|
HC NM CEREBRAL SHUNT EVAL
|
Facility
|
OP
|
$892.35
|
|
|
Service Code
|
CPT 78645
|
| Hospital Charge Code |
34100041
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$282.95 |
| Max. Negotiated Rate |
$1,749.61 |
| Rate for Payer: Aetna American Axle |
$580.03
|
| Rate for Payer: Aetna Commercial |
$758.50
|
| Rate for Payer: Aetna Medicare |
$562.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$580.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$676.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$676.27
|
| Rate for Payer: BCBS Complete |
$297.13
|
| Rate for Payer: BCBS MAPPO |
$541.02
|
| Rate for Payer: BCBS Trust/PPO |
$650.15
|
| Rate for Payer: BCN Commercial |
$650.15
|
| Rate for Payer: BCN Medicare Advantage |
$541.02
|
| Rate for Payer: Cash Price |
$713.88
|
| Rate for Payer: Cash Price |
$713.88
|
| Rate for Payer: Cofinity Advantage |
$624.64
|
| Rate for Payer: Cofinity Commercial |
$767.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$713.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$541.02
|
| Rate for Payer: Healthscope Commercial |
$803.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$624.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$669.26
|
| Rate for Payer: Mclaren Medicaid |
$541.02
|
| Rate for Payer: Mclaren Medicare |
$541.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$568.07
|
| Rate for Payer: Meridian Medicaid |
$568.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$622.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$595.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$758.50
|
| Rate for Payer: Nomi Health Commercial |
$1,623.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$669.26
|
| Rate for Payer: PACE Medicare |
$513.97
|
| Rate for Payer: PACE SWMI |
$541.02
|
| Rate for Payer: PHP Commercial |
$758.50
|
| Rate for Payer: PHP Medicare Advantage |
$541.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$282.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,749.61
|
| Rate for Payer: Priority Health Medicare |
$541.02
|
| Rate for Payer: Priority Health SBD |
$562.18
|
| Rate for Payer: Priority Health Tiered Network |
$1,399.69
|
| Rate for Payer: Railroad Medicare Medicare |
$541.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$580.03
|
| Rate for Payer: UHC Core |
$464.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$541.02
|
| Rate for Payer: UHC Exchange |
$350.69
|
| Rate for Payer: UHC Medicaid |
$282.95
|
| Rate for Payer: UHCCP Medicaid |
$282.95
|
| Rate for Payer: UMR Bronson Commercial |
$330.17
|
| Rate for Payer: VA VA |
$541.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$669.26
|
|
|
HC NM CEREBRAL SHUNT EVAL
|
Facility
|
IP
|
$892.35
|
|
|
Service Code
|
CPT 78645
|
| Hospital Charge Code |
34100041
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$392.63 |
| Max. Negotiated Rate |
$803.12 |
| Rate for Payer: Aetna American Axle |
$580.03
|
| Rate for Payer: Aetna Commercial |
$758.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$580.03
|
| Rate for Payer: Cash Price |
$713.88
|
| Rate for Payer: Cofinity Advantage |
$624.64
|
| Rate for Payer: Cofinity Commercial |
$767.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$713.88
|
| Rate for Payer: Healthscope Commercial |
$803.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$624.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$669.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$758.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$669.26
|
| Rate for Payer: PHP Commercial |
$758.50
|
| Rate for Payer: Priority Health SBD |
$562.18
|
| Rate for Payer: UMR Bronson Commercial |
$392.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$669.26
|
|
|
HC NM CISTERNOGRAM
|
Facility
|
IP
|
$1,041.20
|
|
|
Service Code
|
CPT 78630
|
| Hospital Charge Code |
34100040
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$458.13 |
| Max. Negotiated Rate |
$937.08 |
| Rate for Payer: Aetna American Axle |
$676.78
|
| Rate for Payer: Aetna Commercial |
$885.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$676.78
|
| Rate for Payer: Cash Price |
$832.96
|
| Rate for Payer: Cofinity Advantage |
$728.84
|
| Rate for Payer: Cofinity Commercial |
$895.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$832.96
|
| Rate for Payer: Healthscope Commercial |
$937.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$728.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$780.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$885.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$780.90
|
| Rate for Payer: PHP Commercial |
$885.02
|
| Rate for Payer: Priority Health SBD |
$655.96
|
| Rate for Payer: UMR Bronson Commercial |
$458.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$780.90
|
|
|
HC NM CISTERNOGRAM
|
Facility
|
OP
|
$1,041.20
|
|
|
Service Code
|
CPT 78630
|
| Hospital Charge Code |
34100040
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$282.95 |
| Max. Negotiated Rate |
$1,749.61 |
| Rate for Payer: Aetna American Axle |
$676.78
|
