|
HC NM LIVER SPLEEN
|
Facility
|
IP
|
$936.94
|
|
|
Service Code
|
CPT 78215
|
| Hospital Charge Code |
34100016
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$412.25 |
| Max. Negotiated Rate |
$843.25 |
| Rate for Payer: Aetna American Axle |
$609.01
|
| Rate for Payer: Aetna Commercial |
$796.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$609.01
|
| 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: 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: Multiplan/Beech St/PHCS Commercial |
$796.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$702.71
|
| Rate for Payer: PHP Commercial |
$796.40
|
| Rate for Payer: Priority Health SBD |
$590.27
|
| Rate for Payer: UMR Bronson Commercial |
$412.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$702.71
|
|
|
HC NM LOCALIZATION TUMOR LMTD AREA
|
Facility
|
IP
|
$807.35
|
|
|
Service Code
|
CPT 78800
|
| Hospital Charge Code |
34100052
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$355.23 |
| Max. Negotiated Rate |
$726.62 |
| Rate for Payer: Aetna American Axle |
$524.78
|
| Rate for Payer: Aetna Commercial |
$686.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$524.78
|
| Rate for Payer: Cash Price |
$645.88
|
| Rate for Payer: Cofinity Advantage |
$565.14
|
| Rate for Payer: Cofinity Commercial |
$694.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$645.88
|
| Rate for Payer: Healthscope Commercial |
$726.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$565.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$605.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$686.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$605.51
|
| Rate for Payer: PHP Commercial |
$686.25
|
| Rate for Payer: Priority Health SBD |
$508.63
|
| Rate for Payer: UMR Bronson Commercial |
$355.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$605.51
|
|
|
HC NM LOCALIZATION TUMOR LMTD AREA
|
Facility
|
OP
|
$807.35
|
|
|
Service Code
|
CPT 78800
|
| Hospital Charge Code |
34100052
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$208.33 |
| Max. Negotiated Rate |
$1,288.18 |
| Rate for Payer: Aetna American Axle |
$524.78
|
| Rate for Payer: Aetna Commercial |
$686.25
|
| Rate for Payer: Aetna Medicare |
$414.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$524.78
|
| 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 |
$486.79
|
| Rate for Payer: BCN Commercial |
$486.79
|
| Rate for Payer: BCN Medicare Advantage |
$398.33
|
| Rate for Payer: Cash Price |
$645.88
|
| Rate for Payer: Cash Price |
$645.88
|
| Rate for Payer: Cofinity Advantage |
$565.14
|
| Rate for Payer: Cofinity Commercial |
$694.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$645.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$398.33
|
| Rate for Payer: Healthscope Commercial |
$726.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$565.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$605.51
|
| 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 |
$686.25
|
| Rate for Payer: Nomi Health Commercial |
$1,194.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$605.51
|
| Rate for Payer: PACE Medicare |
$378.41
|
| Rate for Payer: PACE SWMI |
$398.33
|
| Rate for Payer: PHP Commercial |
$686.25
|
| 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 |
$508.63
|
| 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) |
$524.78
|
| Rate for Payer: UHC Core |
$420.63
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$398.33
|
| Rate for Payer: UHC Exchange |
$317.29
|
| Rate for Payer: UHC Medicaid |
$208.33
|
| Rate for Payer: UHCCP Medicaid |
$208.33
|
| Rate for Payer: UMR Bronson Commercial |
$298.72
|
| Rate for Payer: VA VA |
$398.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$605.51
|
|
|
HC NM LOCALIZATION TUMOR MULTI AREA
|
Facility
|
IP
|
$1,314.50
|
|
|
Service Code
|
CPT 78801
|
| Hospital Charge Code |
34100054
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$578.38 |
| Max. Negotiated Rate |
$1,183.05 |
| Rate for Payer: Aetna American Axle |
$854.42
|
| Rate for Payer: Aetna Commercial |
$1,117.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$854.42
|
| Rate for Payer: Cash Price |
$1,051.60
|
| Rate for Payer: Cofinity Advantage |
$920.15
|
| Rate for Payer: Cofinity Commercial |
$1,130.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,051.60
|
| Rate for Payer: Healthscope Commercial |
$1,183.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$920.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$985.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,117.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$985.88
