|
HC LISTERIA MONOCYTOGENES
|
Facility
|
IP
|
$52.02
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600274
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$22.89 |
| Max. Negotiated Rate |
$46.82 |
| Rate for Payer: Aetna American Axle |
$33.81
|
| Rate for Payer: Aetna Commercial |
$44.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.81
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$36.41
|
| Rate for Payer: Cofinity Commercial |
$44.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$36.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Healthscope Commercial |
$46.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$36.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: PHP Commercial |
$44.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: Priority Health SBD |
$32.77
|
| Rate for Payer: UMR Bronson Commercial |
$22.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.02
|
|
|
HC LISTERIA MONOCYTOGENES
|
Facility
|
OP
|
$52.02
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600274
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.81 |
| Max. Negotiated Rate |
$52.64 |
| Rate for Payer: Aetna American Axle |
$33.81
|
| Rate for Payer: Aetna Commercial |
$44.22
|
| Rate for Payer: Aetna Medicare |
$36.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: BCBS Complete |
$19.75
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$33.81
|
| Rate for Payer: BCN Commercial |
$33.81
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$44.74
|
| Rate for Payer: Cofinity Commercial |
$36.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$36.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$46.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$36.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.02
|
| Rate for Payer: Mclaren Medicaid |
$18.81
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: Meridian Medicaid |
$19.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: Nomi Health Commercial |
$52.64
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$44.22
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health SBD |
$32.77
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.09
|
| Rate for Payer: UHC Exchange |
$35.09
|
| Rate for Payer: UHC Medicare Advantage |
$35.09
|
| Rate for Payer: UHCCP Medicaid |
$18.81
|
| Rate for Payer: UMR Bronson Commercial |
$19.25
|
| Rate for Payer: VA VA |
$35.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.02
|
|
|
HC LITHIUM LEVEL
|
Facility
|
IP
|
$54.94
|
|
|
Service Code
|
CPT 80178
|
| Hospital Charge Code |
30100034
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.17 |
| Max. Negotiated Rate |
$49.45 |
| Rate for Payer: Aetna American Axle |
$35.71
|
| Rate for Payer: Aetna Commercial |
$46.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.71
|
| Rate for Payer: Cash Price |
$43.95
|
| Rate for Payer: Cofinity Commercial |
$38.46
|
| Rate for Payer: Cofinity Commercial |
$47.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$38.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.95
|
| Rate for Payer: Healthscope Commercial |
$49.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$38.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.70
|
| Rate for Payer: PHP Commercial |
$46.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.71
|
| Rate for Payer: Priority Health SBD |
$34.61
|
| Rate for Payer: UMR Bronson Commercial |
$24.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.20
|
|
|
HC LITHIUM LEVEL
|
Facility
|
OP
|
$54.94
|
|
|
Service Code
|
CPT 80178
|
| Hospital Charge Code |
30100034
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.54 |
| Max. Negotiated Rate |
$49.45 |
| Rate for Payer: Mclaren Medicare |
$6.61
|
| Rate for Payer: Aetna American Axle |
$35.71
|
| Rate for Payer: Aetna Commercial |
$46.70
|
| Rate for Payer: Aetna Medicare |
$6.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.26
|
| Rate for Payer: BCBS Complete |
$3.72
|
| Rate for Payer: BCBS MAPPO |
$6.61
|
| Rate for Payer: BCBS Trust/PPO |
$6.37
|
| Rate for Payer: BCN Commercial |
$6.37
|
| Rate for Payer: BCN Medicare Advantage |
$6.61
|
| Rate for Payer: Cash Price |
$43.95
|
| Rate for Payer: Cash Price |
$43.95
|
| Rate for Payer: Cofinity Commercial |
$47.25
|
| Rate for Payer: Cofinity Commercial |
$38.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$38.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.61
|
| Rate for Payer: Healthscope Commercial |
$49.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$38.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.20
|
| Rate for Payer: Mclaren Medicaid |
$3.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.94
|
| Rate for Payer: Meridian Medicaid |
$3.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.70
|
| Rate for Payer: Nomi Health Commercial |
