|
HC OPIATE URIN
|
Facility
|
OP
|
$111.25
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000129
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.50 |
| Max. Negotiated Rate |
$100.12 |
| Rate for Payer: Aetna American Axle |
$72.31
|
| Rate for Payer: Aetna Commercial |
$94.56
|
| Rate for Payer: Aetna Medicare |
$64.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.67
|
| Rate for Payer: BCBS Complete |
$34.13
|
| Rate for Payer: BCBS MAPPO |
$62.14
|
| Rate for Payer: BCBS Trust/PPO |
$71.84
|
| Rate for Payer: BCN Commercial |
$71.84
|
| Rate for Payer: BCN Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$89.00
|
| Rate for Payer: Cash Price |
$89.00
|
| Rate for Payer: Cofinity Advantage |
$77.88
|
| Rate for Payer: Cofinity Commercial |
$95.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Healthscope Commercial |
$100.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$77.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.44
|
| Rate for Payer: Mclaren Medicaid |
$62.14
|
| Rate for Payer: Mclaren Medicare |
$62.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.25
|
| Rate for Payer: Meridian Medicaid |
$65.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$68.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.56
|
| Rate for Payer: Nomi Health Commercial |
$93.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.44
|
| Rate for Payer: PACE Medicare |
$59.03
|
| Rate for Payer: PACE SWMI |
$62.14
|
| Rate for Payer: PHP Commercial |
$94.56
|
| Rate for Payer: PHP Medicare Advantage |
$62.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$62.14
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: Priority Health SBD |
$70.09
|
| Rate for Payer: Priority Health Tiered Network |
$49.71
|
| Rate for Payer: Railroad Medicare Medicare |
$62.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93.21
|
| Rate for Payer: UHC Core |
$93.21
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$62.14
|
| Rate for Payer: UHC Exchange |
$93.21
|
| Rate for Payer: UHC Medicaid |
$32.50
|
| Rate for Payer: UHCCP Medicaid |
$32.50
|
| Rate for Payer: UMR Bronson Commercial |
$41.16
|
| Rate for Payer: VA VA |
$62.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.44
|
|
|
HC OPIATE URIN
|
Facility
|
IP
|
$111.25
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000129
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$48.95 |
| Max. Negotiated Rate |
$100.12 |
| Rate for Payer: Aetna American Axle |
$72.31
|
| Rate for Payer: Aetna Commercial |
$94.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.31
|
| Rate for Payer: Cash Price |
$89.00
|
| Rate for Payer: Cofinity Advantage |
$77.88
|
| Rate for Payer: Cofinity Commercial |
$95.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.00
|
| Rate for Payer: Healthscope Commercial |
$100.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$77.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.44
|
| Rate for Payer: PHP Commercial |
$94.56
|
| Rate for Payer: Priority Health SBD |
$70.09
|
| Rate for Payer: UMR Bronson Commercial |
$48.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.44
|
|
|
HC OPIATE URINE CONFIRM
|
Facility
|
OP
|
$64.50
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
30100579
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.86 |
| Max. Negotiated Rate |
$58.05 |
| Rate for Payer: Aetna American Axle |
$41.92
|
| Rate for Payer: Aetna Commercial |
$54.83
|
| Rate for Payer: Aetna Medicare |
$32.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.92
|
| Rate for Payer: BCBS Complete |
$25.80
|
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cofinity Advantage |
$45.15
|
| Rate for Payer: Cofinity Commercial |
$55.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.60
|
| Rate for Payer: Healthscope Commercial |
$58.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.38
|
| Rate for Payer: PHP Commercial |
$54.83
|
| Rate for Payer: Priority Health SBD |
$40.63
|
| Rate for Payer: UMR Bronson Commercial |