|
| Rate for Payer: PHP Commercial |
$1,117.33
|
| Rate for Payer: Priority Health SBD |
$828.13
|
| Rate for Payer: UMR Bronson Commercial |
$578.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$985.88
|
|
|
HC NM LOCALIZATION TUMOR MULTI AREA
|
Facility
|
OP
|
$1,314.50
|
|
|
Service Code
|
CPT 78801
|
| Hospital Charge Code |
34100054
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$208.33 |
| Max. Negotiated Rate |
$1,288.18 |
| Rate for Payer: Aetna American Axle |
$854.42
|
| Rate for Payer: Aetna Commercial |
$1,117.33
|
| Rate for Payer: Aetna Medicare |
$414.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$854.42
|
| 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 |
$518.80
|
| Rate for Payer: BCN Commercial |
$518.80
|
| Rate for Payer: BCN Medicare Advantage |
$398.33
|
| Rate for Payer: Cash Price |
$1,051.60
|
| Rate for Payer: Cash Price |
$1,051.60
|
| Rate for Payer: Cofinity Advantage |
$920.15
|
| Rate for Payer: Cofinity Commercial |
$1,130.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,051.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$398.33
|
| Rate for Payer: Healthscope Commercial |
$1,183.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$920.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$985.88
|
| 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 |
$1,117.33
|
| Rate for Payer: Nomi Health Commercial |
$1,194.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$985.88
|
| Rate for Payer: PACE Medicare |
$378.41
|
| Rate for Payer: PACE SWMI |
$398.33
|
| Rate for Payer: PHP Commercial |
$1,117.33
|
| 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 |
$828.13
|
| 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) |
$854.42
|
| Rate for Payer: UHC Core |
$684.85
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$398.33
|
| Rate for Payer: UHC Exchange |
$516.60
|
| Rate for Payer: UHC Medicaid |
$208.33
|
| Rate for Payer: UHCCP Medicaid |
$208.33
|
| Rate for Payer: UMR Bronson Commercial |
$486.37
|
| Rate for Payer: VA VA |
$398.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$985.88
|
|
|
HC NM LOCALIZATION TUMOR WHOLE BODY
|
Facility
|
OP
|
$1,769.69
|
|
|
Service Code
|
CPT 78802
|
| Hospital Charge Code |
34100055
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$282.95 |
| Max. Negotiated Rate |
$1,749.61 |
| Rate for Payer: Aetna American Axle |
$1,150.30
|
| Rate for Payer: Aetna Commercial |
$1,504.24
|
| Rate for Payer: Aetna Medicare |
$562.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,150.30
|
| 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 |
$586.94
|
| Rate for Payer: BCN Commercial |
$586.94
|
| Rate for Payer: BCN Medicare Advantage |
$541.02
|
| Rate for Payer: Cash Price |
$1,415.75
|
| Rate for Payer: Cash Price |
$1,415.75
|
| Rate for Payer: Cofinity Advantage |
$1,238.78
|
| Rate for Payer: Cofinity Commercial |
$1,521.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,415.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$541.02
|
| Rate for Payer: Healthscope Commercial |
$1,592.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,238.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,327.27
|
| 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 |
$1,504.24
|
| Rate for Payer: Nomi Health Commercial |
$1,623.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,327.27
|
| Rate for Payer: PACE Medicare |
$513.97
|
| Rate for Payer: PACE SWMI |
$541.02
|
| Rate for Payer: PHP Commercial |
$1,504.24
|
| 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 |
$1,114.90
|
| 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) |
$1,150.30
|
| Rate for Payer: UHC Core |
$922.01
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$541.02
|
| Rate for Payer: UHC Exchange |
$695.49
|
| Rate for Payer: UHC Medicaid |
$282.95
|
| Rate for Payer: UHCCP Medicaid |
$282.95
|
| Rate for Payer: UMR Bronson Commercial |
$654.79
|
| Rate for Payer: VA VA |
$541.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,327.27
|
|
|
HC NM LOCALIZATION TUMOR WHOLE BODY
|
Facility
|
IP
|
$1,769.69
|
|
|
Service Code
|
CPT 78802
|
| Hospital Charge Code |
34100055
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$778.66 |
| Max. Negotiated Rate |
$1,592.72 |
| Rate for Payer: Aetna American Axle |
$1,150.30
|
| Rate for Payer: Aetna Commercial |
$1,504.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,150.30
|
| Rate for Payer: Cash Price |
$1,415.75
|
