|
HC NIFOMETER
|
Facility
|
OP
|
$85.81
|
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$31.75 |
| Max. Negotiated Rate |
$77.23 |
| Rate for Payer: Aetna American Axle |
$55.78
|
| Rate for Payer: Aetna Commercial |
$72.94
|
| Rate for Payer: Aetna Medicare |
$42.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.78
|
| Rate for Payer: BCBS Complete |
$34.32
|
| Rate for Payer: Cash Price |
$68.65
|
| Rate for Payer: Cofinity Advantage |
$60.07
|
| Rate for Payer: Cofinity Commercial |
$73.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.65
|
| Rate for Payer: Healthscope Commercial |
$77.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$60.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$68.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.36
|
| Rate for Payer: PHP Commercial |
$72.94
|
| Rate for Payer: Priority Health SBD |
$54.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.78
|
| Rate for Payer: UHC Core |
$44.71
|
| Rate for Payer: UHC Exchange |
$33.72
|
| Rate for Payer: UMR Bronson Commercial |
$31.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.36
|
|
|
HC NITRIC OXIDE EXPIRED GAS DETERMINATION
|
Facility
|
IP
|
$51.12
|
|
|
Service Code
|
CPT 95012
|
| Hospital Charge Code |
46000031
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$22.49 |
| Max. Negotiated Rate |
$46.01 |
| Rate for Payer: Aetna American Axle |
$33.23
|
| Rate for Payer: Aetna Commercial |
$43.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.23
|
| Rate for Payer: Cash Price |
$40.90
|
| Rate for Payer: Cofinity Advantage |
$35.78
|
| Rate for Payer: Cofinity Commercial |
$43.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.90
|
| Rate for Payer: Healthscope Commercial |
$46.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.34
|
| Rate for Payer: PHP Commercial |
$43.45
|
| Rate for Payer: Priority Health SBD |
$32.21
|
| Rate for Payer: UMR Bronson Commercial |
$22.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.34
|
|
|
HC NITRIC OXIDE EXPIRED GAS DETERMINATION
|
Facility
|
OP
|
$51.12
|
|
|
Service Code
|
CPT 95012
|
| Hospital Charge Code |
46000031
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$18.91 |
| Max. Negotiated Rate |
$120.34 |
| Rate for Payer: Aetna American Axle |
$33.23
|
| Rate for Payer: Aetna Commercial |
$43.45
|
| Rate for Payer: Aetna Medicare |
$38.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$46.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$46.52
|
| Rate for Payer: BCBS Complete |
$20.44
|
| Rate for Payer: BCBS MAPPO |
$37.22
|
| Rate for Payer: BCBS Trust/PPO |
$34.48
|
| Rate for Payer: BCN Commercial |
$34.48
|
| Rate for Payer: BCN Medicare Advantage |
$37.22
|
| Rate for Payer: Cash Price |
$40.90
|
| Rate for Payer: Cash Price |
$40.90
|
| Rate for Payer: Cofinity Advantage |
$35.78
|
| Rate for Payer: Cofinity Commercial |
$43.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.22
|
| Rate for Payer: Healthscope Commercial |
$46.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.34
|
| Rate for Payer: Mclaren Medicaid |
$37.22
|
| Rate for Payer: Mclaren Medicare |
$37.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.08
|
| Rate for Payer: Meridian Medicaid |
$39.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$40.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.45
|
| Rate for Payer: Nomi Health Commercial |
$111.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.34
|
| Rate for Payer: PACE Medicare |
$35.36
|
| Rate for Payer: PACE SWMI |
$37.22
|
| Rate for Payer: PHP Commercial |
$43.45
|
| Rate for Payer: PHP Medicare Advantage |
$37.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$120.34
|
| Rate for Payer: Priority Health Medicare |
$37.22
|
| Rate for Payer: Priority Health SBD |
$32.21
|
| Rate for Payer: Priority Health Tiered Network |
$96.27
|
| Rate for Payer: Railroad Medicare Medicare |
$37.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.23
|
| Rate for Payer: UHC Core |
$26.63
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$37.22
|
| Rate for Payer: UHC Exchange |
$20.09
|
| Rate for Payer: UHC Medicaid |
$19.47
|
| Rate for Payer: UHCCP Medicaid |
$19.47
|
| Rate for Payer: UMR Bronson Commercial |
$18.91
|
| Rate for Payer: VA VA |
$37.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.34
|
|
|
HC NJX NONCMPND SCLEROSANT MULTIPLE INCMPTNT VEINS
|
Facility
|
IP
|
$4,993.92
|
|
|
Service Code
|
CPT 36466
|
| Hospital Charge Code |
76100402
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,197.32 |
| Max. Negotiated Rate |
$4,494.53 |
| Rate for Payer: Aetna American Axle |
$3,246.05
|
| Rate for Payer: Aetna Commercial |
$4,244.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,246.05
|
| Rate for Payer: Cash Price |
$3,995.14
|
| Rate for Payer: Cofinity Advantage |
$3,495.74
|
| Rate for Payer: Cofinity Commercial |
$4,294.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,995.14
|
| Rate for Payer: Healthscope Commercial |
$4,494.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,495.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,745.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,244.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,745.44
|
| Rate for Payer: PHP Commercial |
$4,244.83
|
| Rate for Payer: Priority Health SBD |
$3,146.17
|
| Rate for Payer: UMR Bronson Commercial |
$2,197.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,745.44
|
|
|
HC NJX NONCMPND SCLEROSANT MULTIPLE INCMPTNT VEINS
|
Facility
|
OP
|
$4,993.92
|
|
|
Service Code
|
CPT 36466
|
| Hospital Charge Code |
76100402
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,075.21 |
| Max. Negotiated Rate |
