|
HC MICROSPORIDIA DETECTION
|
Facility
|
IP
|
$22.89
|
|
|
Service Code
|
CPT 87015
|
| Hospital Charge Code |
30600070
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.07 |
| Max. Negotiated Rate |
$20.60 |
| Rate for Payer: Aetna American Axle |
$14.88
|
| Rate for Payer: Aetna Commercial |
$19.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.88
|
| Rate for Payer: Cash Price |
$18.31
|
| Rate for Payer: Cofinity Commercial |
$16.02
|
| Rate for Payer: Cofinity Commercial |
$19.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.31
|
| Rate for Payer: Healthscope Commercial |
$20.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.46
|
| Rate for Payer: PHP Commercial |
$19.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.88
|
| Rate for Payer: Priority Health SBD |
$14.42
|
| Rate for Payer: UMR Bronson Commercial |
$10.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.17
|
|
|
HC MICROSPORIDIA DETECTION CMPT
|
Facility
|
OP
|
$32.64
|
|
|
Service Code
|
CPT 87207
|
| Hospital Charge Code |
30600107
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.21 |
| Max. Negotiated Rate |
$29.38 |
| Rate for Payer: Aetna American Axle |
$21.22
|
| Rate for Payer: Aetna Commercial |
$27.74
|
| Rate for Payer: Aetna Medicare |
$6.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.49
|
| Rate for Payer: BCBS Complete |
$3.37
|
| Rate for Payer: BCBS MAPPO |
$5.99
|
| Rate for Payer: BCN Medicare Advantage |
$5.99
|
| Rate for Payer: Cash Price |
$26.11
|
| Rate for Payer: Cash Price |
$26.11
|
| Rate for Payer: Cofinity Commercial |
$28.07
|
| Rate for Payer: Cofinity Commercial |
$22.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.99
|
| Rate for Payer: Healthscope Commercial |
$29.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.48
|
| Rate for Payer: Mclaren Medicaid |
$3.21
|
| Rate for Payer: Mclaren Medicare |
$5.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.29
|
| Rate for Payer: Meridian Medicaid |
$3.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.74
|
| Rate for Payer: PACE Medicare |
$5.69
|
| Rate for Payer: PACE SWMI |
$5.99
|
| Rate for Payer: PHP Commercial |
$27.74
|
| Rate for Payer: PHP Medicare Advantage |
$5.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.22
|
| Rate for Payer: Priority Health Medicare |
$5.99
|
| Rate for Payer: Priority Health SBD |
$20.56
|
| Rate for Payer: Railroad Medicare Medicare |
$5.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.99
|
| Rate for Payer: UHC Exchange |
$11.45
|
| Rate for Payer: UHC Medicare Advantage |
$5.99
|
| Rate for Payer: UHCCP Medicaid |
$3.21
|
| Rate for Payer: UMR Bronson Commercial |
$12.08
|
| Rate for Payer: VA VA |
$5.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.48
|
|
|
HC MICROSPORIDIA DETECTION CMPT
|
Facility
|
IP
|
$32.64
|
|
|
Service Code
|
CPT 87207
|
| Hospital Charge Code |
30600107
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$14.36 |
| Max. Negotiated Rate |
$29.38 |
| Rate for Payer: Aetna American Axle |
$21.22
|
| Rate for Payer: Aetna Commercial |
$27.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.22
|
| Rate for Payer: Cash Price |
$26.11
|
| Rate for Payer: Cofinity Commercial |
$22.85
|
| Rate for Payer: Cofinity Commercial |
$28.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.11
|
| Rate for Payer: Healthscope Commercial |
$29.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.74
|
| Rate for Payer: PHP Commercial |
$27.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.22
|
| Rate for Payer: Priority Health SBD |
$20.56
|
| Rate for Payer: UMR Bronson Commercial |
$14.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.48
|
|
|
HC MICROSPORIDIA PCR
|
Facility
|
IP
|
$375.36
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600285
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$165.16 |
| Max. Negotiated Rate |
$337.82 |
| Rate for Payer: Aetna American Axle |
$243.98
|
| Rate for Payer: Aetna Commercial |
$319.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$243.98
|
| Rate for Payer: Cash Price |
$300.29
|
| Rate for Payer: Cofinity Commercial |
$262.75
|
| Rate for Payer: Cofinity Commercial |
$322.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$262.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$300.29
|
| Rate for Payer: Healthscope Commercial |
$337.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$262.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$281.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$319.06