$9.92
|
| Rate for Payer: PACE Medicare |
$6.28
|
| Rate for Payer: PACE SWMI |
$6.61
|
| Rate for Payer: PHP Commercial |
$46.70
|
| Rate for Payer: PHP Medicare Advantage |
$6.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6.80
|
| Rate for Payer: Priority Health Medicare |
$6.61
|
| Rate for Payer: Priority Health Narrow Network |
$5.44
|
| Rate for Payer: Priority Health SBD |
$34.61
|
| Rate for Payer: Railroad Medicare Medicare |
$6.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.61
|
| Rate for Payer: UHC Exchange |
$6.61
|
| Rate for Payer: UHC Medicare Advantage |
$6.61
|
| Rate for Payer: UHCCP Medicaid |
$3.54
|
| Rate for Payer: UMR Bronson Commercial |
$20.33
|
| Rate for Payer: VA VA |
$6.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.20
|
|
|
HC LITHOTRIPSY
|
Facility
|
IP
|
$2,852.05
|
|
| Hospital Charge Code |
36000072
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,254.90 |
| Max. Negotiated Rate |
$2,566.84 |
| Rate for Payer: Aetna American Axle |
$1,853.83
|
| Rate for Payer: Aetna Commercial |
$2,424.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,853.83
|
| Rate for Payer: Cash Price |
$2,281.64
|
| Rate for Payer: Cofinity Commercial |
$1,996.44
|
| Rate for Payer: Cofinity Commercial |
$2,452.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,996.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,281.64
|
| Rate for Payer: Healthscope Commercial |
$2,566.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,996.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,139.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,424.24
|
| Rate for Payer: PHP Commercial |
$2,424.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,853.83
|
| Rate for Payer: Priority Health SBD |
$1,796.79
|
| Rate for Payer: UMR Bronson Commercial |
$1,254.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,139.04
|
|
|
HC LITHOTRIPSY
|
Facility
|
OP
|
$2,852.05
|
|
| Hospital Charge Code |
36000072
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,055.26 |
| Max. Negotiated Rate |
$2,566.84 |
| Rate for Payer: Aetna American Axle |
$1,853.83
|
| Rate for Payer: Aetna Commercial |
$2,424.24
|
| Rate for Payer: Aetna Medicare |
$1,426.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,853.83
|
| Rate for Payer: BCBS Complete |
$1,140.82
|
| Rate for Payer: Cash Price |
$2,281.64
|
| Rate for Payer: Cofinity Commercial |
$1,996.44
|
| Rate for Payer: Cofinity Commercial |
$2,452.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,996.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,281.64
|
| Rate for Payer: Healthscope Commercial |
$2,566.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,996.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,139.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,424.24
|
| Rate for Payer: PHP Commercial |
$2,424.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,853.83
|
| Rate for Payer: Priority Health SBD |
$1,796.79
|
| Rate for Payer: UMR Bronson Commercial |
$1,055.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,139.04
|
|
|
HC LIVER BIOPSY
|
Facility
|
OP
|
$1,478.99
|
|
| Hospital Charge Code |
36000073
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$547.23 |
| Max. Negotiated Rate |
$1,331.09 |
| Rate for Payer: Aetna American Axle |
$961.34
|
| Rate for Payer: Aetna Commercial |
$1,257.14
|
| Rate for Payer: Aetna Medicare |
$739.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$961.34
|
| Rate for Payer: BCBS Complete |
$591.60
|
| Rate for Payer: Cash Price |
$1,183.19
|
| Rate for Payer: Cofinity Commercial |
$1,035.29
|
| Rate for Payer: Cofinity Commercial |
$1,271.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,035.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,183.19
|
| Rate for Payer: Healthscope Commercial |
$1,331.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,035.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,109.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,257.14
|
| Rate for Payer: PHP Commercial |
$1,257.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$961.34
|
| Rate for Payer: Priority Health SBD |
$931.76
|
| Rate for Payer: UMR Bronson Commercial |
$547.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,109.24
|
|
|
HC LIVER BIOPSY
|
Facility
|
IP
|
$1,478.99
|
|
| Hospital Charge Code |
36000073
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$650.76 |
| Max. Negotiated Rate |
$1,331.09 |
| Rate for Payer: Aetna American Axle |
$961.34
|
| Rate for Payer: Aetna Commercial |
$1,257.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$961.34
|
| Rate for Payer: Cash Price |
$1,183.19
|
| Rate for Payer: Cofinity Commercial |
$1,035.29
|
| Rate for Payer: Cofinity Commercial |