$6,648.46 |
| Rate for Payer: Aetna American Axle |
$3,246.05
|
| Rate for Payer: Aetna Commercial |
$4,244.83
|
| Rate for Payer: Aetna Medicare |
$2,138.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,246.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,569.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,569.82
|
| Rate for Payer: BCBS Complete |
$1,129.08
|
| Rate for Payer: BCBS MAPPO |
$2,055.86
|
| Rate for Payer: BCBS Trust/PPO |
$1,792.56
|
| Rate for Payer: BCN Commercial |
$1,792.56
|
| Rate for Payer: BCN Medicare Advantage |
$2,055.86
|
| Rate for Payer: Cash Price |
$3,995.14
|
| Rate for Payer: Cash Price |
$3,995.14
|
| Rate for Payer: Cash Price |
$3,995.14
|
| Rate for Payer: Cofinity Advantage |
$3,495.74
|
| Rate for Payer: Cofinity Commercial |
$4,294.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,995.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,055.86
|
| Rate for Payer: Healthscope Commercial |
$4,494.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,495.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,745.44
|
| Rate for Payer: Mclaren Medicaid |
$2,055.86
|
| Rate for Payer: Mclaren Medicare |
$2,055.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,158.65
|
| Rate for Payer: Meridian Medicaid |
$2,158.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,364.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,261.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,244.83
|
| Rate for Payer: Nomi Health Commercial |
$6,167.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,745.44
|
| Rate for Payer: PACE Medicare |
$1,953.07
|
| Rate for Payer: PACE SWMI |
$2,055.86
|
| Rate for Payer: PHP Commercial |
$4,244.83
|
| Rate for Payer: PHP Medicare Advantage |
$2,055.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,075.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,648.46
|
| Rate for Payer: Priority Health Medicare |
$2,055.86
|
| Rate for Payer: Priority Health SBD |
$3,146.17
|
| Rate for Payer: Priority Health Tiered Network |
$5,318.77
|
| Rate for Payer: Railroad Medicare Medicare |
$2,055.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,246.05
|
| Rate for Payer: UHC Core |
$2,601.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,055.86
|
| Rate for Payer: UHC Exchange |
$1,962.61
|
| Rate for Payer: UHC Medicaid |
$1,075.21
|
| Rate for Payer: UHCCP Medicaid |
$1,075.21
|
| Rate for Payer: UMR Bronson Commercial |
$1,847.75
|
| Rate for Payer: VA VA |
$2,055.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,745.44
|
|
|
HC NM BONE MARROW LIMITED AREA
|
Facility
|
IP
|
$919.70
|
|
|
Service Code
|
CPT 78102
|
| Hospital Charge Code |
34100009
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$404.67 |
| Max. Negotiated Rate |
$827.73 |
| Rate for Payer: Aetna American Axle |
$597.80
|
| Rate for Payer: Aetna Commercial |
$781.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$597.80
|
| Rate for Payer: Cash Price |
$735.76
|
| Rate for Payer: Cofinity Advantage |
$643.79
|
| Rate for Payer: Cofinity Commercial |
$790.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$735.76
|
| Rate for Payer: Healthscope Commercial |
$827.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$643.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$689.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$781.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$689.77
|
| Rate for Payer: PHP Commercial |
$781.75
|
| Rate for Payer: Priority Health SBD |
$579.41
|
| Rate for Payer: UMR Bronson Commercial |
$404.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$689.77
|
|
|
HC NM BONE MARROW LIMITED AREA
|
Facility
|
OP
|
$919.70
|
|
|
Service Code
|
CPT 78102
|
| Hospital Charge Code |
34100009
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$208.33 |
| Max. Negotiated Rate |
$1,288.18 |
| Rate for Payer: Aetna American Axle |
$597.80
|
| Rate for Payer: Aetna Commercial |
$781.75
|
| Rate for Payer: Aetna Medicare |
$414.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$597.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$497.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$497.91
|
| Rate for Payer: BCBS Complete |
$218.76
|
| Rate for Payer: BCBS MAPPO |
$398.33
|
| Rate for Payer: BCBS Trust/PPO |
$330.82
|
| Rate for Payer: BCN Commercial |
$330.82
|
| Rate for Payer: BCN Medicare Advantage |
$398.33
|
| Rate for Payer: Cash Price |
$735.76
|
| Rate for Payer: Cash Price |
$735.76
|
| Rate for Payer: Cofinity Advantage |
$643.79
|
| Rate for Payer: Cofinity Commercial |
$790.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$735.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$398.33
|
| Rate for Payer: Healthscope Commercial |
$827.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$643.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$689.77
|
| Rate for Payer: Mclaren Medicaid |
$398.33
|
| Rate for Payer: Mclaren Medicare |
$398.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$418.25
|
| Rate for Payer: Meridian Medicaid |
$418.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$458.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$438.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$781.75
|
| Rate for Payer: Nomi Health Commercial |
$1,194.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$689.77
|
| Rate for Payer: PACE Medicare |
$378.41
|
| Rate for Payer: PACE SWMI |
$398.33
|
| Rate for Payer: PHP Commercial |
$781.75
|
| Rate for Payer: PHP Medicare Advantage |
$398.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,288.18
|
| Rate for Payer: Priority Health Medicare |
$398.33
|
