|
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 Commercial |
$289.08
|
| Rate for Payer: Cofinity Commercial |
$355.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$289.08
|
| 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: PHP Commercial |
$351.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$268.43
|
| 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 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 |
$206.48
|
| 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 Commercial |
$289.08
|
| Rate for Payer: Cofinity Commercial |
$355.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$289.08
|
| 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: PHP Commercial |
$351.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$268.43
|
| 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 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 Commercial |
$2,258.80
|
| Rate for Payer: Cofinity Commercial |
$2,775.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,258.80
|
| 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: PHP Commercial |
$2,742.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,097.45
|
| 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 Commercial |
$2,258.80
|
| Rate for Payer: Cofinity Commercial |
$2,775.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,258.80
|
| 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: PHP Commercial |
$2,742.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,097.45
|
| 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 Commercial |
$1,064.63
|
| Rate for Payer: Cofinity Commercial |
$866.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$866.56
|
| 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: PHP Commercial |
$1,052.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$804.66
|
| 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 Commercial |
$1,064.63
|
| Rate for Payer: Cofinity Commercial |
$866.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$866.56
|
| 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: PHP Commercial |
$1,052.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$804.66
|
| 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 Commercial |
$2,679.13
|
| Rate for Payer: Cofinity Commercial |
$3,291.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,679.13
|
| 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: PHP Commercial |
$3,253.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,487.76
|
| 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 Commercial |
$2,679.13
|
| Rate for Payer: Cofinity Commercial |
$3,291.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,679.13
|
| 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: PHP Commercial |
$3,253.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,487.76
|
| 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: Cash Price |
$1,190.31
|
| 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: Cofinity Commercial |
$1,041.52
|
| Rate for Payer: Cofinity Commercial |
$1,279.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,041.52
|
| 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: PHP Commercial |
$1,264.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$967.13
|
| 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 |
$743.94
|
| 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 Commercial |
$1,041.52
|
| Rate for Payer: Cofinity Commercial |
$1,279.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,041.52
|
| 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: PHP Commercial |
$1,264.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$967.13
|
| 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 |
$3,873.02
|
| 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 Commercial |
$3,189.55
|
| Rate for Payer: Cofinity Commercial |
$3,918.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,189.55
|
| 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 |
$3,873.02
|
| Rate for Payer: PHP Commercial |
$3,873.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,961.72
|
| Rate for Payer: Priority Health SBD |
$2,870.60
|
| 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 |
$3,873.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,961.72
|
| Rate for Payer: Cash Price |
$3,645.20
|
| Rate for Payer: Cofinity Commercial |
$3,189.55
|
| Rate for Payer: Cofinity Commercial |
$3,918.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,189.55