| Rate for Payer: Cofinity Advantage |
$1,238.78
|
| Rate for Payer: Cofinity Commercial |
$1,521.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,415.75
|
| Rate for Payer: Healthscope Commercial |
$1,592.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,238.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,327.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,504.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,327.27
|
| Rate for Payer: PHP Commercial |
$1,504.24
|
| Rate for Payer: Priority Health SBD |
$1,114.90
|
| Rate for Payer: UMR Bronson Commercial |
$778.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,327.27
|
|
|
HC NM LUNG PERF DIFF FUNCT
|
Facility
|
OP
|
$850.11
|
|
|
Service Code
|
CPT 78599
|
| Hospital Charge Code |
34100037
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$208.33 |
| Max. Negotiated Rate |
$1,288.18 |
| Rate for Payer: Aetna American Axle |
$552.57
|
| Rate for Payer: Aetna Commercial |
$722.59
|
| Rate for Payer: Aetna Medicare |
$414.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$552.57
|
| 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: BCN Medicare Advantage |
$398.33
|
| Rate for Payer: Cash Price |
$680.09
|
| Rate for Payer: Cash Price |
$680.09
|
| Rate for Payer: Cofinity Advantage |
$595.08
|
| Rate for Payer: Cofinity Commercial |
$731.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$680.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$398.33
|
| Rate for Payer: Healthscope Commercial |
$765.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$595.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$637.58
|
| 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 |
$722.59
|
| Rate for Payer: Nomi Health Commercial |
$1,194.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$637.58
|
| Rate for Payer: PACE Medicare |
$378.41
|
| Rate for Payer: PACE SWMI |
$398.33
|
| Rate for Payer: PHP Commercial |
$722.59
|
| 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 |
$535.57
|
| 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) |
$552.57
|
| Rate for Payer: UHC Core |
$442.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$398.33
|
| Rate for Payer: UHC Exchange |
$334.09
|
| Rate for Payer: UHC Medicaid |
$208.33
|
| Rate for Payer: UHCCP Medicaid |
$208.33
|
| Rate for Payer: UMR Bronson Commercial |
$314.54
|
| Rate for Payer: VA VA |
$398.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$637.58
|
|
|
HC NM LUNG PERF DIFF FUNCT
|
Facility
|
IP
|
$850.11
|
|
|
Service Code
|
CPT 78599
|
| Hospital Charge Code |
34100037
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$374.05 |
| Max. Negotiated Rate |
$765.10 |
| Rate for Payer: Aetna American Axle |
$552.57
|
| Rate for Payer: Aetna Commercial |
$722.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$552.57
|
| Rate for Payer: Cash Price |
$680.09
|
| Rate for Payer: Cofinity Advantage |
$595.08
|
| Rate for Payer: Cofinity Commercial |
$731.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$680.09
|
| Rate for Payer: Healthscope Commercial |
$765.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$595.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$637.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$722.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$637.58
|
| Rate for Payer: PHP Commercial |
$722.59
|
| Rate for Payer: Priority Health SBD |
$535.57
|
| Rate for Payer: UMR Bronson Commercial |
$374.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$637.58
|
|
|
HC NM LUNG PERFUSION EG PARTICULATE
|
Facility
|
IP
|
$1,041.20
|
|
|
Service Code
|
CPT 78580
|
| Hospital Charge Code |
34100032
|
|
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 LUNG PERFUSION EG PARTICULATE
|
Facility
|
OP
|
$1,041.20
|
|
|
Service Code
|
CPT 78580
|
| Hospital Charge Code |
34100032
|
|
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 |
$439.99
|
| Rate for Payer: BCN Commercial |
$439.99
|
| 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 LYMPHATIC SENTINAL NODE IMAGING
|
Facility
|
OP
|
$1,340.69
|
|
|
Service Code
|
CPT 78195
|
| Hospital Charge Code |
34100012
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$282.95 |
| Max. Negotiated Rate |
$1,749.61 |
| Rate for Payer: Aetna American Axle |
$871.45
|
| Rate for Payer: Aetna Commercial |
$1,139.59
|
| Rate for Payer: Aetna Medicare |
$562.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$871.45
|
| 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 |
$646.05
|
| Rate for Payer: BCN Commercial |
$646.05
|