$23.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.38
|
|
|
HC OPIATE URINE CONFIRM
|
Facility
|
IP
|
$64.50
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
30100579
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.38 |
| Max. Negotiated Rate |
$58.05 |
| Rate for Payer: Aetna American Axle |
$41.92
|
| Rate for Payer: Aetna Commercial |
$54.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.92
|
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cofinity Advantage |
$45.15
|
| Rate for Payer: Cofinity Commercial |
$55.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.60
|
| Rate for Payer: Healthscope Commercial |
$58.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.38
|
| Rate for Payer: PHP Commercial |
$54.83
|
| Rate for Payer: Priority Health SBD |
$40.63
|
| Rate for Payer: UMR Bronson Commercial |
$28.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.38
|
|
|
HC OPIOID DRUG PANEL URIN
|
Facility
|
IP
|
$31.83
|
|
|
Service Code
|
CPT 80305
|
| Hospital Charge Code |
30100645
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.01 |
| Max. Negotiated Rate |
$28.65 |
| Rate for Payer: Aetna American Axle |
$20.69
|
| Rate for Payer: Aetna Commercial |
$27.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.69
|
| Rate for Payer: Cash Price |
$25.46
|
| Rate for Payer: Cofinity Advantage |
$22.28
|
| Rate for Payer: Cofinity Commercial |
$27.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.46
|
| Rate for Payer: Healthscope Commercial |
$28.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.87
|
| Rate for Payer: PHP Commercial |
$27.06
|
| Rate for Payer: Priority Health SBD |
$20.05
|
| Rate for Payer: UMR Bronson Commercial |
$14.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.87
|
|
|
HC OPIOID DRUG PANEL URIN
|
Facility
|
OP
|
$31.83
|
|
|
Service Code
|
CPT 80305
|
| Hospital Charge Code |
30100645
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.59 |
| Max. Negotiated Rate |
$28.65 |
| Rate for Payer: Aetna American Axle |
$20.69
|
| Rate for Payer: Aetna Commercial |
$27.06
|
| Rate for Payer: Aetna Medicare |
$13.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.75
|
| Rate for Payer: BCBS Complete |
$6.92
|
| Rate for Payer: BCBS MAPPO |
$12.60
|
| Rate for Payer: BCBS Trust/PPO |
$14.57
|
| Rate for Payer: BCN Commercial |
$14.57
|
| Rate for Payer: BCN Medicare Advantage |
$12.60
|
| Rate for Payer: Cash Price |
$25.46
|
| Rate for Payer: Cash Price |
$25.46
|
| Rate for Payer: Cofinity Advantage |
$22.28
|
| Rate for Payer: Cofinity Commercial |
$27.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.60
|
| Rate for Payer: Healthscope Commercial |
$28.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.87
|
| Rate for Payer: Mclaren Medicaid |
$12.60
|
| Rate for Payer: Mclaren Medicare |
$12.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.23
|
| Rate for Payer: Meridian Medicaid |
$13.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.06
|
| Rate for Payer: Nomi Health Commercial |
$18.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.87
|
| Rate for Payer: PACE Medicare |
$11.97
|
| Rate for Payer: PACE SWMI |
$12.60
|
| Rate for Payer: PHP Commercial |
$27.06
|
| Rate for Payer: PHP Medicare Advantage |
$12.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12.60
|
| Rate for Payer: Priority Health Medicare |
$12.60
|
| Rate for Payer: Priority Health SBD |
$20.05
|
| Rate for Payer: Priority Health Tiered Network |
$10.08
|
| Rate for Payer: Railroad Medicare Medicare |
$12.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.90
|
| Rate for Payer: UHC Core |
$18.90
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.60
|
| Rate for Payer: UHC Exchange |
$18.90
|
| Rate for Payer: UHC Medicaid |
$6.59
|
| Rate for Payer: UHCCP Medicaid |
$6.59
|
| Rate for Payer: UMR Bronson Commercial |
$11.78
|
| Rate for Payer: VA VA |
$12.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.87
|
|
|
HC OPIOID DRUG PANEL URN.