| Rate for Payer: Aetna Commercial |
$885.02
|
| Rate for Payer: Aetna Medicare |
$562.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$676.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$676.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$676.27
|
| Rate for Payer: BCBS Complete |
$297.13
|
| Rate for Payer: BCBS MAPPO |
$541.02
|
| Rate for Payer: BCBS Trust/PPO |
$664.93
|
| Rate for Payer: BCN Commercial |
$664.93
|
| Rate for Payer: BCN Medicare Advantage |
$541.02
|
| Rate for Payer: Cash Price |
$832.96
|
| Rate for Payer: Cash Price |
$832.96
|
| Rate for Payer: Cofinity Advantage |
$728.84
|
| Rate for Payer: Cofinity Commercial |
$895.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$832.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$541.02
|
| Rate for Payer: Healthscope Commercial |
$937.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$728.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$780.90
|
| Rate for Payer: Mclaren Medicaid |
$541.02
|
| Rate for Payer: Mclaren Medicare |
$541.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$568.07
|
| Rate for Payer: Meridian Medicaid |
$568.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$622.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$595.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$885.02
|
| Rate for Payer: Nomi Health Commercial |
$1,623.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$780.90
|
| Rate for Payer: PACE Medicare |
$513.97
|
| Rate for Payer: PACE SWMI |
$541.02
|
| Rate for Payer: PHP Commercial |
$885.02
|
| Rate for Payer: PHP Medicare Advantage |
$541.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$282.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,749.61
|
| Rate for Payer: Priority Health Medicare |
$541.02
|
| Rate for Payer: Priority Health SBD |
$655.96
|
| Rate for Payer: Priority Health Tiered Network |
$1,399.69
|
| Rate for Payer: Railroad Medicare Medicare |
$541.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$676.78
|
| Rate for Payer: UHC Core |
$542.47
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$541.02
|
| Rate for Payer: UHC Exchange |
$409.19
|
| Rate for Payer: UHC Medicaid |
$282.95
|
| Rate for Payer: UHCCP Medicaid |
$282.95
|
| Rate for Payer: UMR Bronson Commercial |
$385.24
|
| Rate for Payer: VA VA |
$541.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$780.90
|
|
|
HC NM CSF LEAK
|
Facility
|
OP
|
$1,041.20
|
|
|
Service Code
|
CPT 78650
|
| Hospital Charge Code |
34100042
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$385.24 |
| Max. Negotiated Rate |
$4,171.73 |
| Rate for Payer: Aetna American Axle |
$676.78
|
| Rate for Payer: Aetna Commercial |
$885.02
|
| Rate for Payer: Aetna Medicare |
$1,341.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$676.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,612.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,612.49
|
| Rate for Payer: BCBS Complete |
$708.46
|
| Rate for Payer: BCBS MAPPO |
$1,289.99
|
| Rate for Payer: BCBS Trust/PPO |
$537.68
|
| Rate for Payer: BCN Commercial |
$537.68
|
| Rate for Payer: BCN Medicare Advantage |
$1,289.99
|
| Rate for Payer: Cash Price |
$832.96
|
| Rate for Payer: Cash Price |
$832.96
|
| Rate for Payer: Cofinity Advantage |
$728.84
|
| Rate for Payer: Cofinity Commercial |
$895.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$832.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,289.99
|
| Rate for Payer: Healthscope Commercial |
$937.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$728.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$780.90
|
| Rate for Payer: Mclaren Medicaid |
$1,289.99
|
| Rate for Payer: Mclaren Medicare |
$1,289.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,354.49
|
| Rate for Payer: Meridian Medicaid |
$1,354.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,483.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,418.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$885.02
|
| Rate for Payer: Nomi Health Commercial |
$3,869.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$780.90
|
| Rate for Payer: PACE Medicare |
$1,225.49
|
| Rate for Payer: PACE SWMI |
$1,289.99
|
| Rate for Payer: PHP Commercial |
$885.02
|
| Rate for Payer: PHP Medicare Advantage |
$1,289.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$674.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4,171.73
|
| Rate for Payer: Priority Health Medicare |
$1,289.99
|
| Rate for Payer: Priority Health SBD |
$655.96
|
| Rate for Payer: Priority Health Tiered Network |
$3,337.38
|
| Rate for Payer: Railroad Medicare Medicare |
$1,289.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$676.78
|
| Rate for Payer: UHC Core |
$542.47
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,289.99
|
| Rate for Payer: UHC Exchange |
$409.19
|
| Rate for Payer: UHC Medicaid |
$674.66
|
| Rate for Payer: UHCCP Medicaid |
$674.66
|
| Rate for Payer: UMR Bronson Commercial |
$385.24
|
| Rate for Payer: VA VA |
$1,289.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$780.90
