Price |
$68.77
|
| Rate for Payer: Cofinity Commercial |
$73.93
|
| Rate for Payer: Cofinity Commercial |
$60.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.47
|
| Rate for Payer: Healthscope Commercial |
$77.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$60.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.47
|
| Rate for Payer: Mclaren Medicaid |
$14.48
|
| Rate for Payer: Mclaren Medicare |
$26.47
|
| Rate for Payer: Meridian Medicaid |
$15.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$27.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$73.07
|
| Rate for Payer: PACE Medicare |
$25.15
|
| Rate for Payer: PACE SWMI |
$26.47
|
| Rate for Payer: PHP Commercial |
$73.07
|
| Rate for Payer: PHP Medicare Advantage |
$26.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$83.33
|
| Rate for Payer: Priority Health Medicare |
$26.47
|
| Rate for Payer: Priority Health Narrow Network |
$66.66
|
| Rate for Payer: Priority Health SBD |
$54.15
|
| Rate for Payer: Railroad Medicare Medicare |
$26.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.24
|
| Rate for Payer: UHC Core |
$294.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$26.47
|
| Rate for Payer: UHC Exchange |
$11.13
|
| Rate for Payer: UHC Medicare Advantage |
$27.26
|
| Rate for Payer: UMR Bronson Commercial |
$31.81
|
| Rate for Payer: VA VA |
$26.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.47
|
|
|
HC THIAMINE LEVEL VITAMIN B1
|
Facility
|
IP
|
$60.18
|
|
|
Service Code
|
CPT 84425
|
| Hospital Charge Code |
30100432
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.48 |
| Max. Negotiated Rate |
$54.16 |
| Rate for Payer: Aetna American Axle |
$39.12
|
| Rate for Payer: Aetna Commercial |
$51.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.12
|
| Rate for Payer: Cash Price |
$48.14
|
| Rate for Payer: Cofinity Commercial |
$42.13
|
| Rate for Payer: Cofinity Commercial |
$51.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.14
|
| Rate for Payer: Healthscope Commercial |
$54.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.15
|
| Rate for Payer: PHP Commercial |
$51.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.13
|
| Rate for Payer: Priority Health SBD |
$37.91
|
| Rate for Payer: UMR Bronson Commercial |
$26.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.14
|
|
|
HC THIAMINE LEVEL VITAMIN B1
|
Facility
|
OP
|
$60.18
|
|
|
Service Code
|
CPT 84425
|
| Hospital Charge Code |
30100432
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.61 |
| Max. Negotiated Rate |
$54.16 |
| Rate for Payer: Aetna American Axle |
$39.12
|
| Rate for Payer: Aetna Commercial |
$51.15
|
| Rate for Payer: Aetna Medicare |
$22.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.54
|
| Rate for Payer: BCBS Complete |
$12.19
|
| Rate for Payer: BCBS MAPPO |
$21.23
|
| Rate for Payer: BCBS Trust/PPO |
$19.09
|
| Rate for Payer: BCN Medicare Advantage |
$21.23
|
| Rate for Payer: Cash Price |
$48.14
|
| Rate for Payer: Cash Price |
$48.14
|
| Rate for Payer: Cofinity Commercial |
$42.13
|
| Rate for Payer: Cofinity Commercial |
$51.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.23
|
| Rate for Payer: Healthscope Commercial |
$54.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.14
|
| Rate for Payer: Mclaren Medicaid |
$11.61
|
| Rate for Payer: Mclaren Medicare |
$21.23
|
| Rate for Payer: Meridian Medicaid |
$12.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$22.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.15
|
| Rate for Payer: PACE Medicare |
$20.17
|
| Rate for Payer: PACE SWMI |
$21.23
|
| Rate for Payer: PHP Commercial |
$51.15
|
| Rate for Payer: PHP Medicare Advantage |
$21.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$29.12
|
| Rate for Payer: Priority Health Medicare |
$21.23
|
| Rate for Payer: Priority Health Narrow Network |
$23.30
|
| Rate for Payer: Priority Health SBD |
$37.91
|
| Rate for Payer: Railroad Medicare Medicare |
$21.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.48
|
| Rate for Payer: UHC Core |
$35.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.23
|
| Rate for Payer: UHC Exchange |
$21.23
|
| Rate for Payer: UHC Medicare Advantage |
$21.87
|
| Rate for Payer: UMR Bronson Commercial |
$22.27
|
| Rate for Payer: VA VA |
$21.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.14
|
|
|
HC THIN PREP PAP DIAGNOSTIC
|
Facility
|
OP
|
$76.50
|
|
|
Service Code
|
CPT 88142
|
| Hospital Charge Code |
31100004
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$11.08 |
| Max. Negotiated Rate |
$68.85 |
| Rate for Payer: Aetna American Axle |
$49.72
|
