|
HC MNT GROUP 2ND REFERRAL 30 MIN
|
Facility
|
IP
|
$52.63
|
|
|
Service Code
|
HCPCS G0271
|
| Hospital Charge Code |
94200009
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$23.16 |
| Max. Negotiated Rate |
$47.37 |
| Rate for Payer: Aetna American Axle |
$34.21
|
| Rate for Payer: Aetna Commercial |
$44.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.21
|
| Rate for Payer: Cash Price |
$42.10
|
| Rate for Payer: Cofinity Advantage |
$36.84
|
| Rate for Payer: Cofinity Commercial |
$45.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.10
|
| Rate for Payer: Healthscope Commercial |
$47.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$36.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.47
|
| Rate for Payer: PHP Commercial |
$44.74
|
| Rate for Payer: Priority Health SBD |
$33.16
|
| Rate for Payer: UMR Bronson Commercial |
$23.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.47
|
|
|
HC MNT GROUP 2ND REFERRAL 30 MIN
|
Facility
|
OP
|
$52.63
|
|
|
Service Code
|
HCPCS G0271
|
| Hospital Charge Code |
94200009
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$5.16 |
| Max. Negotiated Rate |
$47.37 |
| Rate for Payer: Aetna American Axle |
$34.21
|
| Rate for Payer: Aetna Commercial |
$44.74
|
| Rate for Payer: Aetna Medicare |
$26.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.21
|
| Rate for Payer: BCBS Complete |
$21.05
|
| Rate for Payer: BCBS Trust/PPO |
$35.24
|
| Rate for Payer: BCN Commercial |
$35.24
|
| Rate for Payer: Cash Price |
$42.10
|
| Rate for Payer: Cash Price |
$42.10
|
| Rate for Payer: Cofinity Advantage |
$36.84
|
| Rate for Payer: Cofinity Commercial |
$45.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.10
|
| Rate for Payer: Healthscope Commercial |
$47.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$36.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.47
|
| Rate for Payer: PHP Commercial |
$44.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6.45
|
| Rate for Payer: Priority Health SBD |
$33.16
|
| Rate for Payer: Priority Health Tiered Network |
$5.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.21
|
| Rate for Payer: UHC Core |
$27.42
|
| Rate for Payer: UHC Exchange |
$20.68
|
| Rate for Payer: UMR Bronson Commercial |
$19.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.47
|
|
|
HC MNT GROUP 30 MIN
|
Facility
|
IP
|
$61.74
|
|
|
Service Code
|
CPT 97804
|
| Hospital Charge Code |
94200004
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$27.17 |
| Max. Negotiated Rate |
$55.57 |
| Rate for Payer: Aetna American Axle |
$40.13
|
| Rate for Payer: Aetna Commercial |
$52.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.13
|
| Rate for Payer: Cash Price |
$49.39
|
| Rate for Payer: Cofinity Advantage |
$43.22
|
| Rate for Payer: Cofinity Commercial |
$53.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.39
|
| Rate for Payer: Healthscope Commercial |
$55.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.30
|
| Rate for Payer: PHP Commercial |
$52.48
|
| Rate for Payer: Priority Health SBD |
$38.90
|
| Rate for Payer: UMR Bronson Commercial |
$27.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.30
|
|
|
HC MNT GROUP 30 MIN
|
Facility
|
OP
|
$61.74
|
|
|
Service Code
|
CPT 97804
|
| Hospital Charge Code |
94200004
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$55.57 |
| Rate for Payer: Aetna American Axle |
$40.13
|
| Rate for Payer: Aetna Commercial |
$52.48
|
| Rate for Payer: Aetna Medicare |
$30.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.13
|
| Rate for Payer: BCBS Complete |
$24.70
|
| Rate for Payer: BCBS Trust/PPO |
$35.24
|
| Rate for Payer: BCN Commercial |
$35.24
|
| Rate for Payer: Cash Price |
$49.39
|
| Rate for Payer: Cash Price |
$49.39
|
| Rate for Payer: Cofinity Advantage |
$43.22
|
| Rate for Payer: Cofinity Commercial |
$53.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.39
|
| Rate for Payer: Healthscope Commercial |
$55.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$49.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.30
|
| Rate for Payer: PHP Commercial |
$52.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$15.00
|
| Rate for Payer: Priority Health SBD |
$38.90
|
| Rate for Payer: Priority Health Tiered Network |
$12.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.13
|
| Rate for Payer: UHC Core |
$32.17
|
| Rate for Payer: UHC Exchange |
$24.26
|
| Rate for Payer: UMR Bronson Commercial |
$22.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.30
|
|
|
HC MNT INITIAL 15 MIN
|
Facility
|
IP
|
$141.43
|
|
|
Service Code
|
CPT 97802
|
| Hospital Charge Code |
94200002
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$62.23 |
| Max. Negotiated Rate |
$127.29 |
| Rate for Payer: Aetna American Axle |
$91.93
|
| Rate for Payer: Aetna Commercial |