|
|
|
HC NM CSF LEAK
|
Facility
|
IP
|
$1,041.20
|
|
|
Service Code
|
CPT 78650
|
| Hospital Charge Code |
34100042
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$458.13 |
| Max. Negotiated Rate |
$937.08 |
| Rate for Payer: Aetna American Axle |
$676.78
|
| Rate for Payer: Aetna Commercial |
$885.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$676.78
|
| Rate for Payer: Cash Price |
$832.96
|
| Rate for Payer: Cofinity Advantage |
$728.84
|
| Rate for Payer: Cofinity Commercial |
$895.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$832.96
|
| Rate for Payer: Healthscope Commercial |
$937.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$728.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$780.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$885.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$780.90
|
| Rate for Payer: PHP Commercial |
$885.02
|
| Rate for Payer: Priority Health SBD |
$655.96
|
| Rate for Payer: UMR Bronson Commercial |
$458.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$780.90
|
|
|
HC NMDA-R AB CBA, S
|
Facility
|
OP
|
$468.18
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200429
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$421.36 |
| Rate for Payer: Aetna American Axle |
$304.32
|
| Rate for Payer: Aetna Commercial |
$397.95
|
| Rate for Payer: Aetna Medicare |
$12.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$304.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: BCBS Complete |
$6.62
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$10.45
|
| Rate for Payer: BCN Commercial |
$10.45
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$374.54
|
| Rate for Payer: Cash Price |
$374.54
|
| Rate for Payer: Cofinity Advantage |
$327.73
|
| Rate for Payer: Cofinity Commercial |
$402.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$421.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$327.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$351.13
|
| Rate for Payer: Mclaren Medicaid |
$12.05
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: Meridian Medicaid |
$12.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$397.95
|
| Rate for Payer: Nomi Health Commercial |
$18.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$351.13
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$397.95
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12.05
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health SBD |
$294.95
|
| Rate for Payer: Priority Health Tiered Network |
$9.64
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.08
|
| Rate for Payer: UHC Core |
$18.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.05
|
| Rate for Payer: UHC Exchange |
$18.08
|
| Rate for Payer: UHC Medicaid |
$6.30
|
| Rate for Payer: UHCCP Medicaid |
$6.30
|
| Rate for Payer: UMR Bronson Commercial |
$173.23
|
| Rate for Payer: VA VA |
$12.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$351.13
|
|
|
HC NMDA-R AB CBA, S
|
Facility
|
IP
|
$468.18
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200429
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$206.00 |
| Max. Negotiated Rate |
$421.36 |
| Rate for Payer: Aetna American Axle |
$304.32
|
| Rate for Payer: Aetna Commercial |
$397.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$304.32
|
| Rate for Payer: Cash Price |
$374.54
|
| Rate for Payer: Cofinity Advantage |
$327.73
|
| Rate for Payer: Cofinity Commercial |
$402.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.54
|
| Rate for Payer: Healthscope Commercial |
$421.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$327.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$351.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$397.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$351.13
|
| Rate for Payer: PHP Commercial |
$397.95
|
| Rate for Payer: Priority Health SBD |
$294.95
|
| Rate for Payer: UMR Bronson Commercial |
$206.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$351.13
|
|
|
HC NMDA-R AB CBA, SERUM
|
Facility
|
OP
|
$468.18
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200420
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$421.36 |
| Rate for Payer: Aetna American Axle |
$304.32
|
| Rate for Payer: Aetna Commercial |
$397.95
|
| Rate for Payer: Aetna Medicare |
$12.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$304.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: BCBS Complete |
$6.62
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$10.45
|
| Rate for Payer: BCN Commercial |
$10.45
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$374.54
|
| Rate for Payer: Cash Price |
$374.54
|
| Rate for Payer: Cofinity Advantage |
$327.73
|
| Rate for Payer: Cofinity Commercial |
$402.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$421.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$327.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$351.13
|
| Rate for Payer: Mclaren Medicaid |
$12.05
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: Meridian Medicaid |