| Rate for Payer: Aetna Commercial |
$65.02
|
| Rate for Payer: Aetna Medicare |
$21.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.32
|
| Rate for Payer: BCBS Complete |
$11.64
|
| Rate for Payer: BCBS MAPPO |
$20.26
|
| Rate for Payer: BCBS Trust/PPO |
$18.23
|
| Rate for Payer: BCCCP Commercial |
$20.26
|
| Rate for Payer: BCN Medicare Advantage |
$20.26
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cofinity Commercial |
$53.55
|
| Rate for Payer: Cofinity Commercial |
$65.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.26
|
| Rate for Payer: Healthscope Commercial |
$68.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$53.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.38
|
| Rate for Payer: Mclaren Medicaid |
$11.08
|
| Rate for Payer: Mclaren Medicare |
$20.26
|
| Rate for Payer: Meridian Medicaid |
$11.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$21.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.02
|
| Rate for Payer: PACE Medicare |
$19.25
|
| Rate for Payer: PACE SWMI |
$20.26
|
| Rate for Payer: PHP Commercial |
$65.02
|
| Rate for Payer: PHP Medicare Advantage |
$20.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27.79
|
| Rate for Payer: Priority Health Medicare |
$20.26
|
| Rate for Payer: Priority Health Narrow Network |
$22.23
|
| Rate for Payer: Priority Health SBD |
$48.20
|
| Rate for Payer: Railroad Medicare Medicare |
$20.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.31
|
| Rate for Payer: UHC Core |
$33.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.26
|
| Rate for Payer: UHC Exchange |
$20.26
|
| Rate for Payer: UHC Medicare Advantage |
$20.87
|
| Rate for Payer: UMR Bronson Commercial |
$28.30
|
| Rate for Payer: VA VA |
$20.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.38
|
|
|
HC THIN PREP PAP DIAGNOSTIC
|
Facility
|
IP
|
$76.50
|
|
|
Service Code
|
CPT 88142
|
| Hospital Charge Code |
31100004
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$33.66 |
| Max. Negotiated Rate |
$68.85 |
| Rate for Payer: Aetna American Axle |
$49.72
|
| Rate for Payer: Aetna Commercial |
$65.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.72
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cofinity Commercial |
$53.55
|
| Rate for Payer: Cofinity Commercial |
$65.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.20
|
| Rate for Payer: Healthscope Commercial |
$68.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$53.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.02
|
| Rate for Payer: PHP Commercial |
$65.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.55
|
| Rate for Payer: Priority Health SBD |
$48.20
|
| Rate for Payer: UMR Bronson Commercial |
$33.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.38
|
|
|
HC THIN PREP PAP DIAGNOSTIC AUTO
|
Facility
|
IP
|
$76.50
|
|
|
Service Code
|
CPT 88175
|
| Hospital Charge Code |
31100031
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$33.66 |
| Max. Negotiated Rate |
$68.85 |
| Rate for Payer: Aetna American Axle |
$49.72
|
| Rate for Payer: Aetna Commercial |
$65.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.72
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cofinity Commercial |
$53.55
|
| Rate for Payer: Cofinity Commercial |
$65.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.20
|
| Rate for Payer: Healthscope Commercial |
$68.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$53.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.02
|
| Rate for Payer: PHP Commercial |
$65.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.55
|
| Rate for Payer: Priority Health SBD |
$48.20
|
| Rate for Payer: UMR Bronson Commercial |
$33.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.38
|
|
|
HC THIN PREP PAP DIAGNOSTIC AUTO
|
Facility
|
OP
|
$76.50
|
|
|
Service Code
|
CPT 88175
|
| Hospital Charge Code |
31100031
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$14.56 |
| Max. Negotiated Rate |
$68.85 |
| Rate for Payer: Aetna American Axle |
$49.72
|
| Rate for Payer: Aetna Commercial |
$65.02
|
| Rate for Payer: Aetna Medicare |
$27.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33.26
|
| Rate for Payer: BCBS Complete |
$15.28
|
| Rate for Payer: BCBS MAPPO |
$26.61
|
| Rate for Payer: BCBS Trust/PPO |
$23.93
|
| Rate for Payer: BCCCP Commercial |
$26.49
|
| Rate for Payer: BCN Medicare Advantage |
$26.61
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cofinity Commercial |
$65.79
|
| Rate for Payer: Cofinity Commercial |
$53.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.61
|
| Rate for Payer: Healthscope Commercial |