|
Facility
|
OP
|
$111.25
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100644
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.50 |
| Max. Negotiated Rate |
$100.12 |
| Rate for Payer: Aetna American Axle |
$72.31
|
| Rate for Payer: Aetna Commercial |
$94.56
|
| Rate for Payer: Aetna Medicare |
$64.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.67
|
| Rate for Payer: BCBS Complete |
$34.13
|
| Rate for Payer: BCBS MAPPO |
$62.14
|
| Rate for Payer: BCBS Trust/PPO |
$71.84
|
| Rate for Payer: BCN Commercial |
$71.84
|
| Rate for Payer: BCN Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$89.00
|
| Rate for Payer: Cash Price |
$89.00
|
| Rate for Payer: Cofinity Advantage |
$77.88
|
| Rate for Payer: Cofinity Commercial |
$95.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Healthscope Commercial |
$100.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$77.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.44
|
| Rate for Payer: Mclaren Medicaid |
$62.14
|
| Rate for Payer: Mclaren Medicare |
$62.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.25
|
| Rate for Payer: Meridian Medicaid |
$65.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$68.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.56
|
| Rate for Payer: Nomi Health Commercial |
$93.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.44
|
| Rate for Payer: PACE Medicare |
$59.03
|
| Rate for Payer: PACE SWMI |
$62.14
|
| Rate for Payer: PHP Commercial |
$94.56
|
| Rate for Payer: PHP Medicare Advantage |
$62.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$62.14
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: Priority Health SBD |
$70.09
|
| Rate for Payer: Priority Health Tiered Network |
$49.71
|
| Rate for Payer: Railroad Medicare Medicare |
$62.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93.21
|
| Rate for Payer: UHC Core |
$93.21
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$62.14
|
| Rate for Payer: UHC Exchange |
$93.21
|
| Rate for Payer: UHC Medicaid |
$32.50
|
| Rate for Payer: UHCCP Medicaid |
$32.50
|
| Rate for Payer: UMR Bronson Commercial |
$41.16
|
| Rate for Payer: VA VA |
$62.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.44
|
|
|
HC OPIOID DRUG PANEL URN.
|
Facility
|
IP
|
$111.25
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100644
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.95 |
| Max. Negotiated Rate |
$100.12 |
| Rate for Payer: Aetna American Axle |
$72.31
|
| Rate for Payer: Aetna Commercial |
$94.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.31
|
| Rate for Payer: Cash Price |
$89.00
|
| Rate for Payer: Cofinity Advantage |
$77.88
|
| Rate for Payer: Cofinity Commercial |
$95.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.00
|
| Rate for Payer: Healthscope Commercial |
$100.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$77.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.44
|
| Rate for Payer: PHP Commercial |
$94.56
|
| Rate for Payer: Priority Health SBD |
$70.09
|
| Rate for Payer: UMR Bronson Commercial |
$48.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.44
|
|
|
HC OPIOID DRUG PANEL URN. CMPT
|
Facility
|
IP
|
$96.42
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100646
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.42 |
| Max. Negotiated Rate |
$86.78 |
| Rate for Payer: Aetna American Axle |
$62.67
|
| Rate for Payer: Aetna Commercial |
$81.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.67
|
| Rate for Payer: Cash Price |
$77.14
|
| Rate for Payer: Cofinity Advantage |
$67.49
|
| Rate for Payer: Cofinity Commercial |
$82.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.14
|
| Rate for Payer: Healthscope Commercial |
$86.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$67.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$72.31
|
| Rate for Payer: PHP Commercial |
$81.96
|
| Rate for Payer: Priority Health SBD |
$60.74
|
| Rate for Payer: UMR Bronson Commercial |
$42.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.31
|
|
|
HC OPIOID DRUG PANEL URN. CMPT
|
Facility
|
OP
|
$96.42
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100646
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.50 |
| Max. Negotiated Rate |
$93.21 |
| Rate for Payer: Aetna American Axle |
$62.67
|
| Rate for Payer: Aetna Commercial |
$81.96
|
| Rate for Payer: Aetna Medicare |
$64.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.67
|
| Rate for Payer: BCBS Complete |
$34.13
|
| Rate for Payer: BCBS MAPPO |
$62.14
|
| Rate for Payer: BCBS Trust/PPO |
$71.84
|
| Rate for Payer: BCN Commercial |
$71.84
|
| Rate for Payer: BCN Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$77.14
|
| Rate for Payer: Cash Price |