$1,271.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,035.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,183.19
|
| Rate for Payer: Healthscope Commercial |
$1,331.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,035.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,109.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,257.14
|
| Rate for Payer: PHP Commercial |
$1,257.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$961.34
|
| Rate for Payer: Priority Health SBD |
$931.76
|
| Rate for Payer: UMR Bronson Commercial |
$650.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,109.24
|
|
|
HC LIVER KIDNEY MICROSOME ANTIBODY
|
Facility
|
OP
|
$56.60
|
|
|
Service Code
|
CPT 86376
|
| Hospital Charge Code |
30200208
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$50.94 |
| Rate for Payer: Aetna American Axle |
$36.79
|
| Rate for Payer: Aetna Commercial |
$48.11
|
| Rate for Payer: Aetna Medicare |
$15.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.19
|
| Rate for Payer: BCBS Complete |
$8.19
|
| Rate for Payer: BCBS MAPPO |
$14.55
|
| Rate for Payer: BCBS Trust/PPO |
$14.01
|
| Rate for Payer: BCN Commercial |
$14.01
|
| Rate for Payer: BCN Medicare Advantage |
$14.55
|
| Rate for Payer: Cash Price |
$45.28
|
| Rate for Payer: Cash Price |
$45.28
|
| Rate for Payer: Cofinity Commercial |
$48.68
|
| Rate for Payer: Cofinity Commercial |
$39.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$39.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.55
|
| Rate for Payer: Healthscope Commercial |
$50.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.45
|
| Rate for Payer: Mclaren Medicaid |
$7.80
|
| Rate for Payer: Mclaren Medicare |
$14.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.28
|
| Rate for Payer: Meridian Medicaid |
$8.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.11
|
| Rate for Payer: Nomi Health Commercial |
$21.82
|
| Rate for Payer: PACE Medicare |
$13.82
|
| Rate for Payer: PACE SWMI |
$14.55
|
| Rate for Payer: PHP Commercial |
$48.11
|
| Rate for Payer: PHP Medicare Advantage |
$14.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.97
|
| Rate for Payer: Priority Health Medicare |
$14.55
|
| Rate for Payer: Priority Health Narrow Network |
$11.98
|
| Rate for Payer: Priority Health SBD |
$35.66
|
| Rate for Payer: Railroad Medicare Medicare |
$14.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.55
|
| Rate for Payer: UHC Exchange |
$14.55
|
| Rate for Payer: UHC Medicare Advantage |
$14.55
|
| Rate for Payer: UHCCP Medicaid |
$7.80
|
| Rate for Payer: UMR Bronson Commercial |
$20.94
|
| Rate for Payer: VA VA |
$14.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.45
|
|
|
HC LIVER KIDNEY MICROSOME ANTIBODY
|
Facility
|
IP
|
$56.60
|
|
|
Service Code
|
CPT 86376
|
| Hospital Charge Code |
30200208
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$24.90 |
| Max. Negotiated Rate |
$50.94 |
| Rate for Payer: Aetna American Axle |
$36.79
|
| Rate for Payer: Aetna Commercial |
$48.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.79
|
| Rate for Payer: Cash Price |
$45.28
|
| Rate for Payer: Cofinity Commercial |
$39.62
|
| Rate for Payer: Cofinity Commercial |
$48.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$39.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.28
|
| Rate for Payer: Healthscope Commercial |
$50.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.11
|
| Rate for Payer: PHP Commercial |
$48.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.79
|
| Rate for Payer: Priority Health SBD |
$35.66
|
| Rate for Payer: UMR Bronson Commercial |
$24.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.45
|
|
|
HC LOBSTER IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200045
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna American Axle |
$16.50
|
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$5.04
|
| Rate for Payer: BCN Commercial |
$5.04
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.04
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| 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 |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$7.83
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.37
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$4.30
|
| Rate for Payer: Priority Health SBD |
$16.00
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$5.22
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.80
|
| Rate for Payer: UMR Bronson Commercial |
$9.39
|
| Rate for Payer: VA VA |
$5.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.04
|
|
|
HC LOBSTER IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200045
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.17 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna American Axle |
$16.50
|
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health SBD |