$68.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$53.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.38
|
| Rate for Payer: Mclaren Medicaid |
$14.56
|
| Rate for Payer: Mclaren Medicare |
$26.61
|
| Rate for Payer: Meridian Medicaid |
$15.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$27.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.02
|
| Rate for Payer: PACE Medicare |
$25.28
|
| Rate for Payer: PACE SWMI |
$26.61
|
| Rate for Payer: PHP Commercial |
$65.02
|
| Rate for Payer: PHP Medicare Advantage |
$26.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36.16
|
| Rate for Payer: Priority Health Medicare |
$26.61
|
| Rate for Payer: Priority Health Narrow Network |
$28.93
|
| Rate for Payer: Priority Health SBD |
$48.20
|
| Rate for Payer: Railroad Medicare Medicare |
$26.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.93
|
| Rate for Payer: UHC Core |
$43.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$26.61
|
| Rate for Payer: UHC Exchange |
$26.61
|
| Rate for Payer: UHC Medicare Advantage |
$27.41
|
| Rate for Payer: UMR Bronson Commercial |
$28.30
|
| Rate for Payer: VA VA |
$26.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.38
|
|
|
HC THIN PREP PAP SCREENING
|
Facility
|
OP
|
$76.50
|
|
|
Service Code
|
HCPCS G0123
|
| Hospital Charge Code |
31100028
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$11.08 |
| Max. Negotiated Rate |
$68.85 |
| Rate for Payer: Aetna American Axle |
$49.72
|
| Rate for Payer: Aetna Commercial |
$65.02
|
| Rate for Payer: Aetna Medicare |
$21.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.32
|
| Rate for Payer: BCBS Complete |
$11.64
|
| Rate for Payer: BCBS MAPPO |
$20.26
|
| Rate for Payer: BCBS Trust/PPO |
$18.23
|
| Rate for Payer: BCCCP Commercial |
$20.26
|
| Rate for Payer: BCN Medicare Advantage |
$20.26
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cofinity Commercial |
$53.55
|
| Rate for Payer: Cofinity Commercial |
$65.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.26
|
| Rate for Payer: Healthscope Commercial |
$68.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$53.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.38
|
| Rate for Payer: Mclaren Medicaid |
$11.08
|
| Rate for Payer: Mclaren Medicare |
$20.26
|
| Rate for Payer: Meridian Medicaid |
$11.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$21.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.02
|
| Rate for Payer: PACE Medicare |
$19.25
|
| Rate for Payer: PACE SWMI |
$20.26
|
| Rate for Payer: PHP Commercial |
$65.02
|
| Rate for Payer: PHP Medicare Advantage |
$20.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27.79
|
| Rate for Payer: Priority Health Medicare |
$20.26
|
| Rate for Payer: Priority Health Narrow Network |
$22.23
|
| Rate for Payer: Priority Health SBD |
$48.20
|
| Rate for Payer: Railroad Medicare Medicare |
$20.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.31
|
| Rate for Payer: UHC Core |
$33.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.26
|
| Rate for Payer: UHC Exchange |
$20.26
|
| Rate for Payer: UHC Medicare Advantage |
$20.87
|
| Rate for Payer: UMR Bronson Commercial |
$28.30
|
| Rate for Payer: VA VA |
$20.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.38
|
|
|
HC THIN PREP PAP SCREENING
|
Facility
|
IP
|
$76.50
|
|
|
Service Code
|
HCPCS G0123
|
| Hospital Charge Code |
31100028
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$33.66 |
| Max. Negotiated Rate |
$68.85 |
| Rate for Payer: Aetna American Axle |
$49.72
|
| Rate for Payer: Aetna Commercial |
$65.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.72
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cofinity Commercial |
$65.79
|
| Rate for Payer: Cofinity Commercial |
$53.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.20
|
| Rate for Payer: Healthscope Commercial |
$68.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$53.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.02
|
| Rate for Payer: PHP Commercial |
$65.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.55
|
| Rate for Payer: Priority Health SBD |
$48.20
|
| Rate for Payer: UMR Bronson Commercial |
$33.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.38
|
|
|
HC THIN PREP PAP SCREENING AUTO
|
Facility
|
IP
|
$76.50
|
|
|
Service Code
|
HCPCS G0145
|
| Hospital Charge Code |
31100032
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$33.66 |
| Max. Negotiated Rate |
$68.85 |
| Rate for Payer: Aetna American Axle |
$49.72
|
| Rate for Payer: Aetna Commercial |
$65.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.72