|
| Rate for Payer: PHP Commercial |
$319.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$243.98
|
| Rate for Payer: Priority Health SBD |
$236.48
|
| Rate for Payer: UMR Bronson Commercial |
$165.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$281.52
|
|
|
HC MICROSPORIDIA PCR
|
Facility
|
OP
|
$375.36
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600285
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.81 |
| Max. Negotiated Rate |
$337.82 |
| Rate for Payer: Aetna American Axle |
$243.98
|
| Rate for Payer: Aetna Commercial |
$319.06
|
| Rate for Payer: Aetna Medicare |
$36.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$243.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: BCBS Complete |
$19.75
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$300.29
|
| Rate for Payer: Cash Price |
$300.29
|
| Rate for Payer: Cofinity Commercial |
$322.81
|
| Rate for Payer: Cofinity Commercial |
$262.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$262.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$300.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$337.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$262.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$281.52
|
| Rate for Payer: Mclaren Medicaid |
$18.81
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: Meridian Medicaid |
$19.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$319.06
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$319.06
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$243.98
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health SBD |
$236.48
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$98.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.09
|
| Rate for Payer: UHC Exchange |
$67.06
|
| Rate for Payer: UHC Medicare Advantage |
$35.09
|
| Rate for Payer: UHCCP Medicaid |
$18.81
|
| Rate for Payer: UMR Bronson Commercial |
$138.88
|
| Rate for Payer: VA VA |
$35.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$281.52
|
|
|
HC MICU OBSERVATION PER HOUR
|
Facility
|
IP
|
$200.94
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200005
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$88.41 |
| Max. Negotiated Rate |
$180.85 |
| Rate for Payer: Aetna American Axle |
$130.61
|
| Rate for Payer: Aetna Commercial |
$170.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.61
|
| Rate for Payer: Cash Price |
$160.75
|
| Rate for Payer: Cofinity Commercial |
$140.66
|
| Rate for Payer: Cofinity Commercial |
$172.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$140.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.75
|
| Rate for Payer: Healthscope Commercial |
$180.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$140.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.80
|
| Rate for Payer: PHP Commercial |
$170.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.61
|
| Rate for Payer: Priority Health SBD |
$126.59
|
| Rate for Payer: UMR Bronson Commercial |
$88.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.71
|
|
|
HC MICU OBSERVATION PER HOUR
|
Facility
|
OP
|
$200.94
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200005
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$74.35 |
| Max. Negotiated Rate |
$4,092.00 |
| Rate for Payer: Aetna American Axle |
$130.61
|
| Rate for Payer: Aetna Commercial |
$170.80
|
| Rate for Payer: Aetna Medicare |
$100.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.61
|
| Rate for Payer: BCBS Complete |
$80.38
|
| Rate for Payer: Cash Price |
$160.75
|
| Rate for Payer: Cash Price |
$160.75
|
| Rate for Payer: Cofinity Commercial |
$172.81
|
| Rate for Payer: Cofinity Commercial |
$140.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$140.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.75
|
| Rate for Payer: Healthscope Commercial |
$180.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$140.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.71
|
| Rate for Payer: Meridian Medicaid |
$1,000.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.80
|
| Rate for Payer: PHP Commercial |
$170.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.61
|
| Rate for Payer: Priority Health SBD |
$126.59
|
| Rate for Payer: UHC Core |
$4,092.00
|
| Rate for Payer: UMR Bronson Commercial |
$74.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.71