| Rate for Payer: Priority Health SBD |
$579.41
|
| Rate for Payer: Priority Health Tiered Network |
$1,030.54
|
| Rate for Payer: Railroad Medicare Medicare |
$398.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$597.80
|
| Rate for Payer: UHC Core |
$479.16
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$398.33
|
| Rate for Payer: UHC Exchange |
$361.44
|
| Rate for Payer: UHC Medicaid |
$208.33
|
| Rate for Payer: UHCCP Medicaid |
$208.33
|
| Rate for Payer: UMR Bronson Commercial |
$340.29
|
| Rate for Payer: VA VA |
$398.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$689.77
|
|
|
HC NM BONE MARROW MULTIPLE AREA
|
Facility
|
IP
|
$1,172.40
|
|
|
Service Code
|
CPT 78103
|
| Hospital Charge Code |
34100010
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$515.86 |
| Max. Negotiated Rate |
$1,055.16 |
| Rate for Payer: Aetna American Axle |
$762.06
|
| Rate for Payer: Aetna Commercial |
$996.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$762.06
|
| Rate for Payer: Cash Price |
$937.92
|
| Rate for Payer: Cofinity Advantage |
$820.68
|
| Rate for Payer: Cofinity Commercial |
$1,008.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$937.92
|
| Rate for Payer: Healthscope Commercial |
$1,055.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$820.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$879.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$996.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$879.30
|
| Rate for Payer: PHP Commercial |
$996.54
|
| Rate for Payer: Priority Health SBD |
$738.61
|
| Rate for Payer: UMR Bronson Commercial |
$515.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$879.30
|
|
|
HC NM BONE MARROW MULTIPLE AREA
|
Facility
|
OP
|
$1,172.40
|
|
|
Service Code
|
CPT 78103
|
| Hospital Charge Code |
34100010
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$208.33 |
| Max. Negotiated Rate |
$1,288.18 |
| Rate for Payer: Aetna American Axle |
$762.06
|
| Rate for Payer: Aetna Commercial |
$996.54
|
| Rate for Payer: Aetna Medicare |
$414.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$762.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$497.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$497.91
|
| Rate for Payer: BCBS Complete |
$218.76
|
| Rate for Payer: BCBS MAPPO |
$398.33
|
| Rate for Payer: BCBS Trust/PPO |
$343.14
|
| Rate for Payer: BCN Commercial |
$343.14
|
| Rate for Payer: BCN Medicare Advantage |
$398.33
|
| Rate for Payer: Cash Price |
$937.92
|
| Rate for Payer: Cash Price |
$937.92
|
| Rate for Payer: Cofinity Advantage |
$820.68
|
| Rate for Payer: Cofinity Commercial |
$1,008.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$937.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$398.33
|
| Rate for Payer: Healthscope Commercial |
$1,055.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$820.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$879.30
|
| Rate for Payer: Mclaren Medicaid |
$398.33
|
| Rate for Payer: Mclaren Medicare |
$398.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$418.25
|
| Rate for Payer: Meridian Medicaid |
$418.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$458.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$438.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$996.54
|
| Rate for Payer: Nomi Health Commercial |
$1,194.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$879.30
|
| Rate for Payer: PACE Medicare |
$378.41
|
| Rate for Payer: PACE SWMI |
$398.33
|
| Rate for Payer: PHP Commercial |
$996.54
|
| Rate for Payer: PHP Medicare Advantage |
$398.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,288.18
|
| Rate for Payer: Priority Health Medicare |
$398.33
|
| Rate for Payer: Priority Health SBD |
$738.61
|
| Rate for Payer: Priority Health Tiered Network |
$1,030.54
|
| Rate for Payer: Railroad Medicare Medicare |
$398.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$762.06
|
| Rate for Payer: UHC Core |
$610.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$398.33
|
| Rate for Payer: UHC Exchange |
$460.75
|
| Rate for Payer: UHC Medicaid |
$208.33
|
| Rate for Payer: UHCCP Medicaid |
$208.33
|
| Rate for Payer: UMR Bronson Commercial |
$433.79
|
| Rate for Payer: VA VA |
$398.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$879.30
|
|
|
HC NM BONE MARROW WHOLE BODY
|
Facility
|
OP
|
$1,087.65
|
|
|
Service Code
|
CPT 78104
|
| Hospital Charge Code |
34100011
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$208.33 |
| Max. Negotiated Rate |
$1,288.18 |
| Rate for Payer: Aetna American Axle |
$706.97
|
| Rate for Payer: Aetna Commercial |
$924.50
|
| Rate for Payer: Aetna Medicare |
$414.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$706.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$497.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$497.91
|
| Rate for Payer: BCBS Complete |
$218.76
|
| Rate for Payer: BCBS MAPPO |
$398.33
|
| Rate for Payer: BCBS Trust/PPO |
$464.62
|
| Rate for Payer: BCN Commercial |
$464.62
|
| Rate for Payer: BCN Medicare Advantage |
$398.33
|
| Rate for Payer: Cash Price |
$870.12
|
| Rate for Payer: Cash Price |
$870.12
|
| Rate for Payer: Cofinity Advantage |
$761.36
|
| Rate for Payer: Cofinity Commercial |
$935.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$870.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$398.33
|
| Rate for Payer: Healthscope Commercial |
$978.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$761.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$815.74
|
| Rate for Payer: Mclaren Medicaid |
$398.33
|
| Rate for Payer: Mclaren Medicare |
$398.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$418.25