|
| 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 |
$3,873.02
|
| Rate for Payer: PHP Commercial |
$3,873.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,961.72
|
| Rate for Payer: Priority Health SBD |
$2,870.60
|
| Rate for Payer: UMR Bronson Commercial |
$2,004.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,417.38
|
|
|
HC LEVEL 4 SUBSQ 15 MIN
|
Facility
|
OP
|
$1,658.07
|
|
| Hospital Charge Code |
36000069
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$613.49 |
| Max. Negotiated Rate |
$1,492.26 |
| Rate for Payer: Aetna American Axle |
$1,077.75
|
| Rate for Payer: Aetna Commercial |
$1,409.36
|
| Rate for Payer: Aetna Medicare |
$829.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,077.75
|
| Rate for Payer: BCBS Complete |
$663.23
|
| Rate for Payer: Cash Price |
$1,326.46
|
| Rate for Payer: Cofinity Commercial |
$1,160.65
|
| Rate for Payer: Cofinity Commercial |
$1,425.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,160.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,326.46
|
| Rate for Payer: Healthscope Commercial |
$1,492.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,160.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,243.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,409.36
|
| Rate for Payer: PHP Commercial |
$1,409.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,077.75
|
| Rate for Payer: Priority Health SBD |
$1,044.58
|
| Rate for Payer: UMR Bronson Commercial |
$613.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,243.55
|
|
|
HC LEVEL 4 SUBSQ 15 MIN
|
Facility
|
IP
|
$1,658.07
|
|
| Hospital Charge Code |
36000069
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$729.55 |
| Max. Negotiated Rate |
$1,492.26 |
| Rate for Payer: Aetna American Axle |
$1,077.75
|
| Rate for Payer: Aetna Commercial |
$1,409.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,077.75
|
| Rate for Payer: Cash Price |
$1,326.46
|
| Rate for Payer: Cofinity Commercial |
$1,160.65
|
| Rate for Payer: Cofinity Commercial |
$1,425.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,160.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,326.46
|
| Rate for Payer: Healthscope Commercial |
$1,492.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,160.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,243.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,409.36
|
| Rate for Payer: PHP Commercial |
$1,409.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,077.75
|
| Rate for Payer: Priority Health SBD |
$1,044.58
|
| Rate for Payer: UMR Bronson Commercial |
$729.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,243.55
|
|
|
HC LEVEL 5 INIT 30 MIN
|
Facility
|
IP
|
$5,084.43
|
|
| Hospital Charge Code |
36000070
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,237.15 |
| Max. Negotiated Rate |
$4,575.99 |
| Rate for Payer: Aetna American Axle |
$3,304.88
|
| Rate for Payer: Aetna Commercial |
$4,321.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,304.88
|
| Rate for Payer: Cash Price |
$4,067.54
|
| Rate for Payer: Cofinity Commercial |
$3,559.10
|
| Rate for Payer: Cofinity Commercial |
$4,372.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,559.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,067.54
|
| Rate for Payer: Healthscope Commercial |
$4,575.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,559.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,813.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,321.77
|
| Rate for Payer: PHP Commercial |
$4,321.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,304.88
|
| Rate for Payer: Priority Health SBD |
$3,203.19
|
| Rate for Payer: UMR Bronson Commercial |
$2,237.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,813.32
|
|
|
HC LEVEL 5 INIT 30 MIN
|
Facility
|
OP
|
$5,084.43
|
|
| Hospital Charge Code |
36000070
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,881.24 |
| Max. Negotiated Rate |
$4,575.99 |
| Rate for Payer: Aetna American Axle |
$3,304.88
|
| Rate for Payer: Aetna Commercial |
$4,321.77
|
| Rate for Payer: Aetna Medicare |
$2,542.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,304.88
|
| Rate for Payer: BCBS Complete |
$2,033.77
|
| Rate for Payer: Cash Price |
$4,067.54
|
| Rate for Payer: Cofinity Commercial |
$3,559.10
|
| Rate for Payer: Cofinity Commercial |
$4,372.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,559.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,067.54
