|
HC OP VISIT LEVEL 3
|
Facility
|
IP
|
$211.25
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
51000026
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$92.95 |
| Max. Negotiated Rate |
$190.12 |
| Rate for Payer: Aetna American Axle |
$137.31
|
| Rate for Payer: Aetna Commercial |
$179.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.31
|
| 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: 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: UMR Bronson Commercial |
$92.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$158.44
|
|
|
HC OP VISIT LEVEL 4
|
Facility
|
IP
|
$303.37
|
|
|
Service Code
|
CPT 99214
|
| Hospital Charge Code |
51000030
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$133.48 |
| Max. Negotiated Rate |
$273.03 |
| Rate for Payer: Aetna American Axle |
$197.19
|
| Rate for Payer: Aetna Commercial |
$257.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$197.19
|
| Rate for Payer: Cash Price |
$242.70
|
| Rate for Payer: Cofinity Advantage |
$212.36
|
| Rate for Payer: Cofinity Commercial |
$260.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.70
|
| Rate for Payer: Healthscope Commercial |
$273.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$212.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$227.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$257.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$227.53
|
| Rate for Payer: PHP Commercial |
$257.86
|
| Rate for Payer: Priority Health SBD |
$191.12
|
| Rate for Payer: UMR Bronson Commercial |
$133.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$227.53
|
|
|
HC OP VISIT LEVEL 4
|
Facility
|
OP
|
$303.37
|
|
|
Service Code
|
CPT 99214
|
| Hospital Charge Code |
51000030
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$87.68 |
| Max. Negotiated Rate |
$273.03 |
| Rate for Payer: Aetna American Axle |
$197.19
|
| Rate for Payer: Aetna Commercial |
$257.86
|
| Rate for Payer: Aetna Medicare |
$151.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$197.19
|
| Rate for Payer: BCBS Complete |
$121.35
|
| Rate for Payer: BCBS Trust/PPO |
$155.99
|
| Rate for Payer: BCCCP Commercial |
$87.68
|
| Rate for Payer: BCN Commercial |
$155.99
|
| Rate for Payer: Cash Price |
$242.70
|
| Rate for Payer: Cash Price |
$242.70
|
| Rate for Payer: Cofinity Advantage |
$212.36
|
| Rate for Payer: Cofinity Commercial |
$260.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.70
|
| Rate for Payer: Healthscope Commercial |
$273.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$212.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$227.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$242.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$257.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$227.53
|
| Rate for Payer: PHP Commercial |
$257.86
|
| Rate for Payer: Priority Health SBD |
$191.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$197.19
|
| Rate for Payer: UHC Core |
$158.06
|
| Rate for Payer: UHC Exchange |
$119.22
|
| Rate for Payer: UMR Bronson Commercial |
$112.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$227.53
|
|
|
HC OP VISIT LEVEL 5
|
Facility
|
OP
|
$505.14
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
51000037
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$186.90 |
| Max. Negotiated Rate |
$454.63 |
| Rate for Payer: Aetna American Axle |
$328.34
|
| Rate for Payer: Aetna Commercial |
$429.37
|
| Rate for Payer: Aetna Medicare |
$252.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$328.34
|
| Rate for Payer: BCBS Complete |
$202.06
|
| Rate for Payer: BCBS Trust/PPO |
$200.88
|
| Rate for Payer: BCN Commercial |
$200.88
|
| Rate for Payer: Cash Price |
$404.11
|
| Rate for Payer: Cash Price |
$404.11
|
| Rate for Payer: Cofinity Advantage |
$353.60
|
| Rate for Payer: Cofinity Commercial |
$434.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$404.11
|
| Rate for Payer: Healthscope Commercial |
$454.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$353.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$378.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$404.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$429.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$378.86
|
| Rate for Payer: PHP Commercial |
$429.37
|
| Rate for Payer: Priority Health SBD |
$318.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$328.34
|
| Rate for Payer: UHC Core |
$263.18
|
| Rate for Payer: UHC Exchange |
$198.52
|
| Rate for Payer: UMR Bronson Commercial |
$186.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$378.86
|
|
|
HC OP VISIT LEVEL 5
|
Facility
|
IP
|
$505.14
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
51000037
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$222.26 |
| Max. Negotiated Rate |
$454.63 |
| Rate for Payer: Aetna American Axle |
$328.34
|
| Rate for Payer: Aetna Commercial |
$429.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$328.34
|
| Rate for Payer: Cash Price |
$404.11
|
| Rate for Payer: Cofinity Advantage |
$353.60
|
| Rate for Payer: Cofinity Commercial |
$434.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$404.11
|
| Rate for Payer: Healthscope Commercial |
$454.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$353.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$378.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$429.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$378.86
|
| Rate for Payer: PHP Commercial |
$429.37
|
| Rate for Payer: Priority Health SBD |
$318.24
|
| Rate for Payer: UMR Bronson Commercial |
$222.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$378.86
|
|
|
HC ORAL CHEMO ADMINISTRATION
|
Facility
|
IP
|
$134.71
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000089
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$59.27 |
| Max. Negotiated Rate |
$121.24 |
| Rate for Payer: Aetna American Axle |
$87.56
|
| Rate for Payer: Aetna Commercial |
$114.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.56
|
| Rate for Payer: Cash Price |
$107.77
|
| Rate for Payer: Cofinity Advantage |
$94.30
|
| Rate for Payer: Cofinity Commercial |
$115.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.77
|
| Rate for Payer: Healthscope Commercial |
$121.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$94.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$101.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$101.03
|