| Rate for Payer: BCN Medicare Advantage |
$541.02
|
| Rate for Payer: Cash Price |
$1,072.55
|
| Rate for Payer: Cash Price |
$1,072.55
|
| Rate for Payer: Cofinity Advantage |
$938.48
|
| Rate for Payer: Cofinity Commercial |
$1,152.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,072.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$541.02
|
| Rate for Payer: Healthscope Commercial |
$1,206.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$938.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,005.52
|
| 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 |
$1,139.59
|
| Rate for Payer: Nomi Health Commercial |
$1,623.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,005.52
|
| Rate for Payer: PACE Medicare |
$513.97
|
| Rate for Payer: PACE SWMI |
$541.02
|
| Rate for Payer: PHP Commercial |
$1,139.59
|
| 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 |
$844.63
|
| 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) |
$871.45
|
| Rate for Payer: UHC Core |
$698.50
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$541.02
|
| Rate for Payer: UHC Exchange |
$526.89
|
| Rate for Payer: UHC Medicaid |
$282.95
|
| Rate for Payer: UHCCP Medicaid |
$282.95
|
| Rate for Payer: UMR Bronson Commercial |
$496.06
|
| Rate for Payer: VA VA |
$541.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,005.52
|
|
|
HC NM LYMPHATIC SENTINAL NODE IMAGING
|
Facility
|
IP
|
$1,340.69
|
|
|
Service Code
|
CPT 78195
|
| Hospital Charge Code |
34100012
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$589.90 |
| Max. Negotiated Rate |
$1,206.62 |
| Rate for Payer: Aetna American Axle |
$871.45
|
| Rate for Payer: Aetna Commercial |
$1,139.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$871.45
|
| Rate for Payer: Cash Price |
$1,072.55
|
| Rate for Payer: Cofinity Advantage |
$938.48
|
| Rate for Payer: Cofinity Commercial |
$1,152.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,072.55
|
| Rate for Payer: Healthscope Commercial |
$1,206.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$938.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,005.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,139.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,005.52
|
| Rate for Payer: PHP Commercial |
$1,139.59
|
| Rate for Payer: Priority Health SBD |
$844.63
|
| Rate for Payer: UMR Bronson Commercial |
$589.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,005.52
|
|
|
HC NM MECKELS OR ABD
|
Facility
|
OP
|
$1,168.96
|
|
|
Service Code
|
CPT 78290
|
| Hospital Charge Code |
34100021
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$208.33 |
| Max. Negotiated Rate |
$1,288.18 |
| Rate for Payer: Aetna American Axle |
$759.82
|
| Rate for Payer: Aetna Commercial |
$993.62
|
| Rate for Payer: Aetna Medicare |
$414.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$759.82
|
| 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 |
$649.33
|
| Rate for Payer: BCN Commercial |
$649.33
|
| Rate for Payer: BCN Medicare Advantage |
$398.33
|
| Rate for Payer: Cash Price |
$935.17
|
| Rate for Payer: Cash Price |
$935.17
|
| Rate for Payer: Cofinity Advantage |
$818.27
|
| Rate for Payer: Cofinity Commercial |
$1,005.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$935.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$398.33
|
| Rate for Payer: Healthscope Commercial |
$1,052.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$818.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$876.72
|
| 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 |
$993.62
|
| Rate for Payer: Nomi Health Commercial |
$1,194.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$876.72
|
| Rate for Payer: PACE Medicare |
$378.41
|
| Rate for Payer: PACE SWMI |
$398.33
|
| Rate for Payer: PHP Commercial |
$993.62
|
| 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 |
$736.44
|
| 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) |
$759.82
|
| Rate for Payer: UHC Core |
$609.03
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$398.33
|
| Rate for Payer: UHC Exchange |
$459.40
|
| Rate for Payer: UHC Medicaid |
$208.33
|
| Rate for Payer: UHCCP Medicaid |
$208.33
|
| Rate for Payer: UMR Bronson Commercial |
$432.52
|
| Rate for Payer: VA VA |
$398.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$876.72
|
|
|
HC NM MECKELS OR ABD
|
Facility
|
IP
|
$1,168.96
|
|
|
Service Code
|
CPT 78290
|
| Hospital Charge Code |
34100021
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$514.34 |
| Max. Negotiated Rate |
$1,052.06 |
| Rate for Payer: Aetna American Axle |