$12.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$397.95
|
| Rate for Payer: Nomi Health Commercial |
$18.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$351.13
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$397.95
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12.05
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health SBD |
$294.95
|
| Rate for Payer: Priority Health Tiered Network |
$9.64
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.08
|
| Rate for Payer: UHC Core |
$18.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.05
|
| Rate for Payer: UHC Exchange |
$18.08
|
| Rate for Payer: UHC Medicaid |
$6.30
|
| Rate for Payer: UHCCP Medicaid |
$6.30
|
| Rate for Payer: UMR Bronson Commercial |
$173.23
|
| Rate for Payer: VA VA |
$12.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$351.13
|
|
|
HC NMDA-R AB CBA, SERUM
|
Facility
|
IP
|
$468.18
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200420
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$206.00 |
| Max. Negotiated Rate |
$421.36 |
| Rate for Payer: Aetna American Axle |
$304.32
|
| Rate for Payer: Aetna Commercial |
$397.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$304.32
|
| Rate for Payer: Cash Price |
$374.54
|
| Rate for Payer: Cofinity Advantage |
$327.73
|
| Rate for Payer: Cofinity Commercial |
$402.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.54
|
| Rate for Payer: Healthscope Commercial |
$421.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$327.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$351.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$397.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$351.13
|
| Rate for Payer: PHP Commercial |
$397.95
|
| Rate for Payer: Priority Health SBD |
$294.95
|
| Rate for Payer: UMR Bronson Commercial |
$206.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$351.13
|
|
|
HC NMDA-R AB IF TITER ASSAY, S
|
Facility
|
OP
|
$119.65
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
30200421
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$107.69 |
| Rate for Payer: Aetna American Axle |
$77.77
|
| Rate for Payer: Aetna Commercial |
$101.70
|
| Rate for Payer: Aetna Medicare |
$12.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: BCBS Complete |
$6.62
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$10.45
|
| Rate for Payer: BCN Commercial |
$10.45
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$95.72
|
| Rate for Payer: Cash Price |
$95.72
|
| Rate for Payer: Cofinity Advantage |
$83.75
|
| Rate for Payer: Cofinity Commercial |
$102.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$107.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$83.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.74
|
| Rate for Payer: Mclaren Medicaid |
$12.05
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: Meridian Medicaid |
$12.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.70
|
| Rate for Payer: Nomi Health Commercial |
$18.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.74
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$101.70
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12.05
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health SBD |
$75.38
|
| Rate for Payer: Priority Health Tiered Network |
$9.64
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.08
|
| Rate for Payer: UHC Core |
$18.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.05
|
| Rate for Payer: UHC Exchange |
$18.08
|
| Rate for Payer: UHC Medicaid |
$6.30
|
| Rate for Payer: UHCCP Medicaid |
$6.30
|
| Rate for Payer: UMR Bronson Commercial |
$44.27
|
| Rate for Payer: VA VA |
$12.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.74
|
|
|
HC NMDA-R AB IF TITER ASSAY, S
|
Facility
|
IP
|
$119.65
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
30200421
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$52.65 |
| Max. Negotiated Rate |
$107.69 |
| Rate for Payer: Aetna American Axle |
$77.77
|
| Rate for Payer: Aetna Commercial |
$101.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.77
|
| Rate for Payer: Cash Price |
$95.72
|
| Rate for Payer: Cofinity Advantage |
$83.75
|
| Rate for Payer: Cofinity Commercial |
$102.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.72
|
| Rate for Payer: Healthscope Commercial |
$107.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$83.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.74
|
| Rate for Payer: PHP Commercial |
$101.70
|
| Rate for Payer: Priority Health SBD |
$75.38
|
| Rate for Payer: UMR Bronson Commercial |
$52.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.74
|
|
|
HC N METHYLHISTAMINE, U
|
Facility
|
OP
|
$84.89
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
30100716
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.60 |
| Max. Negotiated Rate |
$76.40 |
| Rate for Payer: Aetna American Axle |
$55.18
|
| Rate for Payer: Aetna Commercial |
$72.16
|
| Rate for Payer: Aetna Medicare |
$25.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.11
|
| Rate for Payer: BCBS Complete |
$13.23