$120.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.93
|
| Rate for Payer: Cash Price |
$113.14
|
| Rate for Payer: Cofinity Advantage |
$99.00
|
| Rate for Payer: Cofinity Commercial |
$121.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$113.14
|
| Rate for Payer: Healthscope Commercial |
$127.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$99.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$106.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$120.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$106.07
|
| Rate for Payer: PHP Commercial |
$120.22
|
| Rate for Payer: Priority Health SBD |
$89.10
|
| Rate for Payer: UMR Bronson Commercial |
$62.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$106.07
|
|
|
HC MNT INITIAL 15 MIN
|
Facility
|
OP
|
$141.43
|
|
|
Service Code
|
CPT 97802
|
| Hospital Charge Code |
94200002
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$127.29 |
| Rate for Payer: Aetna American Axle |
$91.93
|
| Rate for Payer: Aetna Commercial |
$120.22
|
| Rate for Payer: Aetna Medicare |
$70.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.93
|
| Rate for Payer: BCBS Complete |
$56.57
|
| Rate for Payer: BCBS Trust/PPO |
$78.91
|
| Rate for Payer: BCN Commercial |
$78.91
|
| Rate for Payer: Cash Price |
$113.14
|
| Rate for Payer: Cash Price |
$113.14
|
| Rate for Payer: Cofinity Advantage |
$99.00
|
| Rate for Payer: Cofinity Commercial |
$121.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$113.14
|
| Rate for Payer: Healthscope Commercial |
$127.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$99.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$106.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$113.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$120.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$106.07
|
| Rate for Payer: PHP Commercial |
$120.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$34.00
|
| Rate for Payer: Priority Health SBD |
$89.10
|
| Rate for Payer: Priority Health Tiered Network |
$27.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.93
|
| Rate for Payer: UHC Core |
$73.69
|
| Rate for Payer: UHC Exchange |
$55.58
|
| Rate for Payer: UMR Bronson Commercial |
$52.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$106.07
|
|
|
HC MNT REASSESS & INTERVENT 15 MIN
|
Facility
|
IP
|
$125.01
|
|
|
Service Code
|
CPT 97803
|
| Hospital Charge Code |
94200003
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$55.00 |
| Max. Negotiated Rate |
$112.51 |
| Rate for Payer: Aetna American Axle |
$81.26
|
| Rate for Payer: Aetna Commercial |
$106.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.26
|
| Rate for Payer: Cash Price |
$100.01
|
| Rate for Payer: Cofinity Advantage |
$87.51
|
| Rate for Payer: Cofinity Commercial |
$107.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.01
|
| Rate for Payer: Healthscope Commercial |
$112.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$87.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.76
|
| Rate for Payer: PHP Commercial |
$106.26
|
| Rate for Payer: Priority Health SBD |
$78.76
|
| Rate for Payer: UMR Bronson Commercial |
$55.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.76
|
|
|
HC MNT REASSESS & INTERVENT 15 MIN
|
Facility
|
OP
|
$125.01
|
|
|
Service Code
|
CPT 97803
|
| Hospital Charge Code |
94200003
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$23.20 |
| Max. Negotiated Rate |
$112.51 |
| Rate for Payer: Aetna American Axle |
$81.26
|
| Rate for Payer: Aetna Commercial |
$106.26
|
| Rate for Payer: Aetna Medicare |
$62.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.26
|
| Rate for Payer: BCBS Complete |
$50.00
|
| Rate for Payer: BCBS Trust/PPO |
$70.44
|
| Rate for Payer: BCN Commercial |
$70.44
|
| Rate for Payer: Cash Price |
$100.01
|
| Rate for Payer: Cash Price |
$100.01
|
| Rate for Payer: Cofinity Advantage |
$87.51
|
| Rate for Payer: Cofinity Commercial |
$107.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.01
|
| Rate for Payer: Healthscope Commercial |
$112.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$87.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$100.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.76
|
| Rate for Payer: PHP Commercial |
$106.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$29.00
|
| Rate for Payer: Priority Health SBD |
$78.76
|
| Rate for Payer: Priority Health Tiered Network |
$23.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$81.26
|
| Rate for Payer: UHC Core |
$65.13
|
| Rate for Payer: UHC Exchange |
$49.13
|
| Rate for Payer: UMR Bronson Commercial |
$46.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.76
|
|
|
HC MOG FACS, S
|
Facility
|
OP
|
$546.21
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200476