$16.00
|
| Rate for Payer: UMR Bronson Commercial |
$11.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.04
|
|
|
HC LOCAL ANES ADDL 15 MIN
|
Facility
|
OP
|
$96.37
|
|
| Hospital Charge Code |
37000009
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$35.66 |
| Max. Negotiated Rate |
$86.73 |
| Rate for Payer: Aetna American Axle |
$62.64
|
| Rate for Payer: Aetna Commercial |
$81.91
|
| Rate for Payer: Aetna Medicare |
$48.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.64
|
| Rate for Payer: BCBS Complete |
$38.55
|
| Rate for Payer: Cash Price |
$77.10
|
| Rate for Payer: Cofinity Commercial |
$67.46
|
| Rate for Payer: Cofinity Commercial |
$82.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$67.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.10
|
| Rate for Payer: Healthscope Commercial |
$86.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$67.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.91
|
| Rate for Payer: PHP Commercial |
$81.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.64
|
| Rate for Payer: Priority Health SBD |
$60.71
|
| Rate for Payer: UMR Bronson Commercial |
$35.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.28
|
|
|
HC LOCAL ANES ADDL 15 MIN
|
Facility
|
IP
|
$96.37
|
|
| Hospital Charge Code |
37000009
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$42.40 |
| Max. Negotiated Rate |
$86.73 |
| Rate for Payer: Aetna American Axle |
$62.64
|
| Rate for Payer: Aetna Commercial |
$81.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.64
|
| Rate for Payer: Cash Price |
$77.10
|
| Rate for Payer: Cofinity Commercial |
$67.46
|
| Rate for Payer: Cofinity Commercial |
$82.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$67.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.10
|
| Rate for Payer: Healthscope Commercial |
$86.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$67.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.91
|
| Rate for Payer: PHP Commercial |
$81.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.64
|
| Rate for Payer: Priority Health SBD |
$60.71
|
| Rate for Payer: UMR Bronson Commercial |
$42.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.28
|
|
|
HC LOCAL ANES INIT 30 MIN
|
Facility
|
OP
|
$349.64
|
|
| Hospital Charge Code |
37000010
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$129.37 |
| Max. Negotiated Rate |
$314.68 |
| Rate for Payer: Aetna American Axle |
$227.27
|
| Rate for Payer: Aetna Commercial |
$297.19
|
| Rate for Payer: Aetna Medicare |
$174.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$227.27
|
| Rate for Payer: BCBS Complete |
$139.86
|
| Rate for Payer: Cash Price |
$279.71
|
| Rate for Payer: Cofinity Commercial |
$244.75
|
| Rate for Payer: Cofinity Commercial |
$300.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$244.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$279.71
|
| Rate for Payer: Healthscope Commercial |
$314.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$244.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$262.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$297.19
|
| Rate for Payer: PHP Commercial |
$297.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$227.27
|
| Rate for Payer: Priority Health SBD |
$220.27
|
| Rate for Payer: UMR Bronson Commercial |
$129.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$262.23
|
|
|
HC LOCAL ANES INIT 30 MIN
|
Facility
|
IP
|
$349.64
|
|
| Hospital Charge Code |
37000010
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$153.84 |
| Max. Negotiated Rate |
$314.68 |
| Rate for Payer: Aetna American Axle |
$227.27
|
| Rate for Payer: Aetna Commercial |
$297.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$227.27
|
| Rate for Payer: Cash Price |
$279.71
|
| Rate for Payer: Cofinity Commercial |
$244.75
|
| Rate for Payer: Cofinity Commercial |
$300.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$244.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$279.71
|
| Rate for Payer: Healthscope Commercial |
$314.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$244.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$262.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$297.19
|
| Rate for Payer: PHP Commercial |
$297.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$227.27
|
| Rate for Payer: Priority Health SBD |
$220.27
|
| Rate for Payer: UMR Bronson Commercial |
$153.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$262.23
|
|
|
HC LOCALIZATION CLIP
|
Facility
|
OP
|
$206.83
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
27800040
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$76.53 |
| Max. Negotiated Rate |
$186.15 |
| Rate for Payer: Aetna American Axle |
$134.44
|
| Rate for Payer: Aetna Commercial |
$175.81
|