|
|
|
HC MILK IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200047
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna American Axle |
$16.50
|
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.04
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$16.00
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$9.98
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.80
|
| Rate for Payer: UMR Bronson Commercial |
$9.39
|
| Rate for Payer: VA VA |
$5.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.04
|
|
|
HC MILK IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200047
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.17 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna American Axle |
$16.50
|
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health SBD |
$16.00
|
| Rate for Payer: UMR Bronson Commercial |
$11.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.04
|
|
|
HC MINI BAL PROCEDURE
|
Facility
|
IP
|
$309.26
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
41000014
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$136.07 |
| Max. Negotiated Rate |
$278.33 |
| Rate for Payer: Aetna American Axle |
$201.02
|
| Rate for Payer: Aetna Commercial |
$262.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$201.02
|
| Rate for Payer: Cash Price |
$247.41
|
| Rate for Payer: Cofinity Commercial |
$216.48
|
| Rate for Payer: Cofinity Commercial |
$265.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$216.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.41
|
| Rate for Payer: Healthscope Commercial |
$278.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$216.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$231.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$262.87
|
| Rate for Payer: PHP Commercial |
$262.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$201.02
|
| Rate for Payer: Priority Health SBD |
$194.83
|
| Rate for Payer: UMR Bronson Commercial |
$136.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$231.94
|
|
|
HC MINI BAL PROCEDURE
|
Facility
|
OP
|
$309.26
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
41000014
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$81.79 |
| Max. Negotiated Rate |
$429.53 |
| Rate for Payer: Aetna American Axle |
$201.02
|
| Rate for Payer: Aetna Commercial |
$262.87
|
| Rate for Payer: Aetna Medicare |
$158.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$201.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$190.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$190.74
|
| Rate for Payer: BCBS Complete |
$85.88
|
| Rate for Payer: BCBS MAPPO |
$152.59
|
| Rate for Payer: BCN Medicare Advantage |
$152.59
|
| Rate for Payer: Cash Price |
$247.41
|
| Rate for Payer: Cash Price |
$247.41
|
| Rate for Payer: Cash Price |
$247.41
|
| Rate for Payer: Cofinity Commercial |
$216.48
|
| Rate for Payer: Cofinity Commercial |
$265.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$216.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$152.59
|
| Rate for Payer: Healthscope Commercial |
$278.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$216.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$231.94
|
| Rate for Payer: Mclaren Medicaid |
$81.79
|
| Rate for Payer: Mclaren Medicare |
$152.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$160.22
|
| Rate for Payer: Meridian Medicaid |
$85.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$175.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$262.87
|
| Rate for Payer: PACE Medicare |
$144.96
|
| Rate for Payer: PACE SWMI |
$152.59
|
| Rate for Payer: PHP Commercial |
$262.87
|
| Rate for Payer: PHP Medicare Advantage |
$152.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$81.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$201.02
|
| Rate for Payer: Priority Health Medicare |
$152.59
|
| Rate for Payer: Priority Health SBD |
$194.83
|
| Rate for Payer: Railroad Medicare Medicare |
$152.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$429.53
|
| Rate for Payer: UHC Core |
$294.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$152.59
|
| Rate for Payer: UHC Exchange |
$291.61
|
| Rate for Payer: UHC Medicare Advantage |
$152.59
|
| Rate for Payer: UHCCP Medicaid |
$81.79
|
| Rate for Payer: UMR Bronson Commercial |
$114.43
|
| Rate for Payer: VA VA |
$152.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$231.94
|
|
|
HC MINIMUM BACTERICIDAL CONCENTRA