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$491.59 |
| Rate for Payer: Aetna American Axle |
$355.04
|
| Rate for Payer: Aetna Commercial |
$464.28
|
| Rate for Payer: Aetna Medicare |
$12.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$355.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: BCBS Complete |
$6.62
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$10.45
|
| Rate for Payer: BCN Commercial |
$10.45
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$436.97
|
| Rate for Payer: Cash Price |
$436.97
|
| Rate for Payer: Cofinity Advantage |
$382.35
|
| Rate for Payer: Cofinity Commercial |
$469.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$436.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$491.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$382.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$409.66
|
| Rate for Payer: Mclaren Medicaid |
$12.05
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: Meridian Medicaid |
$12.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$464.28
|
| Rate for Payer: Nomi Health Commercial |
$18.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$409.66
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$464.28
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12.05
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health SBD |
$344.11
|
| Rate for Payer: Priority Health Tiered Network |
$9.64
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.08
|
| Rate for Payer: UHC Core |
$18.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.05
|
| Rate for Payer: UHC Exchange |
$18.08
|
| Rate for Payer: UHC Medicaid |
$6.30
|
| Rate for Payer: UHCCP Medicaid |
$6.30
|
| Rate for Payer: UMR Bronson Commercial |
$202.10
|
| Rate for Payer: VA VA |
$12.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$409.66
|
|
|
HC MOG FACS, S
|
Facility
|
IP
|
$546.21
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200476
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$240.33 |
| Max. Negotiated Rate |
$491.59 |
| Rate for Payer: Aetna American Axle |
$355.04
|
| Rate for Payer: Aetna Commercial |
$464.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$355.04
|
| Rate for Payer: Cash Price |
$436.97
|
| Rate for Payer: Cofinity Advantage |
$382.35
|
| Rate for Payer: Cofinity Commercial |
$469.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$436.97
|
| Rate for Payer: Healthscope Commercial |
$491.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$382.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$409.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$464.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$409.66
|
| Rate for Payer: PHP Commercial |
$464.28
|
| Rate for Payer: Priority Health SBD |
$344.11
|
| Rate for Payer: UMR Bronson Commercial |
$240.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$409.66
|
|
|
HC MOG FACS TITER, S
|
Facility
|
IP
|
$78.03
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
30200477
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$34.33 |
| Max. Negotiated Rate |
$70.23 |
| Rate for Payer: Aetna American Axle |
$50.72
|
| Rate for Payer: Aetna Commercial |
$66.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.72
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cofinity Advantage |
$54.62
|
| Rate for Payer: Cofinity Commercial |
$67.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.42
|
| Rate for Payer: Healthscope Commercial |
$70.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$54.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.52
|
| Rate for Payer: PHP Commercial |
$66.33
|
| Rate for Payer: Priority Health SBD |
$49.16
|
| Rate for Payer: UMR Bronson Commercial |
$34.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.52
|
|
|
HC MOG FACS TITER, S
|
Facility
|
OP
|
$78.03
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
30200477
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$70.23 |
| Rate for Payer: Aetna American Axle |
$50.72
|
| Rate for Payer: Aetna Commercial |
$66.33
|
| Rate for Payer: Aetna Medicare |
$12.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: BCBS Complete |
$6.62
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$10.45
|
| Rate for Payer: BCN Commercial |
$10.45
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cofinity Advantage |
$54.62
|
| Rate for Payer: Cofinity Commercial |
$67.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$70.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$54.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.52
|
| Rate for Payer: Mclaren Medicaid |
$12.05
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: Meridian Medicaid |
$12.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.33
|
| Rate for Payer: Nomi Health Commercial |