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cofinity Commercial |
$65.79
|
| Rate for Payer: Cofinity Commercial |
$53.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.20
|
| Rate for Payer: Healthscope Commercial |
$68.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$53.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.02
|
| Rate for Payer: PHP Commercial |
$65.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.55
|
| Rate for Payer: Priority Health SBD |
$48.20
|
| Rate for Payer: UMR Bronson Commercial |
$33.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.38
|
|
|
HC THIN PREP PAP SCREENING AUTO
|
Facility
|
OP
|
$76.50
|
|
|
Service Code
|
HCPCS G0145
|
| Hospital Charge Code |
31100032
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$14.49 |
| Max. Negotiated Rate |
$68.85 |
| Rate for Payer: Aetna American Axle |
$49.72
|
| Rate for Payer: Aetna Commercial |
$65.02
|
| Rate for Payer: Aetna Medicare |
$27.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33.11
|
| Rate for Payer: BCBS Complete |
$15.22
|
| Rate for Payer: BCBS MAPPO |
$26.49
|
| Rate for Payer: BCBS Trust/PPO |
$23.83
|
| Rate for Payer: BCCCP Commercial |
$26.49
|
| Rate for Payer: BCN Medicare Advantage |
$26.49
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cofinity Commercial |
$53.55
|
| Rate for Payer: Cofinity Commercial |
$65.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.49
|
| Rate for Payer: Healthscope Commercial |
$68.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$53.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.38
|
| Rate for Payer: Mclaren Medicaid |
$14.49
|
| Rate for Payer: Mclaren Medicare |
$26.49
|
| Rate for Payer: Meridian Medicaid |
$15.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$27.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.02
|
| Rate for Payer: PACE Medicare |
$25.17
|
| Rate for Payer: PACE SWMI |
$26.49
|
| Rate for Payer: PHP Commercial |
$65.02
|
| Rate for Payer: PHP Medicare Advantage |
$26.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36.16
|
| Rate for Payer: Priority Health Medicare |
$26.49
|
| Rate for Payer: Priority Health Narrow Network |
$28.93
|
| Rate for Payer: Priority Health SBD |
$48.20
|
| Rate for Payer: Railroad Medicare Medicare |
$26.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.79
|
| Rate for Payer: UHC Core |
$43.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$26.49
|
| Rate for Payer: UHC Exchange |
$26.49
|
| Rate for Payer: UHC Medicare Advantage |
$27.28
|
| Rate for Payer: UMR Bronson Commercial |
$28.30
|
| Rate for Payer: VA VA |
$26.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.38
|
|
|
HC THIOPURINE METABOLITES
|
Facility
|
IP
|
$290.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100719
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$127.60 |
| Max. Negotiated Rate |
$261.00 |
| Rate for Payer: Aetna American Axle |
$188.50
|
| Rate for Payer: Aetna Commercial |
$246.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$188.50
|
| Rate for Payer: Cash Price |
$232.00
|
| Rate for Payer: Cofinity Commercial |
$249.40
|
| Rate for Payer: Cofinity Commercial |
$203.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.00
|
| Rate for Payer: Healthscope Commercial |
$261.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$203.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$217.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$246.50
|
| Rate for Payer: PHP Commercial |
$246.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$203.00
|
| Rate for Payer: Priority Health SBD |
$182.70
|
| Rate for Payer: UMR Bronson Commercial |
$127.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$217.50
|
|
|
HC THIOPURINE METABOLITES
|
Facility
|
OP
|
$290.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100719
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.20 |
| Max. Negotiated Rate |
$261.00 |
| Rate for Payer: Aetna American Axle |
$188.50
|
| Rate for Payer: Aetna Commercial |
$246.50
|
| Rate for Payer: Aetna Medicare |
$19.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$188.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.30
|
| Rate for Payer: BCBS Complete |
$10.71
|
| Rate for Payer: BCBS MAPPO |
$18.64
|
| Rate for Payer: BCBS Trust/PPO |
$16.76
|
| Rate for Payer: BCN Medicare Advantage |
$18.64
|
| Rate for Payer: Cash Price |
$232.00
|
| Rate for Payer: Cash Price |
$232.00
|
| Rate for Payer: Cofinity Commercial |
$249.40
|
| Rate for Payer: Cofinity Commercial |
$203.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.64
|
| Rate for Payer: Healthscope Commercial |