|
| Rate for Payer: BCBS MAPPO |
$24.09
|
| Rate for Payer: BCBS Trust/PPO |
$27.85
|
| Rate for Payer: BCN Commercial |
$27.85
|
| Rate for Payer: BCN Medicare Advantage |
$24.09
|
| Rate for Payer: Cash Price |
$67.91
|
| Rate for Payer: Cash Price |
$67.91
|
| Rate for Payer: Cofinity Advantage |
$59.42
|
| Rate for Payer: Cofinity Commercial |
$73.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.09
|
| Rate for Payer: Healthscope Commercial |
$76.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$59.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.67
|
| Rate for Payer: Mclaren Medicaid |
$24.09
|
| Rate for Payer: Mclaren Medicare |
$24.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.29
|
| Rate for Payer: Meridian Medicaid |
$25.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$26.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.16
|
| Rate for Payer: Nomi Health Commercial |
$36.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$63.67
|
| Rate for Payer: PACE Medicare |
$22.89
|
| Rate for Payer: PACE SWMI |
$24.09
|
| Rate for Payer: PHP Commercial |
$72.16
|
| Rate for Payer: PHP Medicare Advantage |
$24.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$24.09
|
| Rate for Payer: Priority Health Medicare |
$24.09
|
| Rate for Payer: Priority Health SBD |
$53.48
|
| Rate for Payer: Priority Health Tiered Network |
$19.27
|
| Rate for Payer: Railroad Medicare Medicare |
$24.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.14
|
| Rate for Payer: UHC Core |
$36.14
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$24.09
|
| Rate for Payer: UHC Exchange |
$36.14
|
| Rate for Payer: UHC Medicaid |
$12.60
|
| Rate for Payer: UHCCP Medicaid |
$12.60
|
| Rate for Payer: UMR Bronson Commercial |
$31.41
|
| Rate for Payer: VA VA |
$24.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.67
|
|
|
HC N METHYLHISTAMINE, U
|
Facility
|
IP
|
$84.89
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
30100716
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.35 |
| Max. Negotiated Rate |
$76.40 |
| Rate for Payer: Aetna American Axle |
$55.18
|
| Rate for Payer: Aetna Commercial |
$72.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.18
|
| Rate for Payer: Cash Price |
$67.91
|
| Rate for Payer: Cofinity Advantage |
$59.42
|
| Rate for Payer: Cofinity Commercial |
$73.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.91
|
| Rate for Payer: Healthscope Commercial |
$76.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$59.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$63.67
|
| Rate for Payer: PHP Commercial |
$72.16
|
| Rate for Payer: Priority Health SBD |
$53.48
|
| Rate for Payer: UMR Bronson Commercial |
$37.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.67
|
|
|
HC NM GASTRIC EMPTYING
|
Facility
|
IP
|
$1,457.68
|
|
|
Service Code
|
CPT 78264
|
| Hospital Charge Code |
34100019
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$641.38 |
| Max. Negotiated Rate |
$1,311.91 |
| Rate for Payer: Aetna American Axle |
$947.49
|
| Rate for Payer: Aetna Commercial |
$1,239.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$947.49
|
| Rate for Payer: Cash Price |
$1,166.14
|
| Rate for Payer: Cofinity Advantage |
$1,020.38
|
| Rate for Payer: Cofinity Commercial |
$1,253.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,166.14
|
| Rate for Payer: Healthscope Commercial |
$1,311.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,020.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,093.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,239.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,093.26
|
| Rate for Payer: PHP Commercial |
$1,239.03
|
| Rate for Payer: Priority Health SBD |
$918.34
|
| Rate for Payer: UMR Bronson Commercial |
$641.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,093.26
|
|
|
HC NM GASTRIC EMPTYING
|
Facility
|
OP
|
$1,457.68
|
|
|
Service Code
|
CPT 78264
|
| Hospital Charge Code |
34100019
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$208.33 |
| Max. Negotiated Rate |
$1,311.91 |
| Rate for Payer: Aetna American Axle |
$947.49
|
| Rate for Payer: Aetna Commercial |
$1,239.03
|
| Rate for Payer: Aetna Medicare |
$414.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$947.49
|
| 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 |
$638.65
|
| Rate for Payer: BCN Commercial |
$638.65
|
| Rate for Payer: BCN Medicare Advantage |
$398.33
|
| Rate for Payer: Cash Price |
$1,166.14
|
| Rate for Payer: Cash Price |
$1,166.14
|
| Rate for Payer: Cofinity Advantage |
$1,020.38
|
| Rate for Payer: Cofinity Commercial |
$1,253.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,166.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$398.33
|
| Rate for Payer: Healthscope Commercial |
$1,311.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,020.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,093.26
|
| 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 |
$1,239.03
|
| Rate for Payer: Nomi Health Commercial |
$1,194.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,093.26