$18.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.52
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$66.33
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12.05
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health SBD |
$49.16
|
| Rate for Payer: Priority Health Tiered Network |
$9.64
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.08
|
| Rate for Payer: UHC Core |
$18.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.05
|
| Rate for Payer: UHC Exchange |
$18.08
|
| Rate for Payer: UHC Medicaid |
$6.30
|
| Rate for Payer: UHCCP Medicaid |
$6.30
|
| Rate for Payer: UMR Bronson Commercial |
$28.87
|
| Rate for Payer: VA VA |
$12.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.52
|
|
|
HC MONITOR DOWNLOAD
|
Facility
|
OP
|
$771.07
|
|
|
Service Code
|
CPT 94776
|
| Hospital Charge Code |
41000013
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$67.05 |
| Max. Negotiated Rate |
$693.96 |
| Rate for Payer: Aetna American Axle |
$501.20
|
| Rate for Payer: Aetna Commercial |
$655.41
|
| Rate for Payer: Aetna Medicare |
$133.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$501.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$160.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$160.26
|
| Rate for Payer: BCBS Complete |
$70.41
|
| Rate for Payer: BCBS MAPPO |
$128.21
|
| Rate for Payer: BCBS Trust/PPO |
$413.88
|
| Rate for Payer: BCN Commercial |
$413.88
|
| Rate for Payer: BCN Medicare Advantage |
$128.21
|
| Rate for Payer: Cash Price |
$616.86
|
| Rate for Payer: Cash Price |
$616.86
|
| Rate for Payer: Cofinity Advantage |
$539.75
|
| Rate for Payer: Cofinity Commercial |
$663.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$616.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$128.21
|
| Rate for Payer: Healthscope Commercial |
$693.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$539.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$578.30
|
| Rate for Payer: Mclaren Medicaid |
$128.21
|
| Rate for Payer: Mclaren Medicare |
$128.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$134.62
|
| Rate for Payer: Meridian Medicaid |
$134.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$147.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$141.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$655.41
|
| Rate for Payer: Nomi Health Commercial |
$384.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$578.30
|
| Rate for Payer: PACE Medicare |
$121.80
|
| Rate for Payer: PACE SWMI |
$128.21
|
| Rate for Payer: PHP Commercial |
$655.41
|
| Rate for Payer: PHP Medicare Advantage |
$128.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$414.63
|
| Rate for Payer: Priority Health Medicare |
$128.21
|
| Rate for Payer: Priority Health SBD |
$485.77
|
| Rate for Payer: Priority Health Tiered Network |
$331.70
|
| Rate for Payer: Railroad Medicare Medicare |
$128.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$501.20
|
| Rate for Payer: UHC Core |
$401.73
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$128.21
|
| Rate for Payer: UHC Exchange |
$303.03
|
| Rate for Payer: UHC Medicaid |
$67.05
|
| Rate for Payer: UHCCP Medicaid |
$67.05
|
| Rate for Payer: UMR Bronson Commercial |
$285.30
|
| Rate for Payer: VA VA |
$128.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$578.30
|
|
|
HC MONITOR DOWNLOAD
|
Facility
|
IP
|
$771.07
|
|
|
Service Code
|
CPT 94776
|
| Hospital Charge Code |
41000013
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$339.27 |
| Max. Negotiated Rate |
$693.96 |
| Rate for Payer: Aetna American Axle |
$501.20
|
| Rate for Payer: Aetna Commercial |
$655.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$501.20
|
| Rate for Payer: Cash Price |
$616.86
|
| Rate for Payer: Cofinity Advantage |
$539.75
|
| Rate for Payer: Cofinity Commercial |
$663.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$616.86
|
| Rate for Payer: Healthscope Commercial |
$693.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$539.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$578.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$655.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$578.30
|
| Rate for Payer: PHP Commercial |
$655.41
|
| Rate for Payer: Priority Health SBD |
$485.77
|
| Rate for Payer: UMR Bronson Commercial |
$339.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$578.30
|
|
|
HC MONITORED EXERCISE
|
Facility
|
IP
|
$249.83
|
|
|
Service Code
|
CPT 93798
|
| Hospital Charge Code |
94300001
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$109.93 |
| Max. Negotiated Rate |
$224.85 |
| Rate for Payer: Aetna American Axle |
$162.39
|
| Rate for Payer: Aetna Commercial |
$212.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.39
|
| Rate for Payer: Cash Price |
$199.86
|
| Rate for Payer: Cofinity Advantage |