|
| Rate for Payer: Healthscope Commercial |
$4,575.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,559.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,813.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,321.77
|
| Rate for Payer: PHP Commercial |
$4,321.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,304.88
|
| Rate for Payer: Priority Health SBD |
$3,203.19
|
| Rate for Payer: UMR Bronson Commercial |
$1,881.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,813.32
|
|
|
HC LEVEL 5 SUBSQ 15 MIN
|
Facility
|
OP
|
$2,078.52
|
|
| Hospital Charge Code |
36000071
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$769.05 |
| Max. Negotiated Rate |
$1,870.67 |
| Rate for Payer: Aetna American Axle |
$1,351.04
|
| Rate for Payer: Aetna Commercial |
$1,766.74
|
| Rate for Payer: Aetna Medicare |
$1,039.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,351.04
|
| Rate for Payer: BCBS Complete |
$831.41
|
| Rate for Payer: Cash Price |
$1,662.82
|
| Rate for Payer: Cofinity Commercial |
$1,454.96
|
| Rate for Payer: Cofinity Commercial |
$1,787.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,454.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,662.82
|
| Rate for Payer: Healthscope Commercial |
$1,870.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,454.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,558.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,766.74
|
| Rate for Payer: PHP Commercial |
$1,766.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,351.04
|
| Rate for Payer: Priority Health SBD |
$1,309.47
|
| Rate for Payer: UMR Bronson Commercial |
$769.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,558.89
|
|
|
HC LEVEL 5 SUBSQ 15 MIN
|
Facility
|
IP
|
$2,078.52
|
|
| Hospital Charge Code |
36000071
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$914.55 |
| Max. Negotiated Rate |
$1,870.67 |
| Rate for Payer: Aetna American Axle |
$1,351.04
|
| Rate for Payer: Aetna Commercial |
$1,766.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,351.04
|
| Rate for Payer: Cash Price |
$1,662.82
|
| Rate for Payer: Cofinity Commercial |
$1,454.96
|
| Rate for Payer: Cofinity Commercial |
$1,787.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,454.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,662.82
|
| Rate for Payer: Healthscope Commercial |
$1,870.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,454.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,558.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,766.74
|
| Rate for Payer: PHP Commercial |
$1,766.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,351.04
|
| Rate for Payer: Priority Health SBD |
$1,309.47
|
| Rate for Payer: UMR Bronson Commercial |
$914.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,558.89
|
|
|
HC LEVETIRACETAM LEVEL
|
Facility
|
IP
|
$76.79
|
|
|
Service Code
|
CPT 80177
|
| Hospital Charge Code |
30100057
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.79 |
| Max. Negotiated Rate |
$69.11 |
| Rate for Payer: Aetna American Axle |
$49.91
|
| Rate for Payer: Aetna Commercial |
$65.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.91
|
| Rate for Payer: Cash Price |
$61.43
|
| Rate for Payer: Cofinity Commercial |
$53.75
|
| Rate for Payer: Cofinity Commercial |
$66.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$53.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.43
|
| Rate for Payer: Healthscope Commercial |
$69.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$53.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.27
|
| Rate for Payer: PHP Commercial |
$65.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.91
|
| Rate for Payer: Priority Health SBD |
$48.38
|
| Rate for Payer: UMR Bronson Commercial |
$33.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.59
|
|
|
HC LEVETIRACETAM LEVEL
|
Facility
|
OP
|
$76.79
|
|
|
Service Code
|
CPT 80177
|
| Hospital Charge Code |
30100057
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.10 |
| Max. Negotiated Rate |
$69.11 |
| Rate for Payer: Meridian Medicaid |
$7.46
|
| Rate for Payer: Aetna American Axle |
$49.91
|
| Rate for Payer: Aetna Commercial |
$65.27
|
| Rate for Payer: Aetna Medicare |
$13.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.56
|
| Rate for Payer: BCBS Complete |
$7.46
|
| Rate for Payer: BCBS MAPPO |
$13.25
|
| Rate for Payer: BCBS Trust/PPO |
$12.77
|