|
| Rate for Payer: Meridian Medicaid |
$418.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$458.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$438.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$924.50
|
| Rate for Payer: Nomi Health Commercial |
$1,194.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$815.74
|
| Rate for Payer: PACE Medicare |
$378.41
|
| Rate for Payer: PACE SWMI |
$398.33
|
| Rate for Payer: PHP Commercial |
$924.50
|
| Rate for Payer: PHP Medicare Advantage |
$398.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,288.18
|
| Rate for Payer: Priority Health Medicare |
$398.33
|
| Rate for Payer: Priority Health SBD |
$685.22
|
| Rate for Payer: Priority Health Tiered Network |
$1,030.54
|
| Rate for Payer: Railroad Medicare Medicare |
$398.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$706.97
|
| Rate for Payer: UHC Core |
$566.67
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$398.33
|
| Rate for Payer: UHC Exchange |
$427.45
|
| Rate for Payer: UHC Medicaid |
$208.33
|
| Rate for Payer: UHCCP Medicaid |
$208.33
|
| Rate for Payer: UMR Bronson Commercial |
$402.43
|
| Rate for Payer: VA VA |
$398.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$815.74
|
|
|
HC NM BONE MARROW WHOLE BODY
|
Facility
|
IP
|
$1,087.65
|
|
|
Service Code
|
CPT 78104
|
| Hospital Charge Code |
34100011
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$478.57 |
| Max. Negotiated Rate |
$978.88 |
| Rate for Payer: Aetna American Axle |
$706.97
|
| Rate for Payer: Aetna Commercial |
$924.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$706.97
|
| Rate for Payer: Cash Price |
$870.12
|
| Rate for Payer: Cofinity Advantage |
$761.36
|
| Rate for Payer: Cofinity Commercial |
$935.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$870.12
|
| Rate for Payer: Healthscope Commercial |
$978.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$761.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$815.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$924.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$815.74
|
| Rate for Payer: PHP Commercial |
$924.50
|
| Rate for Payer: Priority Health SBD |
$685.22
|
| Rate for Payer: UMR Bronson Commercial |
$478.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$815.74
|
|
|
HC NM BONE MULTIPLE AREAS
|
Facility
|
IP
|
$1,322.01
|
|
|
Service Code
|
CPT 78305
|
| Hospital Charge Code |
34100024
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$581.68 |
| Max. Negotiated Rate |
$1,189.81 |
| Rate for Payer: Aetna American Axle |
$859.31
|
| Rate for Payer: Aetna Commercial |
$1,123.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$859.31
|
| Rate for Payer: Cash Price |
$1,057.61
|
| Rate for Payer: Cofinity Advantage |
$925.41
|
| Rate for Payer: Cofinity Commercial |
$1,136.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,057.61
|
| Rate for Payer: Healthscope Commercial |
$1,189.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$925.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$991.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,123.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$991.51
|
| Rate for Payer: PHP Commercial |
$1,123.71
|
| Rate for Payer: Priority Health SBD |
$832.87
|
| Rate for Payer: UMR Bronson Commercial |
$581.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$991.51
|
|
|
HC NM BONE MULTIPLE AREAS
|
Facility
|
OP
|
$1,322.01
|
|
|
Service Code
|
CPT 78305
|
| Hospital Charge Code |
34100024
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$208.33 |
| Max. Negotiated Rate |
$1,288.18 |
| Rate for Payer: Aetna American Axle |
$859.31
|
| Rate for Payer: Aetna Commercial |
$1,123.71
|
| Rate for Payer: Aetna Medicare |
$414.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$859.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$497.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$497.91
|
| Rate for Payer: BCBS Complete |
$218.76
|
| Rate for Payer: BCBS MAPPO |
$398.33
|
| Rate for Payer: BCBS Trust/PPO |
$513.07
|
| Rate for Payer: BCN Commercial |
$513.07
|
| Rate for Payer: BCN Medicare Advantage |
$398.33
|
| Rate for Payer: Cash Price |
$1,057.61
|
| Rate for Payer: Cash Price |
$1,057.61
|
| Rate for Payer: Cofinity Advantage |
$925.41
|
| Rate for Payer: Cofinity Commercial |
$1,136.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,057.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$398.33
|
| Rate for Payer: Healthscope Commercial |
$1,189.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$925.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$991.51
|
| Rate for Payer: Mclaren Medicaid |
$398.33
|
| Rate for Payer: Mclaren Medicare |
$398.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$418.25
|
| Rate for Payer: Meridian Medicaid |
$418.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$458.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$438.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,123.71
|
| Rate for Payer: Nomi Health Commercial |
$1,194.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$991.51
|
| Rate for Payer: PACE Medicare |
$378.41
|
| Rate for Payer: PACE SWMI |
$398.33
|
| Rate for Payer: PHP Commercial |
$1,123.71
|
| Rate for Payer: PHP Medicare Advantage |
$398.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,288.18
|
| Rate for Payer: Priority Health Medicare |
$398.33
|
| Rate for Payer: Priority Health SBD |
$832.87
|
| Rate for Payer: Priority Health Tiered Network |
$1,030.54
|
| Rate for Payer: Railroad Medicare Medicare |
$398.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$859.31
|