| Rate for Payer: Aetna Medicare |
$103.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.44
|
| Rate for Payer: BCBS Complete |
$82.73
|
| Rate for Payer: Cash Price |
$165.46
|
| Rate for Payer: Cofinity Commercial |
$144.78
|
| Rate for Payer: Cofinity Commercial |
$177.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$144.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.46
|
| Rate for Payer: Healthscope Commercial |
$186.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$144.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$155.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.81
|
| Rate for Payer: PHP Commercial |
$175.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.44
|
| Rate for Payer: Priority Health SBD |
$130.30
|
| Rate for Payer: UMR Bronson Commercial |
$76.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$155.12
|
|
|
HC LOCALIZATION CLIP
|
Facility
|
IP
|
$206.83
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
27800040
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$91.01 |
| Max. Negotiated Rate |
$186.15 |
| Rate for Payer: Aetna American Axle |
$134.44
|
| Rate for Payer: Aetna Commercial |
$175.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.44
|
| Rate for Payer: Cash Price |
$165.46
|
| Rate for Payer: Cofinity Commercial |
$144.78
|
| Rate for Payer: Cofinity Commercial |
$177.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$144.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.46
|
| Rate for Payer: Healthscope Commercial |
$186.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$144.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$155.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.81
|
| Rate for Payer: PHP Commercial |
$175.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.44
|
| Rate for Payer: Priority Health SBD |
$130.30
|
| Rate for Payer: UMR Bronson Commercial |
$91.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$155.12
|
|
|
HC LOCALIZATION DEVICE LEVEL 1
|
Facility
|
OP
|
$146.88
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
27800350
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$54.35 |
| Max. Negotiated Rate |
$132.19 |
| Rate for Payer: Aetna American Axle |
$95.47
|
| Rate for Payer: Aetna Commercial |
$124.85
|
| Rate for Payer: Aetna Medicare |
$73.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.47
|
| Rate for Payer: BCBS Complete |
$58.75
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cofinity Commercial |
$102.82
|
| Rate for Payer: Cofinity Commercial |
$126.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$102.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.50
|
| Rate for Payer: Healthscope Commercial |
$132.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$102.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$124.85
|
| Rate for Payer: PHP Commercial |
$124.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.47
|
| Rate for Payer: Priority Health SBD |
$92.53
|
| Rate for Payer: UMR Bronson Commercial |
$54.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.16
|
|
|
HC LOCALIZATION DEVICE LEVEL 1
|
Facility
|
IP
|
$146.88
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
27800350
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$64.63 |
| Max. Negotiated Rate |
$132.19 |
| Rate for Payer: Aetna American Axle |
$95.47
|
| Rate for Payer: Aetna Commercial |
$124.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.47
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cofinity Commercial |
$102.82
|
| Rate for Payer: Cofinity Commercial |
$126.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$102.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.50
|
| Rate for Payer: Healthscope Commercial |
$132.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$102.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$124.85
|
| Rate for Payer: PHP Commercial |
$124.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.47
|
| Rate for Payer: Priority Health SBD |
$92.53
|
| Rate for Payer: UMR Bronson Commercial |
$64.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.16
|
|
|
HC LOC INFIL W/CS 15 MIN
|
Facility
|
IP
|
$144.37
|
|
| Hospital Charge Code |
37000007
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$63.52 |
| Max. Negotiated Rate |
$129.93 |
| Rate for Payer: Aetna American Axle |
$93.84
|
| Rate for Payer: Aetna Commercial |
$122.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.84
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cofinity Commercial |
$101.06
|
| Rate for Payer: Cofinity Commercial |
$124.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$101.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.50
|
| Rate for Payer: Healthscope Commercial |
$129.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$101.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$122.71