$77.14
|
| Rate for Payer: Cofinity Advantage |
$67.49
|
| Rate for Payer: Cofinity Commercial |
$82.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Healthscope Commercial |
$86.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$67.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.31
|
| Rate for Payer: Mclaren Medicaid |
$62.14
|
| Rate for Payer: Mclaren Medicare |
$62.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.25
|
| Rate for Payer: Meridian Medicaid |
$65.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$68.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.96
|
| Rate for Payer: Nomi Health Commercial |
$93.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$72.31
|
| Rate for Payer: PACE Medicare |
$59.03
|
| Rate for Payer: PACE SWMI |
$62.14
|
| Rate for Payer: PHP Commercial |
$81.96
|
| Rate for Payer: PHP Medicare Advantage |
$62.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$62.14
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: Priority Health SBD |
$60.74
|
| Rate for Payer: Priority Health Tiered Network |
$49.71
|
| Rate for Payer: Railroad Medicare Medicare |
$62.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93.21
|
| Rate for Payer: UHC Core |
$93.21
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$62.14
|
| Rate for Payer: UHC Exchange |
$93.21
|
| Rate for Payer: UHC Medicaid |
$32.50
|
| Rate for Payer: UHCCP Medicaid |
$32.50
|
| Rate for Payer: UMR Bronson Commercial |
$35.68
|
| Rate for Payer: VA VA |
$62.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.31
|
|
|
HC OPN AX/SUBCLA ART EXPOS DLVR EVASC PROSTH UNI
|
Facility
|
OP
|
$2,091.00
|
|
|
Service Code
|
CPT 34715
|
| Hospital Charge Code |
36000123
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$773.67 |
| Max. Negotiated Rate |
$1,881.90 |
| Rate for Payer: Aetna American Axle |
$1,359.15
|
| Rate for Payer: Aetna Commercial |
$1,777.35
|
| Rate for Payer: Aetna Medicare |
$1,045.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,359.15
|
| Rate for Payer: BCBS Complete |
$836.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,338.67
|
| Rate for Payer: BCN Commercial |
$1,338.67
|
| Rate for Payer: Cash Price |
$1,672.80
|
| Rate for Payer: Cash Price |
$1,672.80
|
| Rate for Payer: Cash Price |
$1,672.80
|
| Rate for Payer: Cofinity Advantage |
$1,463.70
|
| Rate for Payer: Cofinity Commercial |
$1,798.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,672.80
|
| Rate for Payer: Healthscope Commercial |
$1,881.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,463.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,568.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,672.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,777.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,568.25
|
| Rate for Payer: PHP Commercial |
$1,777.35
|
| Rate for Payer: Priority Health SBD |
$1,317.33
|
| Rate for Payer: UMR Bronson Commercial |
$773.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,568.25
|
|
|
HC OPN AX/SUBCLA ART EXPOS DLVR EVASC PROSTH UNI
|
Facility
|
IP
|
$2,091.00
|
|
|
Service Code
|
CPT 34715
|
| Hospital Charge Code |
36000123
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$920.04 |
| Max. Negotiated Rate |
$1,881.90 |
| Rate for Payer: Aetna American Axle |
$1,359.15
|
| Rate for Payer: Aetna Commercial |
$1,777.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,359.15
|
| Rate for Payer: Cash Price |
$1,672.80
|
| Rate for Payer: Cofinity Advantage |
$1,463.70
|
| Rate for Payer: Cofinity Commercial |
$1,798.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,672.80
|
| Rate for Payer: Healthscope Commercial |
$1,881.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,463.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,568.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,777.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,568.25
|
| Rate for Payer: PHP Commercial |
$1,777.35
|
| Rate for Payer: Priority Health SBD |
$1,317.33
|
| Rate for Payer: UMR Bronson Commercial |
$920.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,568.25
|
|
|
HC OPSITE LGE SHEET
|
Facility
|
OP
|
$63.16
|
|
| Hospital Charge Code |
27000128
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$23.37 |
| Max. Negotiated Rate |
$56.84 |
| Rate for Payer: Aetna American Axle |
$41.05
|
| Rate for Payer: Aetna Commercial |
$53.69
|
| Rate for Payer: Aetna Medicare |
$31.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.05
|
| Rate for Payer: BCBS Complete |
$25.26
|
| Rate for Payer: Cash Price |
$50.53
|
| Rate for Payer: Cofinity Advantage |
$44.21
|
| Rate for Payer: Cofinity Commercial |
$54.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.53
|