| Rate for Payer: UHC Core |
$688.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$398.33
|
| Rate for Payer: UHC Exchange |
$519.55
|
| Rate for Payer: UHC Medicaid |
$208.33
|
| Rate for Payer: UHCCP Medicaid |
$208.33
|
| Rate for Payer: UMR Bronson Commercial |
$489.14
|
| Rate for Payer: VA VA |
$398.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$991.51
|
|
|
HC NM BONE SINGLE AREA
|
Facility
|
OP
|
$1,228.56
|
|
|
Service Code
|
CPT 78300
|
| Hospital Charge Code |
34100023
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$208.33 |
| Max. Negotiated Rate |
$1,288.18 |
| Rate for Payer: Aetna American Axle |
$798.56
|
| Rate for Payer: Aetna Commercial |
$1,044.28
|
| Rate for Payer: Aetna Medicare |
$414.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$798.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$497.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$497.91
|
| Rate for Payer: BCBS Complete |
$218.76
|
| Rate for Payer: BCBS MAPPO |
$398.33
|
| Rate for Payer: BCBS Trust/PPO |
$427.68
|
| Rate for Payer: BCN Commercial |
$427.68
|
| Rate for Payer: BCN Medicare Advantage |
$398.33
|
| Rate for Payer: Cash Price |
$982.85
|
| Rate for Payer: Cash Price |
$982.85
|
| Rate for Payer: Cofinity Advantage |
$859.99
|
| Rate for Payer: Cofinity Commercial |
$1,056.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$982.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$398.33
|
| Rate for Payer: Healthscope Commercial |
$1,105.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$859.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$921.42
|
| Rate for Payer: Mclaren Medicaid |
$398.33
|
| Rate for Payer: Mclaren Medicare |
$398.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$418.25
|
| Rate for Payer: Meridian Medicaid |
$418.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$458.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$438.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,044.28
|
| Rate for Payer: Nomi Health Commercial |
$1,194.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$921.42
|
| Rate for Payer: PACE Medicare |
$378.41
|
| Rate for Payer: PACE SWMI |
$398.33
|
| Rate for Payer: PHP Commercial |
$1,044.28
|
| Rate for Payer: PHP Medicare Advantage |
$398.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,288.18
|
| Rate for Payer: Priority Health Medicare |
$398.33
|
| Rate for Payer: Priority Health SBD |
$773.99
|
| Rate for Payer: Priority Health Tiered Network |
$1,030.54
|
| Rate for Payer: Railroad Medicare Medicare |
$398.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$798.56
|
| Rate for Payer: UHC Core |
$640.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$398.33
|
| Rate for Payer: UHC Exchange |
$482.82
|
| Rate for Payer: UHC Medicaid |
$208.33
|
| Rate for Payer: UHCCP Medicaid |
$208.33
|
| Rate for Payer: UMR Bronson Commercial |
$454.57
|
| Rate for Payer: VA VA |
$398.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$921.42
|
|
|
HC NM BONE SINGLE AREA
|
Facility
|
IP
|
$1,228.56
|
|
|
Service Code
|
CPT 78300
|
| Hospital Charge Code |
34100023
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$540.57 |
| Max. Negotiated Rate |
$1,105.70 |
| Rate for Payer: Aetna American Axle |
$798.56
|
| Rate for Payer: Aetna Commercial |
$1,044.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$798.56
|
| Rate for Payer: Cash Price |
$982.85
|
| Rate for Payer: Cofinity Advantage |
$859.99
|
| Rate for Payer: Cofinity Commercial |
$1,056.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$982.85
|
| Rate for Payer: Healthscope Commercial |
$1,105.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$859.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$921.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,044.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$921.42
|
| Rate for Payer: PHP Commercial |
$1,044.28
|
| Rate for Payer: Priority Health SBD |
$773.99
|
| Rate for Payer: UMR Bronson Commercial |
$540.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$921.42
|
|
|
HC NM BONE TOTAL BODY
|
Facility
|
IP
|
$1,801.27
|
|
|
Service Code
|
CPT 78306
|
| Hospital Charge Code |
34100025
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$792.56 |
| Max. Negotiated Rate |
$1,621.14 |
| Rate for Payer: Aetna American Axle |
$1,170.83
|
| Rate for Payer: Aetna Commercial |
$1,531.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,170.83
|
| Rate for Payer: Cash Price |
$1,441.02
|
| Rate for Payer: Cofinity Advantage |
$1,260.89
|
| Rate for Payer: Cofinity Commercial |
$1,549.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,441.02
|
| Rate for Payer: Healthscope Commercial |
$1,621.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,260.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,350.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,531.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,350.95
|
| Rate for Payer: PHP Commercial |
$1,531.08
|
| Rate for Payer: Priority Health SBD |
$1,134.80
|
| Rate for Payer: UMR Bronson Commercial |
$792.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,350.95
|
|
|
HC NM BONE TOTAL BODY
|
Facility
|
OP
|
$1,801.27
|
|
|
Service Code
|
CPT 78306
|
| Hospital Charge Code |
34100025
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$208.33 |
| Max. Negotiated Rate |
$1,621.14 |
| Rate for Payer: Aetna American Axle |
$1,170.83
|
| Rate for Payer: Aetna Commercial |
$1,531.08
|
| Rate for Payer: Aetna Medicare |
$414.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,170.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$497.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$497.91