$174.88
|
| Rate for Payer: Cofinity Commercial |
$214.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.86
|
| Rate for Payer: Healthscope Commercial |
$224.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$174.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$187.37
|
| Rate for Payer: PHP Commercial |
$212.36
|
| Rate for Payer: Priority Health SBD |
$157.39
|
| Rate for Payer: UMR Bronson Commercial |
$109.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.37
|
|
|
HC MONITORED EXERCISE
|
Facility
|
OP
|
$249.83
|
|
|
Service Code
|
CPT 93798
|
| Hospital Charge Code |
94300001
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$64.81 |
| Max. Negotiated Rate |
$415.38 |
| Rate for Payer: Aetna American Axle |
$162.39
|
| Rate for Payer: Aetna Commercial |
$212.36
|
| Rate for Payer: Aetna Medicare |
$133.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$160.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$160.55
|
| Rate for Payer: BCBS Complete |
$70.54
|
| Rate for Payer: BCBS MAPPO |
$128.44
|
| Rate for Payer: BCBS Trust/PPO |
$64.81
|
| Rate for Payer: BCN Commercial |
$64.81
|
| Rate for Payer: BCN Medicare Advantage |
$128.44
|
| Rate for Payer: Cash Price |
$199.86
|
| Rate for Payer: Cash Price |
$199.86
|
| Rate for Payer: Cofinity Advantage |
$174.88
|
| Rate for Payer: Cofinity Commercial |
$214.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$128.44
|
| Rate for Payer: Healthscope Commercial |
$224.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$174.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.37
|
| Rate for Payer: Mclaren Medicaid |
$128.44
|
| Rate for Payer: Mclaren Medicare |
$128.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$134.86
|
| Rate for Payer: Meridian Medicaid |
$134.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$147.71
|
| Rate for Payer: Molina Medicare/Medicaid |
$141.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.36
|
| Rate for Payer: Nomi Health Commercial |
$385.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$187.37
|
| Rate for Payer: PACE Medicare |
$122.02
|
| Rate for Payer: PACE SWMI |
$128.44
|
| Rate for Payer: PHP Commercial |
$212.36
|
| Rate for Payer: PHP Medicare Advantage |
$128.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$415.38
|
| Rate for Payer: Priority Health Medicare |
$128.44
|
| Rate for Payer: Priority Health SBD |
$157.39
|
| Rate for Payer: Priority Health Tiered Network |
$332.30
|
| Rate for Payer: Railroad Medicare Medicare |
$128.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$162.39
|
| Rate for Payer: UHC Core |
$130.16
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$128.44
|
| Rate for Payer: UHC Exchange |
$98.18
|
| Rate for Payer: UHC Medicaid |
$67.17
|
| Rate for Payer: UHCCP Medicaid |
$67.17
|
| Rate for Payer: UMR Bronson Commercial |
$92.44
|
| Rate for Payer: VA VA |
$128.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.37
|
|
|
HC MONITOR SET QUICK PRESSURE
|
Facility
|
OP
|
$446.25
|
|
| Hospital Charge Code |
27000707
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$165.11 |
| Max. Negotiated Rate |
$401.62 |
| Rate for Payer: Aetna American Axle |
$290.06
|
| Rate for Payer: Aetna Commercial |
$379.31
|
| Rate for Payer: Aetna Medicare |
$223.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$290.06
|
| Rate for Payer: BCBS Complete |
$178.50
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: Cofinity Advantage |
$312.38
|
| Rate for Payer: Cofinity Commercial |
$383.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$357.00
|
| Rate for Payer: Healthscope Commercial |
$401.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$312.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$334.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$357.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$379.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$334.69
|
| Rate for Payer: PHP Commercial |
$379.31
|
| Rate for Payer: Priority Health SBD |
$281.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$290.06
|
| Rate for Payer: UHC Core |
$232.50
|
| Rate for Payer: UHC Exchange |
$175.38
|
| Rate for Payer: UMR Bronson Commercial |
$165.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$334.69
|
|
|
HC MONITOR SET QUICK PRESSURE
|
Facility
|
IP
|
$446.25
|
|
| Hospital Charge Code |
27000707
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$196.35 |
| Max. Negotiated Rate |
$401.62 |
| Rate for Payer: Aetna American Axle |
$290.06
|
| Rate for Payer: Aetna Commercial |
$379.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$290.06
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: Cofinity Advantage |
$312.38
|
| Rate for Payer: Cofinity Commercial |
$383.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$357.00