$759.82
|
| Rate for Payer: Aetna Commercial |
$993.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$759.82
|
| Rate for Payer: Cash Price |
$935.17
|
| Rate for Payer: Cofinity Advantage |
$818.27
|
| Rate for Payer: Cofinity Commercial |
$1,005.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$935.17
|
| Rate for Payer: Healthscope Commercial |
$1,052.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$818.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$876.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$993.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$876.72
|
| Rate for Payer: PHP Commercial |
$993.62
|
| Rate for Payer: Priority Health SBD |
$736.44
|
| Rate for Payer: UMR Bronson Commercial |
$514.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$876.72
|
|
|
HC NM MYOCARD PERF SPECT EF WM MU
|
Facility
|
IP
|
$5,230.77
|
|
|
Service Code
|
CPT 78452
|
| Hospital Charge Code |
34100029
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$2,301.54 |
| Max. Negotiated Rate |
$4,707.69 |
| Rate for Payer: Aetna American Axle |
$3,400.00
|
| Rate for Payer: Aetna Commercial |
$4,446.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,400.00
|
| Rate for Payer: Cash Price |
$4,184.62
|
| Rate for Payer: Cofinity Advantage |
$3,661.54
|
| Rate for Payer: Cofinity Commercial |
$4,498.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,184.62
|
| Rate for Payer: Healthscope Commercial |
$4,707.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,661.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,923.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,446.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,923.08
|
| Rate for Payer: PHP Commercial |
$4,446.15
|
| Rate for Payer: Priority Health SBD |
$3,295.39
|
| Rate for Payer: UMR Bronson Commercial |
$2,301.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,923.08
|
|
|
HC NM MYOCARD PERF SPECT EF WM MU
|
Facility
|
OP
|
$5,230.77
|
|
|
Service Code
|
CPT 78452
|
| Hospital Charge Code |
34100029
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$674.66 |
| Max. Negotiated Rate |
$4,707.69 |
| Rate for Payer: Aetna American Axle |
$3,400.00
|
| Rate for Payer: Aetna Commercial |
$4,446.15
|
| Rate for Payer: Aetna Medicare |
$1,341.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,400.00
|
| 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 |
$854.56
|
| Rate for Payer: BCN Commercial |
$854.56
|
| Rate for Payer: BCN Medicare Advantage |
$1,289.99
|
| Rate for Payer: Cash Price |
$4,184.62
|
| Rate for Payer: Cash Price |
$4,184.62
|
| Rate for Payer: Cofinity Advantage |
$3,661.54
|
| Rate for Payer: Cofinity Commercial |
$4,498.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,184.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,289.99
|
| Rate for Payer: Healthscope Commercial |
$4,707.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,661.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,923.08
|
| 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 |
$4,446.15
|
| Rate for Payer: Nomi Health Commercial |
$3,869.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,923.08
|
| Rate for Payer: PACE Medicare |
$1,225.49
|
| Rate for Payer: PACE SWMI |
$1,289.99
|
| Rate for Payer: PHP Commercial |
$4,446.15
|
| 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 |
$3,295.39
|
| 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) |
$3,400.00
|
| Rate for Payer: UHC Core |
$2,725.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,289.99
|
| Rate for Payer: UHC Exchange |
$2,055.69
|
| Rate for Payer: UHC Medicaid |
$674.66
|
| Rate for Payer: UHCCP Medicaid |
$674.66
|
| Rate for Payer: UMR Bronson Commercial |
$1,935.38
|
| Rate for Payer: VA VA |
$1,289.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,923.08
|
|
|
HC NM MYOCARD PERF SPECT EF WM SI
|
Facility
|
OP
|
$1,868.13
|
|
|
Service Code
|
CPT 78451
|
| Hospital Charge Code |
34100067
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$598.44 |
| Max. Negotiated Rate |
$4,171.73 |
| Rate for Payer: Aetna American Axle |
$1,214.28
|
| Rate for Payer: Aetna Commercial |
$1,587.91
|
| Rate for Payer: Aetna Medicare |
$1,341.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,214.28
|
| 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 |
$598.44
|
| Rate for Payer: BCN Commercial |
$598.44
|
| Rate for Payer: BCN Medicare Advantage |
$1,289.99
|
| Rate for Payer: Cash Price |
$1,494.50
|
| Rate for Payer: Cash Price |
$1,494.50
|