|
| Rate for Payer: BCBS Complete |
$218.76
|
| Rate for Payer: BCBS MAPPO |
$398.33
|
| Rate for Payer: BCBS Trust/PPO |
$552.46
|
| Rate for Payer: BCN Commercial |
$552.46
|
| Rate for Payer: BCN Medicare Advantage |
$398.33
|
| Rate for Payer: Cash Price |
$1,441.02
|
| Rate for Payer: Cash Price |
$1,441.02
|
| Rate for Payer: Cofinity Advantage |
$1,260.89
|
| Rate for Payer: Cofinity Commercial |
$1,549.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,441.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$398.33
|
| Rate for Payer: Healthscope Commercial |
$1,621.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,260.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,350.95
|
| Rate for Payer: Mclaren Medicaid |
$398.33
|
| Rate for Payer: Mclaren Medicare |
$398.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$418.25
|
| Rate for Payer: Meridian Medicaid |
$418.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$458.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$438.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,531.08
|
| Rate for Payer: Nomi Health Commercial |
$1,194.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,350.95
|
| Rate for Payer: PACE Medicare |
$378.41
|
| Rate for Payer: PACE SWMI |
$398.33
|
| Rate for Payer: PHP Commercial |
$1,531.08
|
| Rate for Payer: PHP Medicare Advantage |
$398.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,288.18
|
| Rate for Payer: Priority Health Medicare |
$398.33
|
| Rate for Payer: Priority Health SBD |
$1,134.80
|
| Rate for Payer: Priority Health Tiered Network |
$1,030.54
|
| Rate for Payer: Railroad Medicare Medicare |
$398.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,170.83
|
| Rate for Payer: UHC Core |
$938.46
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$398.33
|
| Rate for Payer: UHC Exchange |
$707.90
|
| Rate for Payer: UHC Medicaid |
$208.33
|
| Rate for Payer: UHCCP Medicaid |
$208.33
|
| Rate for Payer: UMR Bronson Commercial |
$666.47
|
| Rate for Payer: VA VA |
$398.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,350.95
|
|
|
HC NM BONE W BLOOD FLOW 3 PHASE
|
Facility
|
OP
|
$1,769.94
|
|
|
Service Code
|
CPT 78315
|
| Hospital Charge Code |
34100026
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$208.33 |
| Max. Negotiated Rate |
$1,592.95 |
| Rate for Payer: Aetna American Axle |
$1,150.46
|
| Rate for Payer: Aetna Commercial |
$1,504.45
|
| Rate for Payer: Aetna Medicare |
$414.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,150.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$497.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$497.91
|
| Rate for Payer: BCBS Complete |
$218.76
|
| Rate for Payer: BCBS MAPPO |
$398.33
|
| Rate for Payer: BCBS Trust/PPO |
$647.69
|
| Rate for Payer: BCN Commercial |
$647.69
|
| Rate for Payer: BCN Medicare Advantage |
$398.33
|
| Rate for Payer: Cash Price |
$1,415.95
|
| Rate for Payer: Cash Price |
$1,415.95
|
| Rate for Payer: Cofinity Advantage |
$1,238.96
|
| Rate for Payer: Cofinity Commercial |
$1,522.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,415.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$398.33
|
| Rate for Payer: Healthscope Commercial |
$1,592.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,238.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,327.45
|
| Rate for Payer: Mclaren Medicaid |
$398.33
|
| Rate for Payer: Mclaren Medicare |
$398.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$418.25
|
| Rate for Payer: Meridian Medicaid |
$418.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$458.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$438.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,504.45
|
| Rate for Payer: Nomi Health Commercial |
$1,194.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,327.45
|
| Rate for Payer: PACE Medicare |
$378.41
|
| Rate for Payer: PACE SWMI |
$398.33
|
| Rate for Payer: PHP Commercial |
$1,504.45
|
| Rate for Payer: PHP Medicare Advantage |
$398.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,288.18
|
| Rate for Payer: Priority Health Medicare |
$398.33
|
| Rate for Payer: Priority Health SBD |
$1,115.06
|
| Rate for Payer: Priority Health Tiered Network |
$1,030.54
|
| Rate for Payer: Railroad Medicare Medicare |
$398.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,150.46
|
| Rate for Payer: UHC Core |
$922.14
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$398.33
|
| Rate for Payer: UHC Exchange |
$695.59
|
| Rate for Payer: UHC Medicaid |
$208.33
|
| Rate for Payer: UHCCP Medicaid |
$208.33
|
| Rate for Payer: UMR Bronson Commercial |
$654.88
|
| Rate for Payer: VA VA |
$398.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,327.45
|
|
|
HC NM BONE W BLOOD FLOW 3 PHASE
|
Facility
|
IP
|
$1,769.94
|
|
|
Service Code
|
CPT 78315
|
| Hospital Charge Code |
34100026
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$778.77 |
| Max. Negotiated Rate |
$1,592.95 |
| Rate for Payer: Aetna American Axle |
$1,150.46
|
| Rate for Payer: Aetna Commercial |
$1,504.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,150.46
|
| Rate for Payer: Cash Price |
$1,415.95
|
| Rate for Payer: Cofinity Advantage |
$1,238.96
|
| Rate for Payer: Cofinity Commercial |
$1,522.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,415.95
|
| Rate for Payer: Healthscope Commercial |
$1,592.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,238.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,327.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,504.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,327.45
|
| Rate for Payer: PHP Commercial |