|
Facility
|
IP
|
$30.60
|
|
|
Service Code
|
CPT 87188
|
| Hospital Charge Code |
30600103
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$13.46 |
| Max. Negotiated Rate |
$27.54 |
| Rate for Payer: Aetna American Axle |
$19.89
|
| Rate for Payer: Aetna Commercial |
$26.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.89
|
| Rate for Payer: Cash Price |
$24.48
|
| Rate for Payer: Cofinity Commercial |
$21.42
|
| Rate for Payer: Cofinity Commercial |
$26.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.48
|
| Rate for Payer: Healthscope Commercial |
$27.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.01
|
| Rate for Payer: PHP Commercial |
$26.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.89
|
| Rate for Payer: Priority Health SBD |
$19.28
|
| Rate for Payer: UMR Bronson Commercial |
$13.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.95
|
|
|
HC MINIMUM BACTERICIDAL CONCENTRA
|
Facility
|
OP
|
$30.60
|
|
|
Service Code
|
CPT 87188
|
| Hospital Charge Code |
30600103
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.56 |
| Max. Negotiated Rate |
$27.54 |
| Rate for Payer: Aetna American Axle |
$19.89
|
| Rate for Payer: Aetna Commercial |
$26.01
|
| Rate for Payer: Aetna Medicare |
$6.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.30
|
| Rate for Payer: BCBS Complete |
$3.74
|
| Rate for Payer: BCBS MAPPO |
$6.64
|
| Rate for Payer: BCN Medicare Advantage |
$6.64
|
| Rate for Payer: Cash Price |
$24.48
|
| Rate for Payer: Cash Price |
$24.48
|
| Rate for Payer: Cofinity Commercial |
$26.32
|
| Rate for Payer: Cofinity Commercial |
$21.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.64
|
| Rate for Payer: Healthscope Commercial |
$27.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.95
|
| Rate for Payer: Mclaren Medicaid |
$3.56
|
| Rate for Payer: Mclaren Medicare |
$6.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.97
|
| Rate for Payer: Meridian Medicaid |
$3.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.01
|
| Rate for Payer: PACE Medicare |
$6.31
|
| Rate for Payer: PACE SWMI |
$6.64
|
| Rate for Payer: PHP Commercial |
$26.01
|
| Rate for Payer: PHP Medicare Advantage |
$6.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.89
|
| Rate for Payer: Priority Health Medicare |
$6.64
|
| Rate for Payer: Priority Health SBD |
$19.28
|
| Rate for Payer: Railroad Medicare Medicare |
$6.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.64
|
| Rate for Payer: UHC Exchange |
$12.69
|
| Rate for Payer: UHC Medicare Advantage |
$6.64
|
| Rate for Payer: UHCCP Medicaid |
$3.56
|
| Rate for Payer: UMR Bronson Commercial |
$11.32
|
| Rate for Payer: VA VA |
$6.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.95
|
|
|
HC MINIMUM LETHAL CONCENTRATION (MLC)
|
Facility
|
OP
|
$46.82
|
|
|
Service Code
|
CPT 87187
|
| Hospital Charge Code |
30600102
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$17.32 |
| Max. Negotiated Rate |
$113.07 |
| Rate for Payer: Aetna American Axle |
$30.43
|
| Rate for Payer: Aetna Commercial |
$39.80
|
| Rate for Payer: Aetna Medicare |
$41.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$50.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$50.21
|
| Rate for Payer: BCBS Complete |
$22.61
|
| Rate for Payer: BCBS MAPPO |
$40.17
|
| Rate for Payer: BCN Medicare Advantage |
$40.17
|
| Rate for Payer: Cash Price |
$37.46
|
| Rate for Payer: Cash Price |
$37.46
|
| Rate for Payer: Cofinity Commercial |
$40.27
|
| Rate for Payer: Cofinity Commercial |
$32.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$32.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.17
|
| Rate for Payer: Healthscope Commercial |
$42.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.12
|
| Rate for Payer: Mclaren Medicaid |
$21.53
|
| Rate for Payer: Mclaren Medicare |
$40.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$42.18
|
| Rate for Payer: Meridian Medicaid |
$22.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.80
|
| Rate for Payer: PACE Medicare |
$38.16
|
| Rate for Payer: PACE SWMI |
$40.17
|
| Rate for Payer: PHP Commercial |
$39.80
|
| Rate for Payer: PHP Medicare Advantage |
$40.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.43
|
| Rate for Payer: Priority Health Medicare |
$40.17
|
| Rate for Payer: Priority Health SBD |
$29.50
|
| Rate for Payer: Railroad Medicare Medicare |