| Rate for Payer: Cofinity Advantage |
$1,307.69
|
| Rate for Payer: Cofinity Commercial |
$1,606.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,494.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,289.99
|
| Rate for Payer: Healthscope Commercial |
$1,681.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,307.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,401.10
|
| 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 |
$1,587.91
|
| Rate for Payer: Nomi Health Commercial |
$3,869.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,401.10
|
| Rate for Payer: PACE Medicare |
$1,225.49
|
| Rate for Payer: PACE SWMI |
$1,289.99
|
| Rate for Payer: PHP Commercial |
$1,587.91
|
| 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 |
$1,176.92
|
| 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) |
$1,214.28
|
| Rate for Payer: UHC Core |
$973.30
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,289.99
|
| Rate for Payer: UHC Exchange |
$734.18
|
| Rate for Payer: UHC Medicaid |
$674.66
|
| Rate for Payer: UHCCP Medicaid |
$674.66
|
| Rate for Payer: UMR Bronson Commercial |
$691.21
|
| Rate for Payer: VA VA |
$1,289.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,401.10
|
|
|
HC NM MYOCARD PERF SPECT EF WM SI
|
Facility
|
IP
|
$1,868.13
|
|
|
Service Code
|
CPT 78451
|
| Hospital Charge Code |
34100067
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$821.98 |
| Max. Negotiated Rate |
$1,681.32 |
| Rate for Payer: Aetna American Axle |
$1,214.28
|
| Rate for Payer: Aetna Commercial |
$1,587.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,214.28
|
| Rate for Payer: Cash Price |
$1,494.50
|
| Rate for Payer: Cofinity Advantage |
$1,307.69
|
| Rate for Payer: Cofinity Commercial |
$1,606.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,494.50
|
| Rate for Payer: Healthscope Commercial |
$1,681.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,307.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,401.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,587.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,401.10
|
| Rate for Payer: PHP Commercial |
$1,587.91
|
| Rate for Payer: Priority Health SBD |
$1,176.92
|
| Rate for Payer: UMR Bronson Commercial |
$821.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,401.10
|
|
|
HC NMO/AQP4 FACS TITER SERUM
|
Facility
|
IP
|
$104.04
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
30200395
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$45.78 |
| Max. Negotiated Rate |
$93.64 |
| Rate for Payer: Aetna American Axle |
$67.63
|
| Rate for Payer: Aetna Commercial |
$88.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.63
|
| Rate for Payer: Cash Price |
$83.23
|
| Rate for Payer: Cofinity Advantage |
$72.83
|
| Rate for Payer: Cofinity Commercial |
$89.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.23
|
| Rate for Payer: Healthscope Commercial |
$93.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$72.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.03
|
| Rate for Payer: PHP Commercial |
$88.43
|
| Rate for Payer: Priority Health SBD |
$65.55
|
| Rate for Payer: UMR Bronson Commercial |
$45.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.03
|
|
|
HC NMO/AQP4 FACS TITER SERUM
|
Facility
|
OP
|
$104.04
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
30200395
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$93.64 |
| Rate for Payer: Aetna American Axle |
$67.63
|
| Rate for Payer: Aetna Commercial |
$88.43
|
| Rate for Payer: Aetna Medicare |
$12.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.63
|
| 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 |
$83.23
|
| Rate for Payer: Cash Price |
$83.23
|
| Rate for Payer: Cofinity Advantage |
$72.83
|
| Rate for Payer: Cofinity Commercial |
$89.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$93.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$72.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.03
|
| 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 |
$88.43
|
| Rate for Payer: Nomi Health Commercial |
$18.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.03
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$88.43
|
| 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 |
$65.55
|
| 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 |
$38.49
|
| Rate for Payer: VA VA |
$12.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.03
|
|
|
HC NMO/AQP4-IGG CBA, S
|
Facility
|
OP
|
$358.94
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200422