| Rate for Payer: BCN Commercial |
$12.77
|
| Rate for Payer: BCN Medicare Advantage |
$13.25
|
| Rate for Payer: Cash Price |
$61.43
|
| Rate for Payer: Cash Price |
$61.43
|
| Rate for Payer: Cofinity Commercial |
$66.04
|
| Rate for Payer: Cofinity Commercial |
$53.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$53.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.25
|
| Rate for Payer: Healthscope Commercial |
$69.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$53.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.59
|
| Rate for Payer: Mclaren Medicaid |
$7.10
|
| Rate for Payer: Mclaren Medicare |
$13.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.27
|
| Rate for Payer: Nomi Health Commercial |
$19.88
|
| Rate for Payer: PACE Medicare |
$12.59
|
| Rate for Payer: PACE SWMI |
$13.25
|
| Rate for Payer: PHP Commercial |
$65.27
|
| Rate for Payer: PHP Medicare Advantage |
$13.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.64
|
| Rate for Payer: Priority Health Medicare |
$13.25
|
| Rate for Payer: Priority Health Narrow Network |
$10.91
|
| Rate for Payer: Priority Health SBD |
$48.38
|
| Rate for Payer: Railroad Medicare Medicare |
$13.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.25
|
| Rate for Payer: UHC Exchange |
$13.25
|
| Rate for Payer: UHC Medicare Advantage |
$13.25
|
| Rate for Payer: UHCCP Medicaid |
$7.10
|
| Rate for Payer: UMR Bronson Commercial |
$28.41
|
| Rate for Payer: VA VA |
$13.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.59
|
|
|
HC LEVONORGESTREL-RELEASING ICS, 52MG, 5 YR
|
Facility
|
OP
|
$3,846.72
|
|
|
Service Code
|
CPT J7298
|
| Hospital Charge Code |
63600106
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$980.96 |
| Max. Negotiated Rate |
$3,462.05 |
| Rate for Payer: Aetna American Axle |
$2,500.37
|
| Rate for Payer: Aetna Commercial |
$3,269.71
|
| Rate for Payer: Aetna Medicare |
$1,923.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,500.37
|
| Rate for Payer: BCBS Complete |
$1,538.69
|
| Rate for Payer: BCBS Trust/PPO |
$3,230.46
|
| Rate for Payer: BCN Commercial |
$3,230.46
|
| Rate for Payer: Cash Price |
$3,077.38
|
| Rate for Payer: Cash Price |
$3,077.38
|
| Rate for Payer: Cofinity Commercial |
$2,692.70
|
| Rate for Payer: Cofinity Commercial |
$3,308.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,692.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,077.38
|
| Rate for Payer: Healthscope Commercial |
$3,462.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,692.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,885.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,269.71
|
| Rate for Payer: PHP Commercial |
$3,269.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,500.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,226.20
|
| Rate for Payer: Priority Health Narrow Network |
$980.96
|
| Rate for Payer: Priority Health SBD |
$2,423.43
|
| Rate for Payer: UMR Bronson Commercial |
$1,423.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,885.04
|
|
|
HC LEVONORGESTREL-RELEASING ICS, 52MG, 5 YR
|
Facility
|
IP
|
$3,846.72
|
|
|
Service Code
|
CPT J7298
|
| Hospital Charge Code |
63600106
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,692.56 |
| Max. Negotiated Rate |
$3,462.05 |
| Rate for Payer: Aetna American Axle |
$2,500.37
|
| Rate for Payer: Aetna Commercial |
$3,269.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,500.37
|
| Rate for Payer: Cash Price |
$3,077.38
|
| Rate for Payer: Cofinity Commercial |
$2,692.70
|
| Rate for Payer: Cofinity Commercial |
$3,308.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,692.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,077.38
|
| Rate for Payer: Healthscope Commercial |
$3,462.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,692.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,885.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,269.71
|
| Rate for Payer: PHP Commercial |
$3,269.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,500.37
|
| Rate for Payer: Priority Health SBD |
$2,423.43
|
| Rate for Payer: UMR Bronson Commercial |
$1,692.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,885.04
|
|
|
HC LH (LUTEINIZING HORMONE)
|
Facility
|
OP
|
$78.03
|
|
|
Service Code
|
CPT 83002
|
| Hospital Charge Code |
30100231
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.93 |
| Max. Negotiated Rate |
$70.23 |
| Rate for Payer: UHCCP Medicaid |
$9.93
|