$1,504.45
|
| Rate for Payer: Priority Health SBD |
$1,115.06
|
| Rate for Payer: UMR Bronson Commercial |
$778.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,327.45
|
|
|
HC NM BRAIN <4 STATC VIEW W VAS F
|
Facility
|
OP
|
$1,322.01
|
|
|
Service Code
|
CPT 78601
|
| Hospital Charge Code |
34100038
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$208.33 |
| Max. Negotiated Rate |
$1,288.18 |
| Rate for Payer: Aetna American Axle |
$859.31
|
| Rate for Payer: Aetna Commercial |
$1,123.71
|
| Rate for Payer: Aetna Medicare |
$414.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$859.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$497.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$497.91
|
| Rate for Payer: BCBS Complete |
$218.76
|
| Rate for Payer: BCBS MAPPO |
$398.33
|
| Rate for Payer: BCBS Trust/PPO |
$426.05
|
| Rate for Payer: BCN Commercial |
$426.05
|
| Rate for Payer: BCN Medicare Advantage |
$398.33
|
| Rate for Payer: Cash Price |
$1,057.61
|
| Rate for Payer: Cash Price |
$1,057.61
|
| Rate for Payer: Cofinity Advantage |
$925.41
|
| Rate for Payer: Cofinity Commercial |
$1,136.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,057.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$398.33
|
| Rate for Payer: Healthscope Commercial |
$1,189.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$925.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$991.51
|
| Rate for Payer: Mclaren Medicaid |
$398.33
|
| Rate for Payer: Mclaren Medicare |
$398.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$418.25
|
| Rate for Payer: Meridian Medicaid |
$418.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$458.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$438.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,123.71
|
| Rate for Payer: Nomi Health Commercial |
$1,194.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$991.51
|
| Rate for Payer: PACE Medicare |
$378.41
|
| Rate for Payer: PACE SWMI |
$398.33
|
| Rate for Payer: PHP Commercial |
$1,123.71
|
| Rate for Payer: PHP Medicare Advantage |
$398.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,288.18
|
| Rate for Payer: Priority Health Medicare |
$398.33
|
| Rate for Payer: Priority Health SBD |
$832.87
|
| Rate for Payer: Priority Health Tiered Network |
$1,030.54
|
| Rate for Payer: Railroad Medicare Medicare |
$398.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$859.31
|
| Rate for Payer: UHC Core |
$688.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$398.33
|
| Rate for Payer: UHC Exchange |
$519.55
|
| Rate for Payer: UHC Medicaid |
$208.33
|
| Rate for Payer: UHCCP Medicaid |
$208.33
|
| Rate for Payer: UMR Bronson Commercial |
$489.14
|
| Rate for Payer: VA VA |
$398.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$991.51
|
|
|
HC NM BRAIN <4 STATC VIEW W VAS F
|
Facility
|
IP
|
$1,322.01
|
|
|
Service Code
|
CPT 78601
|
| Hospital Charge Code |
34100038
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$581.68 |
| Max. Negotiated Rate |
$1,189.81 |
| Rate for Payer: Aetna American Axle |
$859.31
|
| Rate for Payer: Aetna Commercial |
$1,123.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$859.31
|
| Rate for Payer: Cash Price |
$1,057.61
|
| Rate for Payer: Cofinity Advantage |
$925.41
|
| Rate for Payer: Cofinity Commercial |
$1,136.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,057.61
|
| Rate for Payer: Healthscope Commercial |
$1,189.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$925.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$991.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,123.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$991.51
|
| Rate for Payer: PHP Commercial |
$1,123.71
|
| Rate for Payer: Priority Health SBD |
$832.87
|
| Rate for Payer: UMR Bronson Commercial |
$581.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$991.51
|
|
|
HC NM BREAST IMAGING BILAT
|
Facility
|
OP
|
$1,207.13
|
|
|
Service Code
|
CPT 78800
|
| Hospital Charge Code |
34100053
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$208.33 |
| Max. Negotiated Rate |
$1,288.18 |
| Rate for Payer: Aetna American Axle |
$784.63
|
| Rate for Payer: Aetna Commercial |
$1,026.06
|
| Rate for Payer: Aetna Medicare |
$414.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$784.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$497.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$497.91
|
| Rate for Payer: BCBS Complete |
$218.76
|
| Rate for Payer: BCBS MAPPO |
$398.33
|
| Rate for Payer: BCBS Trust/PPO |
$486.79
|
| Rate for Payer: BCN Commercial |
$486.79
|
| Rate for Payer: BCN Medicare Advantage |
$398.33
|
| Rate for Payer: Cash Price |
$965.70
|
| Rate for Payer: Cash Price |
$965.70
|
| Rate for Payer: Cofinity Advantage |
$844.99
|
| Rate for Payer: Cofinity Commercial |
$1,038.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$965.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$398.33
|
| Rate for Payer: Healthscope Commercial |
$1,086.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$844.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$905.35
|
| Rate for Payer: Mclaren Medicaid |
$398.33
|
| Rate for Payer: Mclaren Medicare |
$398.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$418.25
|
| Rate for Payer: Meridian Medicaid |
$418.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$458.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$438.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,026.06
|
| Rate for Payer: Nomi Health Commercial |
$1,194.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$905.35
|
| Rate for Payer: PACE Medicare |