| Rate for Payer: Healthscope Commercial |
$56.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.37
|
| Rate for Payer: PHP Commercial |
$53.69
|
| Rate for Payer: Priority Health SBD |
$39.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.05
|
| Rate for Payer: UHC Core |
$32.91
|
| Rate for Payer: UHC Exchange |
$24.82
|
| Rate for Payer: UMR Bronson Commercial |
$23.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.37
|
|
|
HC OPSITE LGE SHEET
|
Facility
|
IP
|
$63.16
|
|
| Hospital Charge Code |
27000128
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$27.79 |
| Max. Negotiated Rate |
$56.84 |
| Rate for Payer: Aetna American Axle |
$41.05
|
| Rate for Payer: Aetna Commercial |
$53.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.05
|
| Rate for Payer: Cash Price |
$50.53
|
| Rate for Payer: Cofinity Advantage |
$44.21
|
| Rate for Payer: Cofinity Commercial |
$54.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.53
|
| Rate for Payer: Healthscope Commercial |
$56.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.37
|
| Rate for Payer: PHP Commercial |
$53.69
|
| Rate for Payer: Priority Health SBD |
$39.79
|
| Rate for Payer: UMR Bronson Commercial |
$27.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.37
|
|
|
HC OPTISON 1ST ML
|
Facility
|
IP
|
$93.39
|
|
|
Service Code
|
HCPCS Q9956
|
| Hospital Charge Code |
63600168
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.09 |
| Max. Negotiated Rate |
$84.05 |
| Rate for Payer: Aetna American Axle |
$60.70
|
| Rate for Payer: Aetna Commercial |
$79.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.70
|
| Rate for Payer: Cash Price |
$74.71
|
| Rate for Payer: Cofinity Advantage |
$65.37
|
| Rate for Payer: Cofinity Commercial |
$80.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.71
|
| Rate for Payer: Healthscope Commercial |
$84.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$65.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.04
|
| Rate for Payer: PHP Commercial |
$79.38
|
| Rate for Payer: Priority Health SBD |
$58.84
|
| Rate for Payer: UMR Bronson Commercial |
$41.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.04
|
|
|
HC OPTISON 1ST ML
|
Facility
|
OP
|
$93.39
|
|
|
Service Code
|
HCPCS Q9956
|
| Hospital Charge Code |
63600168
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.55 |
| Max. Negotiated Rate |
$130.36 |
| Rate for Payer: Aetna American Axle |
$60.70
|
| Rate for Payer: Aetna Commercial |
$79.38
|
| Rate for Payer: Aetna Medicare |
$46.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.70
|
| Rate for Payer: BCBS Complete |
$37.36
|
| Rate for Payer: BCBS Trust/PPO |
$130.36
|
| Rate for Payer: BCN Commercial |
$130.36
|
| Rate for Payer: Cash Price |
$74.71
|
| Rate for Payer: Cash Price |
$74.71
|
| Rate for Payer: Cofinity Advantage |
$65.37
|
| Rate for Payer: Cofinity Commercial |
$80.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.71
|
| Rate for Payer: Healthscope Commercial |
$84.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$65.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$74.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.04
|
| Rate for Payer: PHP Commercial |
$79.38
|
| Rate for Payer: Priority Health SBD |
$58.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.35
|
| Rate for Payer: UHC Core |
$66.35
|
| Rate for Payer: UHC Exchange |
$66.35
|
| Rate for Payer: UMR Bronson Commercial |
$34.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.04
|
|
|
HC OPTISON 2ND ML
|
Facility
|
OP
|
$93.39
|
|
|
Service Code
|
HCPCS Q9956
|
| Hospital Charge Code |
63600169
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.55 |
| Max. Negotiated Rate |
$130.36 |
| Rate for Payer: Aetna American Axle |
$60.70
|
| Rate for Payer: Aetna Commercial |
$79.38
|
| Rate for Payer: Aetna Medicare |
$46.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.70
|
| Rate for Payer: BCBS Complete |
$37.36
|
| Rate for Payer: BCBS Trust/PPO |
$130.36
|
| Rate for Payer: BCN Commercial |
$130.36
|
| Rate for Payer: Cash Price |
$74.71
|
| Rate for Payer: Cash Price |
$74.71
|
| Rate for Payer: Cofinity Advantage |
$65.37
|
| Rate for Payer: Cofinity Commercial |
$80.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.71
|
| Rate for Payer: Healthscope Commercial |
$84.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$65.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$74.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.04
|
| Rate for Payer: PHP Commercial |
$79.38
|
| Rate for Payer: Priority Health SBD |
$58.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.35
|
| Rate for Payer: UHC Core |
$66.35
|
| Rate for Payer: UHC Exchange |
$66.35
|
| Rate for Payer: UMR Bronson Commercial |