|
| Rate for Payer: Healthscope Commercial |
$401.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$312.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$334.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$379.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$334.69
|
| Rate for Payer: PHP Commercial |
$379.31
|
| Rate for Payer: Priority Health SBD |
$281.14
|
| Rate for Payer: UMR Bronson Commercial |
$196.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$334.69
|
|
|
HC MONO SCREENING MONOSPOT
|
Facility
|
OP
|
$26.53
|
|
|
Service Code
|
CPT 86308
|
| Hospital Charge Code |
30200186
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.71 |
| Max. Negotiated Rate |
$23.88 |
| Rate for Payer: Aetna American Axle |
$17.24
|
| Rate for Payer: Aetna Commercial |
$22.55
|
| Rate for Payer: Aetna Medicare |
$5.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.47
|
| Rate for Payer: BCBS Complete |
$2.84
|
| Rate for Payer: BCBS MAPPO |
$5.18
|
| Rate for Payer: BCBS Trust/PPO |
$6.00
|
| Rate for Payer: BCN Commercial |
$6.00
|
| Rate for Payer: BCN Medicare Advantage |
$5.18
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cofinity Advantage |
$18.57
|
| Rate for Payer: Cofinity Commercial |
$22.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.18
|
| Rate for Payer: Healthscope Commercial |
$23.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.90
|
| Rate for Payer: Mclaren Medicaid |
$5.18
|
| Rate for Payer: Mclaren Medicare |
$5.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.44
|
| Rate for Payer: Meridian Medicaid |
$5.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.55
|
| Rate for Payer: Nomi Health Commercial |
$7.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.90
|
| Rate for Payer: PACE Medicare |
$4.92
|
| Rate for Payer: PACE SWMI |
$5.18
|
| Rate for Payer: PHP Commercial |
$22.55
|
| Rate for Payer: PHP Medicare Advantage |
$5.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.18
|
| Rate for Payer: Priority Health Medicare |
$5.18
|
| Rate for Payer: Priority Health SBD |
$16.71
|
| Rate for Payer: Priority Health Tiered Network |
$4.14
|
| Rate for Payer: Railroad Medicare Medicare |
$5.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.77
|
| Rate for Payer: UHC Core |
$7.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.18
|
| Rate for Payer: UHC Exchange |
$7.77
|
| Rate for Payer: UHC Medicaid |
$2.71
|
| Rate for Payer: UHCCP Medicaid |
$2.71
|
| Rate for Payer: UMR Bronson Commercial |
$9.82
|
| Rate for Payer: VA VA |
$5.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.90
|
|
|
HC MONO SCREENING MONOSPOT
|
Facility
|
IP
|
$26.53
|
|
|
Service Code
|
CPT 86308
|
| Hospital Charge Code |
30200186
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.67 |
| Max. Negotiated Rate |
$23.88 |
| Rate for Payer: Aetna American Axle |
$17.24
|
| Rate for Payer: Aetna Commercial |
$22.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.24
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cofinity Advantage |
$18.57
|
| Rate for Payer: Cofinity Commercial |
$22.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.22
|
| Rate for Payer: Healthscope Commercial |
$23.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.90
|
| Rate for Payer: PHP Commercial |
$22.55
|
| Rate for Payer: Priority Health SBD |
$16.71
|
| Rate for Payer: UMR Bronson Commercial |
$11.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.90
|
|
|
HC MORPHINE LVL
|
Facility
|
OP
|
$121.73
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
30100578
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.04 |
| Max. Negotiated Rate |
$109.56 |
| Rate for Payer: Aetna American Axle |
$79.12
|
| Rate for Payer: Aetna Commercial |
$103.47
|
| Rate for Payer: Aetna Medicare |
$60.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.12
|
| Rate for Payer: BCBS Complete |
$48.69
|
| Rate for Payer: Cash Price |
$97.38
|
| Rate for Payer: Cofinity Advantage |
$85.21
|
| Rate for Payer: Cofinity Commercial |
$104.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.38
|
| Rate for Payer: Healthscope Commercial |
$109.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$85.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$97.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$91.30
|
| Rate for Payer: PHP Commercial |
$103.47
|
| Rate for Payer: Priority Health SBD |
$76.69
|
| Rate for Payer: UMR Bronson Commercial |
$45.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.30
|
|
|
HC MORPHINE LVL
|
Facility
|
IP
|
$121.73
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
30100578
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$53.56 |
| Max. Negotiated Rate |
$109.56 |
| Rate for Payer: Aetna American Axle |
$79.12
|