|
| Rate for Payer: PACE Medicare |
$378.41
|
| Rate for Payer: PACE SWMI |
$398.33
|
| Rate for Payer: PHP Commercial |
$1,239.03
|
| 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 |
$918.34
|
| 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) |
$947.49
|
| Rate for Payer: UHC Core |
$759.45
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$398.33
|
| Rate for Payer: UHC Exchange |
$572.87
|
| Rate for Payer: UHC Medicaid |
$208.33
|
| Rate for Payer: UHCCP Medicaid |
$208.33
|
| Rate for Payer: UMR Bronson Commercial |
$539.34
|
| Rate for Payer: VA VA |
$398.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,093.26
|
|
|
HC NM GE REFLUX
|
Facility
|
IP
|
$1,291.08
|
|
|
Service Code
|
CPT 78262
|
| Hospital Charge Code |
34100018
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$568.08 |
| Max. Negotiated Rate |
$1,161.97 |
| Rate for Payer: Aetna American Axle |
$839.20
|
| Rate for Payer: Aetna Commercial |
$1,097.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$839.20
|
| Rate for Payer: Cash Price |
$1,032.86
|
| Rate for Payer: Cofinity Advantage |
$903.76
|
| Rate for Payer: Cofinity Commercial |
$1,110.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,032.86
|
| Rate for Payer: Healthscope Commercial |
$1,161.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$903.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$968.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,097.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$968.31
|
| Rate for Payer: PHP Commercial |
$1,097.42
|
| Rate for Payer: Priority Health SBD |
$813.38
|
| Rate for Payer: UMR Bronson Commercial |
$568.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$968.31
|
|
|
HC NM GE REFLUX
|
Facility
|
OP
|
$1,291.08
|
|
|
Service Code
|
CPT 78262
|
| Hospital Charge Code |
34100018
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$208.33 |
| Max. Negotiated Rate |
$1,288.18 |
| Rate for Payer: Aetna American Axle |
$839.20
|
| Rate for Payer: Aetna Commercial |
$1,097.42
|
| Rate for Payer: Aetna Medicare |
$414.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$839.20
|
| 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 |
$469.56
|
| Rate for Payer: BCN Commercial |
$469.56
|
| Rate for Payer: BCN Medicare Advantage |
$398.33
|
| Rate for Payer: Cash Price |
$1,032.86
|
| Rate for Payer: Cash Price |
$1,032.86
|
| Rate for Payer: Cofinity Advantage |
$903.76
|
| Rate for Payer: Cofinity Commercial |
$1,110.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,032.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$398.33
|
| Rate for Payer: Healthscope Commercial |
$1,161.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$903.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$968.31
|
| 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 |
$1,097.42
|
| Rate for Payer: Nomi Health Commercial |
$1,194.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$968.31
|
| Rate for Payer: PACE Medicare |
$378.41
|
| Rate for Payer: PACE SWMI |
$398.33
|
| Rate for Payer: PHP Commercial |
$1,097.42
|
| 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 |
$813.38
|
| 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) |
$839.20
|
| Rate for Payer: UHC Core |
$672.65
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$398.33
|
| Rate for Payer: UHC Exchange |
$507.39
|
| Rate for Payer: UHC Medicaid |
$208.33
|
| Rate for Payer: UHCCP Medicaid |
$208.33
|
| Rate for Payer: UMR Bronson Commercial |
$477.70
|
| Rate for Payer: VA VA |
$398.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$968.31
|
|
|
HC NM GI BLOOD LOSS
|
Facility
|
OP
|
$1,041.20
|
|
|
Service Code
|
CPT 78278
|
| Hospital Charge Code |
34100020
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$208.33 |
| Max. Negotiated Rate |
$1,288.18 |
| Rate for Payer: Aetna American Axle |
$676.78
|
| Rate for Payer: Aetna Commercial |
$885.02
|
| Rate for Payer: Aetna Medicare |
$414.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$676.78
|
| 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 |
$656.72
|
| Rate for Payer: BCN Commercial |
$656.72
|
| Rate for Payer: BCN Medicare Advantage |
$398.33
|
| Rate for Payer: Cash Price |
$832.96
|
| Rate for Payer: Cash Price |
$832.96
|
| Rate for Payer: Cofinity Advantage |
$728.84
|
| Rate for Payer: Cofinity Commercial |
$895.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$832.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$398.33
|
| Rate for Payer: Healthscope Commercial |
$937.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$728.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$780.90
|
| 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 |
$885.02
|
| Rate for Payer: Nomi Health Commercial |
$1,194.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$780.90
|
| Rate for Payer: PACE Medicare |
$378.41
|
| Rate for Payer: PACE SWMI |
$398.33
|
| Rate for Payer: PHP Commercial |
$885.02
|
| 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 |
$655.96
|