$261.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$203.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$217.50
|
| Rate for Payer: Mclaren Medicaid |
$10.20
|
| Rate for Payer: Mclaren Medicare |
$18.64
|
| Rate for Payer: Meridian Medicaid |
$10.71
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$246.50
|
| Rate for Payer: PACE Medicare |
$17.71
|
| Rate for Payer: PACE SWMI |
$18.64
|
| Rate for Payer: PHP Commercial |
$246.50
|
| Rate for Payer: PHP Medicare Advantage |
$18.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$203.00
|
| Rate for Payer: Priority Health Medicare |
$18.64
|
| Rate for Payer: Priority Health SBD |
$182.70
|
| Rate for Payer: Railroad Medicare Medicare |
$18.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.37
|
| Rate for Payer: UHC Core |
$22.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.64
|
| Rate for Payer: UHC Exchange |
$18.64
|
| Rate for Payer: UHC Medicare Advantage |
$19.20
|
| Rate for Payer: UMR Bronson Commercial |
$107.30
|
| Rate for Payer: VA VA |
$18.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$217.50
|
|
|
HC THIOPURINE METHYLTRANSFERASE RBC
|
Facility
|
IP
|
$324.00
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
30100621
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$142.56 |
| Max. Negotiated Rate |
$291.60 |
| Rate for Payer: Aetna American Axle |
$210.60
|
| Rate for Payer: Aetna Commercial |
$275.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$210.60
|
| Rate for Payer: Cash Price |
$259.20
|
| Rate for Payer: Cofinity Commercial |
$226.80
|
| Rate for Payer: Cofinity Commercial |
$278.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$259.20
|
| Rate for Payer: Healthscope Commercial |
$291.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$226.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$243.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$275.40
|
| Rate for Payer: PHP Commercial |
$275.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$226.80
|
| Rate for Payer: Priority Health SBD |
$204.12
|
| Rate for Payer: UMR Bronson Commercial |
$142.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$243.00
|
|
|
HC THIOPURINE METHYLTRANSFERASE RBC
|
Facility
|
OP
|
$324.00
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
30100621
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.13 |
| Max. Negotiated Rate |
$291.60 |
| Rate for Payer: Aetna American Axle |
$210.60
|
| Rate for Payer: Aetna Commercial |
$275.40
|
| Rate for Payer: Aetna Medicare |
$23.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$210.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.71
|
| Rate for Payer: BCBS Complete |
$12.73
|
| Rate for Payer: BCBS MAPPO |
$22.17
|
| Rate for Payer: BCBS Trust/PPO |
$19.94
|
| Rate for Payer: BCN Medicare Advantage |
$22.17
|
| Rate for Payer: Cash Price |
$259.20
|
| Rate for Payer: Cash Price |
$259.20
|
| Rate for Payer: Cofinity Commercial |
$226.80
|
| Rate for Payer: Cofinity Commercial |
$278.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$259.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.17
|
| Rate for Payer: Healthscope Commercial |
$291.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$226.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$243.00
|
| Rate for Payer: Mclaren Medicaid |
$12.13
|
| Rate for Payer: Mclaren Medicare |
$22.17
|
| Rate for Payer: Meridian Medicaid |
$12.73
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$23.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$275.40
|
| Rate for Payer: PACE Medicare |
$21.06
|
| Rate for Payer: PACE SWMI |
$22.17
|
| Rate for Payer: PHP Commercial |
$275.40
|
| Rate for Payer: PHP Medicare Advantage |
$22.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$226.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.98
|
| Rate for Payer: Priority Health Medicare |
$22.17
|
| Rate for Payer: Priority Health Narrow Network |
$12.78
|
| Rate for Payer: Priority Health SBD |
$204.12
|
| Rate for Payer: Railroad Medicare Medicare |
$22.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.60
|
| Rate for Payer: UHC Core |
$29.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.17
|
| Rate for Payer: UHC Exchange |
$22.17
|
| Rate for Payer: UHC Medicare Advantage |
$22.84
|
| Rate for Payer: UMR Bronson Commercial |
$119.88
|
| Rate for Payer: VA VA |
$22.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$243.00
|
|
|
HC THIOPURINE METHYLTRANSFERASE T
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
30100290
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.78 |
| Max. Negotiated Rate |