| Rate for Payer: Aetna Commercial |
$103.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.12
|
| Rate for Payer: Cash Price |
$97.38
|
| Rate for Payer: Cofinity Advantage |
$85.21
|
| Rate for Payer: Cofinity Commercial |
$104.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.38
|
| Rate for Payer: Healthscope Commercial |
$109.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$85.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$91.30
|
| Rate for Payer: PHP Commercial |
$103.47
|
| Rate for Payer: Priority Health SBD |
$76.69
|
| Rate for Payer: UMR Bronson Commercial |
$53.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.30
|
|
|
HC MOUSE IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200048
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.40 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna American Axle |
$16.84
|
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Advantage |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: Priority Health SBD |
$16.32
|
| Rate for Payer: UMR Bronson Commercial |
$11.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.43
|
|
|
HC MOUSE IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200048
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna American Axle |
$16.84
|
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: BCBS Complete |
$2.87
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$6.04
|
| Rate for Payer: BCN Commercial |
$6.04
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Advantage |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.43
|
| Rate for Payer: Mclaren Medicaid |
$5.22
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$7.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.22
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$16.32
|
| Rate for Payer: Priority Health Tiered Network |
$4.18
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.83
|
| Rate for Payer: UHC Core |
$7.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.22
|
| Rate for Payer: UHC Exchange |
$7.83
|
| Rate for Payer: UHC Medicaid |
$2.73
|
| Rate for Payer: UHCCP Medicaid |
$2.73
|
| Rate for Payer: UMR Bronson Commercial |
$9.58
|
| Rate for Payer: VA VA |
$5.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.43
|
|
|
HC MPCDS CELL SORTING BM
|
Facility
|
OP
|
$174.20
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
31100048
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$64.45 |
| Max. Negotiated Rate |
$1,155.01 |
| Rate for Payer: Aetna American Axle |
$113.23
|
| Rate for Payer: Aetna Commercial |
$148.07
|
| Rate for Payer: Aetna Medicare |
$371.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$446.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$446.45
|
| Rate for Payer: BCBS Complete |
$196.15
|
| Rate for Payer: BCBS MAPPO |
$357.16
|
| Rate for Payer: BCBS Trust/PPO |
$144.07
|
| Rate for Payer: BCN Commercial |
$144.07
|
| Rate for Payer: BCN Medicare Advantage |
$357.16
|
| Rate for Payer: Cash Price |
$139.36
|
| Rate for Payer: Cash Price |
$139.36
|
| Rate for Payer: Cofinity Advantage |
$121.94
|
| Rate for Payer: Cofinity Commercial |
$149.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$357.16
|
| Rate for Payer: Healthscope Commercial |
$156.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$121.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$130.65
|
| Rate for Payer: Mclaren Medicaid |
$357.16
|
| Rate for Payer: Mclaren Medicare |
$357.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$375.02
|
| Rate for Payer: Meridian Medicaid |
$375.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$410.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$392.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$148.07
|
| Rate for Payer: Nomi Health Commercial |
$1,071.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$130.65
|
| Rate for Payer: PACE Medicare |
$339.30
|
| Rate for Payer: PACE SWMI |
$357.16
|
| Rate for Payer: PHP Commercial |
$148.07
|
| Rate for Payer: PHP Medicare Advantage |
$357.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$186.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,155.01
|
| Rate for Payer: Priority Health Medicare |
$357.16
|
| Rate for Payer: Priority Health SBD |
$109.75
|
| Rate for Payer: Priority Health Tiered Network |
$924.01
|
| Rate for Payer: Railroad Medicare Medicare |
$357.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$539.58
|
| Rate for Payer: UHC Core |
$539.58
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$357.16
|
| Rate for Payer: UHC Exchange |
$539.58
|
| Rate for Payer: UHC Medicaid |
$186.79
|
| Rate for Payer: UHCCP Medicaid |
$186.79
|
| Rate for Payer: UMR Bronson Commercial |
$64.45
|
| Rate for Payer: VA VA |
$357.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$130.65
|
|