|
| Rate for Payer: PHP Commercial |
$122.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.84
|
| Rate for Payer: Priority Health SBD |
$90.95
|
| Rate for Payer: UMR Bronson Commercial |
$63.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.28
|
|
|
HC LOC INFIL W/CS 15 MIN
|
Facility
|
OP
|
$144.37
|
|
| Hospital Charge Code |
37000007
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$53.42 |
| Max. Negotiated Rate |
$129.93 |
| Rate for Payer: Aetna American Axle |
$93.84
|
| Rate for Payer: Aetna Commercial |
$122.71
|
| Rate for Payer: Aetna Medicare |
$72.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.84
|
| Rate for Payer: BCBS Complete |
$57.75
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cofinity Commercial |
$101.06
|
| Rate for Payer: Cofinity Commercial |
$124.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$101.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.50
|
| Rate for Payer: Healthscope Commercial |
$129.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$101.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$122.71
|
| Rate for Payer: PHP Commercial |
$122.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.84
|
| Rate for Payer: Priority Health SBD |
$90.95
|
| Rate for Payer: UMR Bronson Commercial |
$53.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.28
|
|
|
HC LOC INFIL W/CS 30 MIN
|
Facility
|
IP
|
$721.58
|
|
| Hospital Charge Code |
37000008
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$317.50 |
| Max. Negotiated Rate |
$649.42 |
| Rate for Payer: Aetna American Axle |
$469.03
|
| Rate for Payer: Aetna Commercial |
$613.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$469.03
|
| Rate for Payer: Cash Price |
$577.26
|
| Rate for Payer: Cofinity Commercial |
$505.11
|
| Rate for Payer: Cofinity Commercial |
$620.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$505.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$577.26
|
| Rate for Payer: Healthscope Commercial |
$649.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$505.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$541.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$613.34
|
| Rate for Payer: PHP Commercial |
$613.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$469.03
|
| Rate for Payer: Priority Health SBD |
$454.60
|
| Rate for Payer: UMR Bronson Commercial |
$317.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$541.18
|
|
|
HC LOC INFIL W/CS 30 MIN
|
Facility
|
OP
|
$721.58
|
|
| Hospital Charge Code |
37000008
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$266.98 |
| Max. Negotiated Rate |
$649.42 |
| Rate for Payer: Aetna American Axle |
$469.03
|
| Rate for Payer: Aetna Commercial |
$613.34
|
| Rate for Payer: Aetna Medicare |
$360.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$469.03
|
| Rate for Payer: BCBS Complete |
$288.63
|
| Rate for Payer: Cash Price |
$577.26
|
| Rate for Payer: Cofinity Commercial |
$505.11
|
| Rate for Payer: Cofinity Commercial |
$620.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$505.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$577.26
|
| Rate for Payer: Healthscope Commercial |
$649.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$505.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$541.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$613.34
|
| Rate for Payer: PHP Commercial |
$613.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$469.03
|
| Rate for Payer: Priority Health SBD |
$454.60
|
| Rate for Payer: UMR Bronson Commercial |
$266.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$541.18
|
|
|
HC LOCM 100-199 MG/ML IODINE/ML1
|
Facility
|
OP
|
$3.75
|
|
|
Service Code
|
HCPCS Q9965
|
| Hospital Charge Code |
25500002
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$1.39 |
| Max. Negotiated Rate |
$3.38 |
| Rate for Payer: BCBS Trust/PPO |
$2.47
|
| Rate for Payer: BCN Commercial |
$2.47
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cofinity Commercial |
$2.62
|
| Rate for Payer: Cofinity Commercial |
$3.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.62
|
| Rate for Payer: Aetna American Axle |
$2.44
|
| Rate for Payer: Aetna Commercial |
$3.19
|
| Rate for Payer: Aetna Medicare |
$1.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.44
|
| Rate for Payer: BCBS Complete |
$1.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.00
|
| Rate for Payer: Healthscope Commercial |
$3.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.19
|
| Rate for Payer: PHP Commercial |
$3.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.44
|
| Rate for Payer: Priority Health SBD |
$2.36
|
| Rate for Payer: UMR Bronson Commercial |
$1.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.81
|
|