$378.41
|
| Rate for Payer: PACE SWMI |
$398.33
|
| Rate for Payer: PHP Commercial |
$1,026.06
|
| Rate for Payer: PHP Medicare Advantage |
$398.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,288.18
|
| Rate for Payer: Priority Health Medicare |
$398.33
|
| Rate for Payer: Priority Health SBD |
$760.49
|
| Rate for Payer: Priority Health Tiered Network |
$1,030.54
|
| Rate for Payer: Railroad Medicare Medicare |
$398.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$784.63
|
| Rate for Payer: UHC Core |
$628.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$398.33
|
| Rate for Payer: UHC Exchange |
$474.40
|
| Rate for Payer: UHC Medicaid |
$208.33
|
| Rate for Payer: UHCCP Medicaid |
$208.33
|
| Rate for Payer: UMR Bronson Commercial |
$446.64
|
| Rate for Payer: VA VA |
$398.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$905.35
|
|
|
HC NM BREAST IMAGING BILAT
|
Facility
|
IP
|
$1,207.13
|
|
|
Service Code
|
CPT 78800
|
| Hospital Charge Code |
34100053
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$531.14 |
| Max. Negotiated Rate |
$1,086.42 |
| Rate for Payer: Aetna American Axle |
$784.63
|
| Rate for Payer: Aetna Commercial |
$1,026.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$784.63
|
| Rate for Payer: Cash Price |
$965.70
|
| Rate for Payer: Cofinity Advantage |
$844.99
|
| Rate for Payer: Cofinity Commercial |
$1,038.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$965.70
|
| Rate for Payer: Healthscope Commercial |
$1,086.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$844.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$905.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,026.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$905.35
|
| Rate for Payer: PHP Commercial |
$1,026.06
|
| Rate for Payer: Priority Health SBD |
$760.49
|
| Rate for Payer: UMR Bronson Commercial |
$531.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$905.35
|
|
|
HC NM CARDIAC GATED WALL MUGA
|
Facility
|
OP
|
$1,353.34
|
|
|
Service Code
|
CPT 78472
|
| Hospital Charge Code |
34100030
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$208.33 |
| Max. Negotiated Rate |
$1,288.18 |
| Rate for Payer: Aetna American Axle |
$879.67
|
| Rate for Payer: Aetna Commercial |
$1,150.34
|
| Rate for Payer: Aetna Medicare |
$414.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$879.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$497.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$497.91
|
| Rate for Payer: BCBS Complete |
$218.76
|
| Rate for Payer: BCBS MAPPO |
$398.33
|
| Rate for Payer: BCBS Trust/PPO |
$397.32
|
| Rate for Payer: BCN Commercial |
$397.32
|
| Rate for Payer: BCN Medicare Advantage |
$398.33
|
| Rate for Payer: Cash Price |
$1,082.67
|
| Rate for Payer: Cash Price |
$1,082.67
|
| Rate for Payer: Cofinity Advantage |
$947.34
|
| Rate for Payer: Cofinity Commercial |
$1,163.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,082.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$398.33
|
| Rate for Payer: Healthscope Commercial |
$1,218.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$947.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,015.00
|
| Rate for Payer: Mclaren Medicaid |
$398.33
|
| Rate for Payer: Mclaren Medicare |
$398.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$418.25
|
| Rate for Payer: Meridian Medicaid |
$418.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$458.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$438.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,150.34
|
| Rate for Payer: Nomi Health Commercial |
$1,194.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,015.00
|
| Rate for Payer: PACE Medicare |
$378.41
|
| Rate for Payer: PACE SWMI |
$398.33
|
| Rate for Payer: PHP Commercial |
$1,150.34
|
| Rate for Payer: PHP Medicare Advantage |
$398.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,288.18
|
| Rate for Payer: Priority Health Medicare |
$398.33
|
| Rate for Payer: Priority Health SBD |
$852.60
|
| Rate for Payer: Priority Health Tiered Network |
$1,030.54
|
| Rate for Payer: Railroad Medicare Medicare |
$398.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$879.67
|
| Rate for Payer: UHC Core |
$705.09
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$398.33
|
| Rate for Payer: UHC Exchange |
$531.86
|
| Rate for Payer: UHC Medicaid |
$208.33
|
| Rate for Payer: UHCCP Medicaid |
$208.33
|
| Rate for Payer: UMR Bronson Commercial |
$500.74
|
| Rate for Payer: VA VA |
$398.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,015.00
|
|
|
HC NM CARDIAC GATED WALL MUGA
|
Facility
|
IP
|
$1,353.34
|
|
|
Service Code
|
CPT 78472
|
| Hospital Charge Code |
34100030
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$595.47 |
| Max. Negotiated Rate |
$1,218.01 |
| Rate for Payer: Aetna American Axle |
$879.67
|
| Rate for Payer: Aetna Commercial |
$1,150.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$879.67
|
| Rate for Payer: Cash Price |
$1,082.67
|
| Rate for Payer: Cofinity Advantage |
$947.34
|
| Rate for Payer: Cofinity Commercial |
$1,163.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,082.67
|
| Rate for Payer: Healthscope Commercial |
$1,218.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$947.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,015.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,150.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,015.00
|
| Rate for Payer: PHP Commercial |
$1,150.34
|
| Rate for Payer: Priority Health SBD |
$852.60
|
| Rate for Payer: UMR Bronson Commercial |
$595.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,015.00
|
|