$40.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$113.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$40.17
|
| Rate for Payer: UHC Exchange |
$76.77
|
| Rate for Payer: UHC Medicare Advantage |
$40.17
|
| Rate for Payer: UHCCP Medicaid |
$21.53
|
| Rate for Payer: UMR Bronson Commercial |
$17.32
|
| Rate for Payer: VA VA |
$40.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.12
|
|
|
HC MINIMUM LETHAL CONCENTRATION (MLC)
|
Facility
|
IP
|
$46.82
|
|
|
Service Code
|
CPT 87187
|
| Hospital Charge Code |
30600102
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$20.60 |
| Max. Negotiated Rate |
$42.14 |
| Rate for Payer: Aetna American Axle |
$30.43
|
| Rate for Payer: Aetna Commercial |
$39.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.43
|
| Rate for Payer: Cash Price |
$37.46
|
| Rate for Payer: Cofinity Commercial |
$32.77
|
| Rate for Payer: Cofinity Commercial |
$40.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$32.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.46
|
| Rate for Payer: Healthscope Commercial |
$42.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.80
|
| Rate for Payer: PHP Commercial |
$39.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.43
|
| Rate for Payer: Priority Health SBD |
$29.50
|
| Rate for Payer: UMR Bronson Commercial |
$20.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.12
|
|
|
HC MINOR PROCEDURE WO SEDATION
|
Facility
|
IP
|
$531.54
|
|
| Hospital Charge Code |
36000076
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$233.88 |
| Max. Negotiated Rate |
$478.39 |
| Rate for Payer: Aetna American Axle |
$345.50
|
| Rate for Payer: Aetna Commercial |
$451.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$345.50
|
| Rate for Payer: Cash Price |
$425.23
|
| Rate for Payer: Cofinity Commercial |
$372.08
|
| Rate for Payer: Cofinity Commercial |
$457.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$372.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$425.23
|
| Rate for Payer: Healthscope Commercial |
$478.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$372.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$398.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$451.81
|
| Rate for Payer: PHP Commercial |
$451.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$345.50
|
| Rate for Payer: Priority Health SBD |
$334.87
|
| Rate for Payer: UMR Bronson Commercial |
$233.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$398.65
|
|
|
HC MINOR PROCEDURE WO SEDATION
|
Facility
|
OP
|
$531.54
|
|
| Hospital Charge Code |
36000076
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$196.67 |
| Max. Negotiated Rate |
$478.39 |
| Rate for Payer: Aetna American Axle |
$345.50
|
| Rate for Payer: Aetna Commercial |
$451.81
|
| Rate for Payer: Aetna Medicare |
$265.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$345.50
|
| Rate for Payer: BCBS Complete |
$212.62
|
| Rate for Payer: Cash Price |
$425.23
|
| Rate for Payer: Cofinity Commercial |
$372.08
|
| Rate for Payer: Cofinity Commercial |
$457.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$372.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$425.23
|
| Rate for Payer: Healthscope Commercial |
$478.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$372.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$398.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$451.81
|
| Rate for Payer: PHP Commercial |
$451.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$345.50
|
| Rate for Payer: Priority Health SBD |
$334.87
|
| Rate for Payer: UMR Bronson Commercial |
$196.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$398.65
|
|
|
HC MINOR PROCEDURE W SEDATION
|
Facility
|
OP
|
$615.92
|
|
| Hospital Charge Code |
36000075
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$227.89 |
| Max. Negotiated Rate |
$554.33 |
| Rate for Payer: Aetna American Axle |
$400.35
|
| Rate for Payer: Aetna Commercial |
$523.53
|
| Rate for Payer: Aetna Medicare |
$307.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$400.35
|
| Rate for Payer: BCBS Complete |
$246.37
|
| Rate for Payer: Cash Price |
$492.74
|
| Rate for Payer: Cofinity Commercial |
$431.14
|
| Rate for Payer: Cofinity Commercial |
$529.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$431.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$492.74
|
| Rate for Payer: Healthscope Commercial |