$34.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.04
|
|
|
HC OPTISON 2ND ML
|
Facility
|
IP
|
$93.39
|
|
|
Service Code
|
HCPCS Q9956
|
| Hospital Charge Code |
63600169
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.09 |
| Max. Negotiated Rate |
$84.05 |
| Rate for Payer: Aetna American Axle |
$60.70
|
| Rate for Payer: Aetna Commercial |
$79.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.70
|
| Rate for Payer: Cash Price |
$74.71
|
| Rate for Payer: Cofinity Advantage |
$65.37
|
| Rate for Payer: Cofinity Commercial |
$80.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.71
|
| Rate for Payer: Healthscope Commercial |
$84.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$65.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.04
|
| Rate for Payer: PHP Commercial |
$79.38
|
| Rate for Payer: Priority Health SBD |
$58.84
|
| Rate for Payer: UMR Bronson Commercial |
$41.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.04
|
|
|
HC OPTISON 3RD ML
|
Facility
|
OP
|
$93.39
|
|
|
Service Code
|
HCPCS Q9956
|
| Hospital Charge Code |
63600170
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.55 |
| Max. Negotiated Rate |
$130.36 |
| Rate for Payer: Aetna American Axle |
$60.70
|
| Rate for Payer: Aetna Commercial |
$79.38
|
| Rate for Payer: Aetna Medicare |
$46.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.70
|
| Rate for Payer: BCBS Complete |
$37.36
|
| Rate for Payer: BCBS Trust/PPO |
$130.36
|
| Rate for Payer: BCN Commercial |
$130.36
|
| Rate for Payer: Cash Price |
$74.71
|
| Rate for Payer: Cash Price |
$74.71
|
| Rate for Payer: Cofinity Advantage |
$65.37
|
| Rate for Payer: Cofinity Commercial |
$80.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.71
|
| Rate for Payer: Healthscope Commercial |
$84.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$65.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$74.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.04
|
| Rate for Payer: PHP Commercial |
$79.38
|
| Rate for Payer: Priority Health SBD |
$58.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.35
|
| Rate for Payer: UHC Core |
$66.35
|
| Rate for Payer: UHC Exchange |
$66.35
|
| Rate for Payer: UMR Bronson Commercial |
$34.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.04
|
|
|
HC OPTISON 3RD ML
|
Facility
|
IP
|
$93.39
|
|
|
Service Code
|
HCPCS Q9956
|
| Hospital Charge Code |
63600170
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.09 |
| Max. Negotiated Rate |
$84.05 |
| Rate for Payer: Aetna American Axle |
$60.70
|
| Rate for Payer: Aetna Commercial |
$79.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.70
|
| Rate for Payer: Cash Price |
$74.71
|
| Rate for Payer: Cofinity Advantage |
$65.37
|
| Rate for Payer: Cofinity Commercial |
$80.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.71
|
| Rate for Payer: Healthscope Commercial |
$84.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$65.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.04
|
| Rate for Payer: PHP Commercial |
$79.38
|
| Rate for Payer: Priority Health SBD |
$58.84
|
| Rate for Payer: UMR Bronson Commercial |
$41.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.04
|
|
|
HC OP VISIT LEVEL 1
|
Facility
|
IP
|
$154.65
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000015
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$68.05 |
| Max. Negotiated Rate |
$139.19 |
| Rate for Payer: Aetna American Axle |
$100.52
|
| Rate for Payer: Aetna Commercial |
$131.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.52
|
| Rate for Payer: Cash Price |
$123.72
|
| Rate for Payer: Cofinity Advantage |
$108.25
|
| Rate for Payer: Cofinity Commercial |
$133.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.72
|
| Rate for Payer: Healthscope Commercial |
$139.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$108.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$115.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$115.99
|
| Rate for Payer: PHP Commercial |
$131.45
|
| Rate for Payer: Priority Health SBD |
$97.43
|
| Rate for Payer: UMR Bronson Commercial |
$68.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$115.99
|
|
|
HC OP VISIT LEVEL 1
|
Facility
|
OP
|
$154.65
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000015
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$21.87 |
| Max. Negotiated Rate |
$139.19 |
| Rate for Payer: Aetna American Axle |
$100.52
|
| Rate for Payer: Aetna Commercial |
$131.45
|
| Rate for Payer: Aetna Medicare |
$77.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.52
|
| Rate for Payer: BCBS Complete |
$61.86
|
| Rate for Payer: BCBS Trust/PPO |
$47.11
|
| Rate for Payer: BCCCP Commercial |
$21.87
|
| Rate for Payer: BCN Commercial |
$47.11