| 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) |
$676.78
|
| Rate for Payer: UHC Core |
$542.47
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$398.33
|
| Rate for Payer: UHC Exchange |
$409.19
|
| Rate for Payer: UHC Medicaid |
$208.33
|
| Rate for Payer: UHCCP Medicaid |
$208.33
|
| Rate for Payer: UMR Bronson Commercial |
$385.24
|
| Rate for Payer: VA VA |
$398.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$780.90
|
|
|
HC NM GI BLOOD LOSS
|
Facility
|
IP
|
$1,041.20
|
|
|
Service Code
|
CPT 78278
|
| Hospital Charge Code |
34100020
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$458.13 |
| Max. Negotiated Rate |
$937.08 |
| Rate for Payer: Aetna American Axle |
$676.78
|
| Rate for Payer: Aetna Commercial |
$885.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$676.78
|
| Rate for Payer: Cash Price |
$832.96
|
| Rate for Payer: Cofinity Advantage |
$728.84
|
| Rate for Payer: Cofinity Commercial |
$895.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$832.96
|
| Rate for Payer: Healthscope Commercial |
$937.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$728.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$780.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$885.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$780.90
|
| Rate for Payer: PHP Commercial |
$885.02
|
| Rate for Payer: Priority Health SBD |
$655.96
|
| Rate for Payer: UMR Bronson Commercial |
$458.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$780.90
|
|
|
HC NM LIVER BILE TRANSPORT WO PHARM
|
Facility
|
IP
|
$1,506.09
|
|
|
Service Code
|
CPT 78226
|
| Hospital Charge Code |
34100072
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$662.68 |
| Max. Negotiated Rate |
$1,355.48 |
| Rate for Payer: Aetna American Axle |
$978.96
|
| Rate for Payer: Aetna Commercial |
$1,280.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$978.96
|
| Rate for Payer: Cash Price |
$1,204.87
|
| Rate for Payer: Cofinity Advantage |
$1,054.26
|
| Rate for Payer: Cofinity Commercial |
$1,295.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,204.87
|
| Rate for Payer: Healthscope Commercial |
$1,355.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,054.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,129.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,280.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,129.57
|
| Rate for Payer: PHP Commercial |
$1,280.18
|
| Rate for Payer: Priority Health SBD |
$948.84
|
| Rate for Payer: UMR Bronson Commercial |
$662.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,129.57
|
|
|
HC NM LIVER BILE TRANSPORT WO PHARM
|
Facility
|
OP
|
$1,506.09
|
|
|
Service Code
|
CPT 78226
|
| Hospital Charge Code |
34100072
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$208.33 |
| Max. Negotiated Rate |
$1,355.48 |
| Rate for Payer: Aetna American Axle |
$978.96
|
| Rate for Payer: Aetna Commercial |
$1,280.18
|
| Rate for Payer: Aetna Medicare |
$414.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$978.96
|
| 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 |
$629.62
|
| Rate for Payer: BCN Commercial |
$629.62
|
| Rate for Payer: BCN Medicare Advantage |
$398.33
|
| Rate for Payer: Cash Price |
$1,204.87
|
| Rate for Payer: Cash Price |
$1,204.87
|
| Rate for Payer: Cofinity Advantage |
$1,054.26
|
| Rate for Payer: Cofinity Commercial |
$1,295.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,204.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$398.33
|
| Rate for Payer: Healthscope Commercial |
$1,355.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,054.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,129.57
|
| 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 |
$1,280.18
|
| Rate for Payer: Nomi Health Commercial |
$1,194.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,129.57
|
| Rate for Payer: PACE Medicare |
$378.41
|
| Rate for Payer: PACE SWMI |
$398.33
|
| Rate for Payer: PHP Commercial |
$1,280.18
|
| 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 |
$948.84
|
| 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) |
$978.96
|
| Rate for Payer: UHC Core |
$784.67
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$398.33
|
| Rate for Payer: UHC Exchange |
$591.89
|
| Rate for Payer: UHC Medicaid |
$208.33
|
| Rate for Payer: UHCCP Medicaid |
$208.33
|
| Rate for Payer: UMR Bronson Commercial |
$557.25
|
| Rate for Payer: VA VA |
$398.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,129.57
|
|
|
HC NM LIVER BILE TRANSPORT W PHARM
|
Facility
|
OP
|
$1,506.09
|
|
|
Service Code
|
CPT 78227
|
| Hospital Charge Code |
34100073
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$282.95 |
| Max. Negotiated Rate |
$1,749.61 |
| Rate for Payer: Aetna American Axle |
$978.96
|
| Rate for Payer: Aetna Commercial |
$1,280.18
|
| Rate for Payer: Aetna Medicare |
$562.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$978.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$676.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$676.27
|
| Rate for Payer: BCBS Complete |
$297.13