$554.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$431.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$461.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$523.53
|
| Rate for Payer: PHP Commercial |
$523.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$400.35
|
| Rate for Payer: Priority Health SBD |
$388.03
|
| Rate for Payer: UMR Bronson Commercial |
$227.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$461.94
|
|
|
HC MINOR PROCEDURE W SEDATION
|
Facility
|
IP
|
$615.92
|
|
| Hospital Charge Code |
36000075
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$271.00 |
| Max. Negotiated Rate |
$554.33 |
| Rate for Payer: Aetna American Axle |
$400.35
|
| Rate for Payer: Aetna Commercial |
$523.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$400.35
|
| Rate for Payer: Cash Price |
$492.74
|
| Rate for Payer: Cofinity Commercial |
$431.14
|
| Rate for Payer: Cofinity Commercial |
$529.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$431.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$492.74
|
| Rate for Payer: Healthscope Commercial |
$554.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$431.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$461.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$523.53
|
| Rate for Payer: PHP Commercial |
$523.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$400.35
|
| Rate for Payer: Priority Health SBD |
$388.03
|
| Rate for Payer: UMR Bronson Commercial |
$271.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$461.94
|
|
|
HC MITOTANE (LYSODREN)
|
Facility
|
OP
|
$117.52
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100731
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.99 |
| Max. Negotiated Rate |
$105.77 |
| Rate for Payer: Aetna American Axle |
$76.39
|
| Rate for Payer: Aetna Commercial |
$99.89
|
| Rate for Payer: Aetna Medicare |
$19.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.30
|
| Rate for Payer: BCBS Complete |
$10.49
|
| Rate for Payer: BCBS MAPPO |
$18.64
|
| Rate for Payer: BCN Medicare Advantage |
$18.64
|
| Rate for Payer: Cash Price |
$94.02
|
| Rate for Payer: Cash Price |
$94.02
|
| Rate for Payer: Cofinity Commercial |
$82.26
|
| Rate for Payer: Cofinity Commercial |
$101.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$82.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.64
|
| Rate for Payer: Healthscope Commercial |
$105.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$82.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$88.14
|
| Rate for Payer: Mclaren Medicaid |
$9.99
|
| Rate for Payer: Mclaren Medicare |
$18.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.57
|
| Rate for Payer: Meridian Medicaid |
$10.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.89
|
| Rate for Payer: PACE Medicare |
$17.71
|
| Rate for Payer: PACE SWMI |
$18.64
|
| Rate for Payer: PHP Commercial |
$99.89
|
| Rate for Payer: PHP Medicare Advantage |
$18.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.39
|
| Rate for Payer: Priority Health Medicare |
$18.64
|
| Rate for Payer: Priority Health SBD |
$74.04
|
| Rate for Payer: Railroad Medicare Medicare |
$18.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.64
|
| Rate for Payer: UHC Exchange |
$35.62
|
| Rate for Payer: UHC Medicare Advantage |
$18.64
|
| Rate for Payer: UHCCP Medicaid |
$9.99
|
| Rate for Payer: UMR Bronson Commercial |
$43.48
|
| Rate for Payer: VA VA |
$18.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$88.14
|
|
|
HC MITOTANE (LYSODREN)
|
Facility
|
IP
|
$117.52
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100731
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$51.71 |
| Max. Negotiated Rate |
$105.77 |
| Rate for Payer: Aetna American Axle |
$76.39
|
| Rate for Payer: Aetna Commercial |
$99.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.39
|
| Rate for Payer: Cash Price |
$94.02
|
| Rate for Payer: Cofinity Commercial |
$101.07
|
| Rate for Payer: Cofinity Commercial |
$82.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$82.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.02
|
| Rate for Payer: Healthscope Commercial |
$105.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$82.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$88.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.89
|
| Rate for Payer: PHP Commercial |
$99.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.39
|
| Rate for Payer: Priority Health SBD |
$74.04
|
| Rate for Payer: UMR Bronson Commercial |