|
| Rate for Payer: Cash Price |
$123.72
|
| Rate for Payer: Cash Price |
$123.72
|
| Rate for Payer: Cofinity Advantage |
$108.25
|
| Rate for Payer: Cofinity Commercial |
$133.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.72
|
| Rate for Payer: Healthscope Commercial |
$139.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$108.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$115.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$123.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$115.99
|
| Rate for Payer: PHP Commercial |
$131.45
|
| Rate for Payer: Priority Health SBD |
$97.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$100.52
|
| Rate for Payer: UHC Core |
$80.57
|
| Rate for Payer: UHC Exchange |
$60.78
|
| Rate for Payer: UMR Bronson Commercial |
$57.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$115.99
|
|
|
HC OP VISIT LEVEL 2
|
Facility
|
IP
|
$174.09
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
51000020
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$76.60 |
| Max. Negotiated Rate |
$156.68 |
| Rate for Payer: Aetna American Axle |
$113.16
|
| Rate for Payer: Aetna Commercial |
$147.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.16
|
| Rate for Payer: Cash Price |
$139.27
|
| Rate for Payer: Cofinity Advantage |
$121.86
|
| Rate for Payer: Cofinity Commercial |
$149.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.27
|
| Rate for Payer: Healthscope Commercial |
$156.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$121.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$130.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$130.57
|
| Rate for Payer: PHP Commercial |
$147.98
|
| Rate for Payer: Priority Health SBD |
$109.68
|
| Rate for Payer: UMR Bronson Commercial |
$76.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$130.57
|
|
|
HC OP VISIT LEVEL 2
|
Facility
|
OP
|
$174.09
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
51000020
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$21.87 |
| Max. Negotiated Rate |
$156.68 |
| Rate for Payer: Aetna American Axle |
$113.16
|
| Rate for Payer: Aetna Commercial |
$147.98
|
| Rate for Payer: Aetna Medicare |
$87.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.16
|
| Rate for Payer: BCBS Complete |
$69.64
|
| Rate for Payer: BCBS Trust/PPO |
$84.65
|
| Rate for Payer: BCCCP Commercial |
$21.87
|
| Rate for Payer: BCN Commercial |
$84.65
|
| Rate for Payer: Cash Price |
$139.27
|
| Rate for Payer: Cash Price |
$139.27
|
| Rate for Payer: Cofinity Advantage |
$121.86
|
| Rate for Payer: Cofinity Commercial |
$149.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.27
|
| Rate for Payer: Healthscope Commercial |
$156.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$121.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$130.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$139.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$130.57
|
| Rate for Payer: PHP Commercial |
$147.98
|
| Rate for Payer: Priority Health SBD |
$109.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$113.16
|
| Rate for Payer: UHC Core |
$90.70
|
| Rate for Payer: UHC Exchange |
$68.42
|
| Rate for Payer: UMR Bronson Commercial |
$64.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$130.57
|
|
|
HC OP VISIT LEVEL 3
|
Facility
|
OP
|
$211.25
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
51000026
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$78.16 |
| Max. Negotiated Rate |
$190.12 |
| Rate for Payer: Aetna American Axle |
$137.31
|
| Rate for Payer: Aetna Commercial |
$179.56
|
| Rate for Payer: Aetna Medicare |
$105.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.31
|
| Rate for Payer: BCBS Complete |
$84.50
|
| Rate for Payer: BCBS Trust/PPO |
$114.04
|
| Rate for Payer: BCCCP Commercial |
$87.68
|
| Rate for Payer: BCN Commercial |
$114.04
|
| Rate for Payer: Cash Price |
$169.00
|
| Rate for Payer: Cash Price |
$169.00
|
| Rate for Payer: Cofinity Advantage |
$147.88
|
| Rate for Payer: Cofinity Commercial |
$181.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.00
|
| Rate for Payer: Healthscope Commercial |
$190.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$147.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$169.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$179.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$158.44
|
| Rate for Payer: PHP Commercial |
$179.56
|
| Rate for Payer: Priority Health SBD |
$133.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$137.31
|
| Rate for Payer: UHC Core |
$110.06
|
| Rate for Payer: UHC Exchange |
$83.02
|
| Rate for Payer: UMR Bronson Commercial |
$78.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$158.44
|
|