$126.00 |
| Rate for Payer: Aetna American Axle |
$91.00
|
| Rate for Payer: Aetna Commercial |
$119.00
|
| Rate for Payer: Aetna Medicare |
$25.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.00
|
| 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 |
$13.84
|
| Rate for Payer: BCBS MAPPO |
$24.09
|
| Rate for Payer: BCBS Trust/PPO |
$21.67
|
| Rate for Payer: BCN Medicare Advantage |
$24.09
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Cofinity Commercial |
$120.40
|
| Rate for Payer: Cofinity Commercial |
$98.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.09
|
| Rate for Payer: Healthscope Commercial |
$126.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$98.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.00
|
| Rate for Payer: Mclaren Medicaid |
$13.18
|
| Rate for Payer: Mclaren Medicare |
$24.09
|
| Rate for Payer: Meridian Medicaid |
$13.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$25.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$119.00
|
| Rate for Payer: PACE Medicare |
$22.89
|
| Rate for Payer: PACE SWMI |
$24.09
|
| Rate for Payer: PHP Commercial |
$119.00
|
| Rate for Payer: PHP Medicare Advantage |
$24.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.98
|
| Rate for Payer: Priority Health Medicare |
$24.09
|
| Rate for Payer: Priority Health Narrow Network |
$12.78
|
| Rate for Payer: Priority Health SBD |
$88.20
|
| Rate for Payer: Railroad Medicare Medicare |
$24.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.91
|
| Rate for Payer: UHC Core |
$29.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.09
|
| Rate for Payer: UHC Exchange |
$24.09
|
| Rate for Payer: UHC Medicare Advantage |
$24.81
|
| Rate for Payer: UMR Bronson Commercial |
$51.80
|
| Rate for Payer: VA VA |
$24.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.00
|
|
|
HC THIOPURINE METHYLTRANSFERASE T
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
30100290
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$61.60 |
| Max. Negotiated Rate |
$126.00 |
| Rate for Payer: Aetna American Axle |
$91.00
|
| Rate for Payer: Aetna Commercial |
$119.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.00
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Cofinity Commercial |
$120.40
|
| Rate for Payer: Cofinity Commercial |
$98.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.00
|
| Rate for Payer: Healthscope Commercial |
$126.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$98.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$119.00
|
| Rate for Payer: PHP Commercial |
$119.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.00
|
| Rate for Payer: Priority Health SBD |
$88.20
|
| Rate for Payer: UMR Bronson Commercial |
$61.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.00
|
|
|
HC THIRD STEP GEL 8 OZ
|
Facility
|
OP
|
$68.42
|
|
| Hospital Charge Code |
27100018
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$25.32 |
| Max. Negotiated Rate |
$61.58 |
| Rate for Payer: Aetna American Axle |
$44.47
|
| Rate for Payer: Aetna Commercial |
$58.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.47
|
| Rate for Payer: BCBS Complete |
$27.37
|
| Rate for Payer: Cash Price |
$54.74
|
| Rate for Payer: Cofinity Commercial |
$47.89
|
| Rate for Payer: Cofinity Commercial |
$58.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.74
|
| Rate for Payer: Healthscope Commercial |
$61.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$58.16
|
| Rate for Payer: PHP Commercial |
$58.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.89
|
| Rate for Payer: Priority Health SBD |
$43.10
|
| Rate for Payer: UMR Bronson Commercial |
$25.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.32
|
|
|
HC THIRD STEP GEL 8 OZ
|
Facility
|
IP
|
$68.42
|
|
| Hospital Charge Code |
27100018
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$30.10 |
| Max. Negotiated Rate |
$61.58 |
| Rate for Payer: Aetna American Axle |
$44.47
|
| Rate for Payer: Aetna Commercial |
$58.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.47
|
| Rate for Payer: Cash Price |
$54.74
|
| Rate for Payer: Cofinity Commercial |
$47.89
|
| Rate for Payer: Cofinity Commercial |
$58.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.74
|
| Rate for Payer: Healthscope Commercial |
$61.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$58.16
|
| Rate for Payer: PHP Commercial |
$58.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.89
|
| Rate for Payer: Priority Health SBD |
$43.10
|
| Rate for Payer: UMR Bronson Commercial |
$30.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.32
|
|