| Rate for Payer: UMR Bronson Commercial |
$28.87
|
| Rate for Payer: VA VA |
$18.52
|
| Rate for Payer: UHC Medicare Advantage |
$18.52
|
| Rate for Payer: Aetna American Axle |
$50.72
|
| Rate for Payer: Aetna Commercial |
$66.33
|
| Rate for Payer: Aetna Medicare |
$19.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.15
|
| Rate for Payer: BCBS Complete |
$10.42
|
| Rate for Payer: BCBS MAPPO |
$18.52
|
| Rate for Payer: BCBS Trust/PPO |
$17.84
|
| Rate for Payer: BCN Commercial |
$17.84
|
| Rate for Payer: BCN Medicare Advantage |
$18.52
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cofinity Commercial |
$67.11
|
| Rate for Payer: Cofinity Commercial |
$54.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$54.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.52
|
| 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 |
$9.93
|
| Rate for Payer: Mclaren Medicare |
$18.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.45
|
| Rate for Payer: Meridian Medicaid |
$10.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.33
|
| Rate for Payer: Nomi Health Commercial |
$27.78
|
| Rate for Payer: PACE Medicare |
$17.59
|
| Rate for Payer: PACE SWMI |
$18.52
|
| Rate for Payer: PHP Commercial |
$66.33
|
| Rate for Payer: PHP Medicare Advantage |
$18.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.05
|
| Rate for Payer: Priority Health Medicare |
$18.52
|
| Rate for Payer: Priority Health Narrow Network |
$15.24
|
| Rate for Payer: Priority Health SBD |
$49.16
|
| Rate for Payer: Railroad Medicare Medicare |
$18.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.52
|
| Rate for Payer: UHC Exchange |
$18.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.52
|
|
|
HC LH (LUTEINIZING HORMONE)
|
Facility
|
IP
|
$78.03
|
|
|
Service Code
|
CPT 83002
|
| Hospital Charge Code |
30100231
|
|
Hospital Revenue Code
|
301
|
| 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 Commercial |
$54.62
|
| Rate for Payer: Cofinity Commercial |
$67.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$54.62
|
| 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: PHP Commercial |
$66.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.72
|
| 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 LH PEDS, S
|
Facility
|
OP
|
$183.60
|
|
|
Service Code
|
CPT 83002
|
| Hospital Charge Code |
30100738
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.93 |
| Max. Negotiated Rate |
$165.24 |
| Rate for Payer: BCN Commercial |
$17.84
|
| Rate for Payer: BCN Medicare Advantage |
$18.52
|
| Rate for Payer: Cash Price |
$146.88
|
| Rate for Payer: Cash Price |
$146.88
|
| Rate for Payer: Cofinity Commercial |
$157.90
|
| Rate for Payer: Cofinity Commercial |
$128.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$128.52
|
| Rate for Payer: Aetna American Axle |
$119.34
|
| Rate for Payer: Aetna Commercial |
$156.06
|
| Rate for Payer: Aetna Medicare |
$19.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$119.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.15
|
| Rate for Payer: BCBS Complete |
$10.42
|
| Rate for Payer: BCBS MAPPO |
$18.52
|
| Rate for Payer: BCBS Trust/PPO |
$17.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.52
|
| Rate for Payer: Healthscope Commercial |
$165.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$128.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$137.70
|
| Rate for Payer: Mclaren Medicaid |
$9.93
|
| Rate for Payer: Mclaren Medicare |
$18.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.45
|
| Rate for Payer: Meridian Medicaid |
$10.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$156.06
|
| Rate for Payer: Nomi Health Commercial |
$27.78
|
| Rate for Payer: PACE Medicare |
$17.59
|
| Rate for Payer: PACE SWMI |
$18.52
|
| Rate for Payer: PHP Commercial |
$156.06
|
| Rate for Payer: PHP Medicare Advantage |
$18.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.05
|
| Rate for Payer: Priority Health Medicare |
$18.52
|
| Rate for Payer: Priority Health Narrow Network |
$15.24
|
| Rate for Payer: Priority Health SBD |
$115.67
|
| Rate for Payer: Railroad Medicare Medicare |
$18.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.52
|
| Rate for Payer: UHC Exchange |
$18.52
|
| Rate for Payer: UHC Medicare Advantage |
$18.52
|
| Rate for Payer: UHCCP Medicaid |
$9.93
|
| Rate for Payer: UMR Bronson Commercial |
$67.93
|
| Rate for Payer: VA VA |
$18.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$137.70
|
|