$51.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$88.14
|
|
|
HC MMR VACCINE
|
Facility
|
OP
|
$109.24
|
|
|
Service Code
|
CPT 90707
|
| Hospital Charge Code |
63600027
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.42 |
| Max. Negotiated Rate |
$98.32 |
| Rate for Payer: Aetna American Axle |
$71.01
|
| Rate for Payer: Aetna Commercial |
$92.85
|
| Rate for Payer: Aetna Medicare |
$54.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.01
|
| Rate for Payer: BCBS Complete |
$43.70
|
| Rate for Payer: Cash Price |
$87.39
|
| Rate for Payer: Cofinity Commercial |
$76.47
|
| Rate for Payer: Cofinity Commercial |
$93.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$76.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.39
|
| Rate for Payer: Healthscope Commercial |
$98.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$76.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.85
|
| Rate for Payer: PHP Commercial |
$92.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.01
|
| Rate for Payer: Priority Health SBD |
$68.82
|
| Rate for Payer: UMR Bronson Commercial |
$40.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.93
|
|
|
HC MMR VACCINE
|
Facility
|
IP
|
$109.24
|
|
|
Service Code
|
CPT 90707
|
| Hospital Charge Code |
63600027
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$48.07 |
| Max. Negotiated Rate |
$98.32 |
| Rate for Payer: Aetna American Axle |
$71.01
|
| Rate for Payer: Aetna Commercial |
$92.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.01
|
| Rate for Payer: Cash Price |
$87.39
|
| Rate for Payer: Cofinity Commercial |
$76.47
|
| Rate for Payer: Cofinity Commercial |
$93.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$76.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.39
|
| Rate for Payer: Healthscope Commercial |
$98.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$76.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.85
|
| Rate for Payer: PHP Commercial |
$92.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.01
|
| Rate for Payer: Priority Health SBD |
$68.82
|
| Rate for Payer: UMR Bronson Commercial |
$48.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.93
|
|
|
HC MNT GROUP 2ND REFERRAL 30 MIN
|
Facility
|
IP
|
$51.60
|
|
|
Service Code
|
HCPCS G0271
|
| Hospital Charge Code |
94200009
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$22.70 |
| Max. Negotiated Rate |
$46.44 |
| Rate for Payer: Aetna American Axle |
$33.54
|
| Rate for Payer: Aetna Commercial |
$43.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.54
|
| Rate for Payer: Cash Price |
$41.28
|
| Rate for Payer: Cofinity Commercial |
$36.12
|
| Rate for Payer: Cofinity Commercial |
$44.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$36.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.28
|
| Rate for Payer: Healthscope Commercial |
$46.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$36.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.86
|
| Rate for Payer: PHP Commercial |
$43.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.54
|
| Rate for Payer: Priority Health SBD |
$32.51
|
| Rate for Payer: UMR Bronson Commercial |
$22.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.70
|
|
|
HC MNT GROUP 2ND REFERRAL 30 MIN
|
Facility
|
OP
|
$51.60
|
|
|
Service Code
|
HCPCS G0271
|
| Hospital Charge Code |
94200009
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$19.09 |
| Max. Negotiated Rate |
$294.00 |
| Rate for Payer: Aetna American Axle |
$33.54
|
| Rate for Payer: Aetna Commercial |
$43.86
|
| Rate for Payer: Aetna Medicare |
$25.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.54
|
| Rate for Payer: BCBS Complete |
$20.64
|
| Rate for Payer: Cash Price |
$41.28
|
| Rate for Payer: Cash Price |
$41.28
|
| Rate for Payer: Cofinity Commercial |
$44.38
|
| Rate for Payer: Cofinity Commercial |
$36.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$36.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.28
|
| Rate for Payer: Healthscope Commercial |
$46.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$36.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.86
|
| Rate for Payer: PHP Commercial |
$43.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.54
|
| Rate for Payer: Priority Health SBD |
$32.51
|
| Rate for Payer: UHC Core |
$294.00
|
| Rate for Payer: UMR Bronson Commercial |
$19.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.70
|
|