|
| Rate for Payer: BCBS MAPPO |
$541.02
|
| Rate for Payer: BCBS Trust/PPO |
$856.19
|
| Rate for Payer: BCN Commercial |
$856.19
|
| Rate for Payer: BCN Medicare Advantage |
$541.02
|
| Rate for Payer: Cash Price |
$1,204.87
|
| Rate for Payer: Cash Price |
$1,204.87
|
| Rate for Payer: Cofinity Advantage |
$1,054.26
|
| Rate for Payer: Cofinity Commercial |
$1,295.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,204.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$541.02
|
| Rate for Payer: Healthscope Commercial |
$1,355.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,054.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,129.57
|
| Rate for Payer: Mclaren Medicaid |
$541.02
|
| Rate for Payer: Mclaren Medicare |
$541.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$568.07
|
| Rate for Payer: Meridian Medicaid |
$568.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$622.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$595.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,280.18
|
| Rate for Payer: Nomi Health Commercial |
$1,623.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,129.57
|
| Rate for Payer: PACE Medicare |
$513.97
|
| Rate for Payer: PACE SWMI |
$541.02
|
| Rate for Payer: PHP Commercial |
$1,280.18
|
| Rate for Payer: PHP Medicare Advantage |
$541.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$282.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,749.61
|
| Rate for Payer: Priority Health Medicare |
$541.02
|
| Rate for Payer: Priority Health SBD |
$948.84
|
| Rate for Payer: Priority Health Tiered Network |
$1,399.69
|
| Rate for Payer: Railroad Medicare Medicare |
$541.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$978.96
|
| Rate for Payer: UHC Core |
$784.67
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$541.02
|
| Rate for Payer: UHC Exchange |
$591.89
|
| Rate for Payer: UHC Medicaid |
$282.95
|
| Rate for Payer: UHCCP Medicaid |
$282.95
|
| Rate for Payer: UMR Bronson Commercial |
$557.25
|
| Rate for Payer: VA VA |
$541.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,129.57
|
|
|
HC NM LIVER BILE TRANSPORT W PHARM
|
Facility
|
IP
|
$1,506.09
|
|
|
Service Code
|
CPT 78227
|
| Hospital Charge Code |
34100073
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$662.68 |
| Max. Negotiated Rate |
$1,355.48 |
| Rate for Payer: Aetna American Axle |
$978.96
|
| Rate for Payer: Aetna Commercial |
$1,280.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$978.96
|
| Rate for Payer: Cash Price |
$1,204.87
|
| Rate for Payer: Cofinity Advantage |
$1,054.26
|
| Rate for Payer: Cofinity Commercial |
$1,295.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,204.87
|
| Rate for Payer: Healthscope Commercial |
$1,355.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,054.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,129.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,280.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,129.57
|
| Rate for Payer: PHP Commercial |
$1,280.18
|
| Rate for Payer: Priority Health SBD |
$948.84
|
| Rate for Payer: UMR Bronson Commercial |
$662.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,129.57
|
|
|
HC NM LIVER SPLEEN
|
Facility
|
OP
|
$936.94
|
|
|
Service Code
|
CPT 78215
|
| Hospital Charge Code |
34100016
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$208.33 |
| Max. Negotiated Rate |
$1,288.18 |
| Rate for Payer: Aetna American Axle |
$609.01
|
| Rate for Payer: Aetna Commercial |
$796.40
|
| Rate for Payer: Aetna Medicare |
$414.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$609.01
|
| 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 |
$386.64
|
| Rate for Payer: BCN Commercial |
$386.64
|
| Rate for Payer: BCN Medicare Advantage |
$398.33
|
| Rate for Payer: Cash Price |
$749.55
|
| Rate for Payer: Cash Price |
$749.55
|
| Rate for Payer: Cofinity Advantage |
$655.86
|
| Rate for Payer: Cofinity Commercial |
$805.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$749.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$398.33
|
| Rate for Payer: Healthscope Commercial |
$843.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$655.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$702.71
|
| 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 |
$796.40
|
| Rate for Payer: Nomi Health Commercial |
$1,194.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$702.71
|
| Rate for Payer: PACE Medicare |
$378.41
|
| Rate for Payer: PACE SWMI |
$398.33
|
| Rate for Payer: PHP Commercial |
$796.40
|
| 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 |
$590.27
|
| 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) |
$609.01
|
| Rate for Payer: UHC Core |
$488.15
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$398.33
|
| Rate for Payer: UHC Exchange |
$368.22
|
| Rate for Payer: UHC Medicaid |
$208.33
|
| Rate for Payer: UHCCP Medicaid |
$208.33
|
| Rate for Payer: UMR Bronson Commercial |
$346.67
|
| Rate for Payer: VA VA |
$398.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$702.71
|
|