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$323.05 |
| Rate for Payer: Aetna American Axle |
$233.31
|
| Rate for Payer: Aetna Commercial |
$305.10
|
| Rate for Payer: Aetna Medicare |
$12.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$233.31
|
| 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 |
$287.15
|
| Rate for Payer: Cash Price |
$287.15
|
| Rate for Payer: Cofinity Advantage |
$251.26
|
| Rate for Payer: Cofinity Commercial |
$308.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$287.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$323.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$251.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$269.20
|
| 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 |
$305.10
|
| Rate for Payer: Nomi Health Commercial |
$18.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$269.20
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$305.10
|
| 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 |
$226.13
|
| 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 |
$132.81
|
| Rate for Payer: VA VA |
$12.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$269.20
|
|
|
HC NMO/AQP4-IGG CBA, S
|
Facility
|
IP
|
$358.94
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200422
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$157.93 |
| Max. Negotiated Rate |
$323.05 |
| Rate for Payer: Aetna American Axle |
$233.31
|
| Rate for Payer: Aetna Commercial |
$305.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$233.31
|
| Rate for Payer: Cash Price |
$287.15
|
| Rate for Payer: Cofinity Advantage |
$251.26
|
| Rate for Payer: Cofinity Commercial |
$308.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$287.15
|
| Rate for Payer: Healthscope Commercial |
$323.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$251.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$269.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$305.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$269.20
|
| Rate for Payer: PHP Commercial |
$305.10
|
| Rate for Payer: Priority Health SBD |
$226.13
|
| Rate for Payer: UMR Bronson Commercial |
$157.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$269.20
|
|
|
HC NMO/AQUAPO 4 IGG CBA
|
Facility
|
IP
|
$357.90
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200394
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$157.48 |
| Max. Negotiated Rate |
$322.11 |
| Rate for Payer: Aetna American Axle |
$232.63
|
| Rate for Payer: Aetna Commercial |
$304.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$232.63
|
| Rate for Payer: Cash Price |
$286.32
|
| Rate for Payer: Cofinity Advantage |
$250.53
|
| Rate for Payer: Cofinity Commercial |
$307.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$286.32
|
| Rate for Payer: Healthscope Commercial |
$322.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$250.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$268.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$304.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$268.43
|
| Rate for Payer: PHP Commercial |
$304.21
|
| Rate for Payer: Priority Health SBD |
$225.48
|
| Rate for Payer: UMR Bronson Commercial |
$157.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$268.43
|
|
|
HC NMO/AQUAPO 4 IGG CBA
|
Facility
|
OP
|
$357.90
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200394
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$322.11 |
| Rate for Payer: Aetna American Axle |
$232.63
|
| Rate for Payer: Aetna Commercial |
$304.21
|
| Rate for Payer: Aetna Medicare |
$12.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$232.63
|
| 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 |
$286.32
|
| Rate for Payer: Cash Price |
$286.32
|
| Rate for Payer: Cofinity Advantage |
$250.53
|
| Rate for Payer: Cofinity Commercial |
$307.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$286.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$322.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$250.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$268.43
|
| 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 |
$304.21
|
| Rate for Payer: Nomi Health Commercial |
$18.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$268.43
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$304.21
|
| 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 |
$225.48
|
| 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 |
$132.42
|
| Rate for Payer: VA VA |
$12.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$268.43
|
|