| Rate for Payer: PHP Commercial |
$114.50
|
| Rate for Payer: Priority Health SBD |
$84.87
|
| Rate for Payer: UMR Bronson Commercial |
$59.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$101.03
|
|
|
HC ORAL CHEMO ADMINISTRATION
|
Facility
|
OP
|
$134.71
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000089
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$21.87 |
| Max. Negotiated Rate |
$121.24 |
| Rate for Payer: Aetna American Axle |
$87.56
|
| Rate for Payer: Aetna Commercial |
$114.50
|
| Rate for Payer: Aetna Medicare |
$67.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.56
|
| Rate for Payer: BCBS Complete |
$53.88
|
| 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 |
$107.77
|
| Rate for Payer: Cash Price |
$107.77
|
| Rate for Payer: Cofinity Advantage |
$94.30
|
| Rate for Payer: Cofinity Commercial |
$115.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.77
|
| Rate for Payer: Healthscope Commercial |
$121.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$94.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$101.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$107.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$101.03
|
| Rate for Payer: PHP Commercial |
$114.50
|
| Rate for Payer: Priority Health SBD |
$84.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$87.56
|
| Rate for Payer: UHC Core |
$70.18
|
| Rate for Payer: UHC Exchange |
$52.94
|
| Rate for Payer: UMR Bronson Commercial |
$49.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$101.03
|
|
|
HC ORCHARD GRASS IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200052
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.40 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna American Axle |
$16.84
|
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Advantage |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: Priority Health SBD |
$16.32
|
| Rate for Payer: UMR Bronson Commercial |
$11.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.43
|
|
|
HC ORCHARD GRASS IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200052
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna American Axle |
$16.84
|
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| 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 |
$2.87
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$6.04
|
| Rate for Payer: BCN Commercial |
$6.04
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Advantage |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.43
|
| Rate for Payer: Mclaren Medicaid |
$5.22
|
| 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 |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$7.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.22
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$16.32
|
| Rate for Payer: Priority Health Tiered Network |
$4.18
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.83
|
| Rate for Payer: UHC Core |
$7.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.22
|
| Rate for Payer: UHC Exchange |
$7.83
|
| Rate for Payer: UHC Medicaid |
$2.73
|
| Rate for Payer: UHCCP Medicaid |
$2.73
|
| Rate for Payer: UMR Bronson Commercial |
$9.58
|
| Rate for Payer: VA VA |
$5.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.43
|
|
|
HC ORGANIC ACIDS SCREEN URINE
|
Facility
|
IP
|
$76.99
|
|
|
Service Code
|
CPT 83918
|
| Hospital Charge Code |
30100372
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.88 |
| Max. Negotiated Rate |
$69.29 |
| Rate for Payer: Aetna American Axle |
$50.04
|
| Rate for Payer: Aetna Commercial |
$65.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.04
|
| Rate for Payer: Cash Price |
$61.59
|
| Rate for Payer: Cofinity Advantage |
$53.89
|
| Rate for Payer: Cofinity Commercial |
$66.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.59
|
| Rate for Payer: Healthscope Commercial |
$69.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$53.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.74
|
| Rate for Payer: PHP Commercial |
$65.44
|
| Rate for Payer: Priority Health SBD |
$48.50
|
| Rate for Payer: UMR Bronson Commercial |
$33.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.74
|
|
|
HC ORGANIC ACIDS SCREEN URINE
|
Facility
|
OP
|
$76.99
|
|
|
Service Code
|
CPT 83918
|
| Hospital Charge Code |
30100372
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.34 |
| Max. Negotiated Rate |
$69.29 |
| Rate for Payer: Aetna American Axle |
$50.04
|
| Rate for Payer: Aetna Commercial |
$65.44
|
| Rate for Payer: Aetna Medicare |
$24.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.50
|
| Rate for Payer: BCBS Complete |
$12.96
|
| Rate for Payer: BCBS MAPPO |
$23.60
|
| Rate for Payer: BCBS Trust/PPO |
$27.28
|
| Rate for Payer: BCN Commercial |
$27.28
|
| Rate for Payer: BCN Medicare Advantage |
$23.60
|
| Rate for Payer: Cash Price |
$61.59
|
| Rate for Payer: Cash Price |
$61.59
|
| Rate for Payer: Cofinity Advantage |
$53.89
|
| Rate for Payer: Cofinity Commercial |
$66.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.60
|
| Rate for Payer: Healthscope Commercial |
$69.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$53.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.74
|
| Rate for Payer: Mclaren Medicaid |
$23.60
|
| Rate for Payer: Mclaren Medicare |
$23.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.78
|
| Rate for Payer: Meridian Medicaid |
$24.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$25.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.44
|
| Rate for Payer: Nomi Health Commercial |
$35.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.74
|
| Rate for Payer: PACE Medicare |
$22.42
|
| Rate for Payer: PACE SWMI |
$23.60
|
| Rate for Payer: PHP Commercial |
$65.44
|
| Rate for Payer: PHP Medicare Advantage |
$23.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$23.60
|
| Rate for Payer: Priority Health Medicare |
$23.60
|
| Rate for Payer: Priority Health SBD |
$48.50
|
| Rate for Payer: Priority Health Tiered Network |
$18.88
|
| Rate for Payer: Railroad Medicare Medicare |
$23.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.40
|
| Rate for Payer: UHC Core |
$35.40
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$23.60
|
| Rate for Payer: UHC Exchange |
$35.40
|
| Rate for Payer: UHC Medicaid |
$12.34
|
| Rate for Payer: UHCCP Medicaid |
$12.34
|
| Rate for Payer: UMR Bronson Commercial |
$28.49
|
| Rate for Payer: VA VA |
$23.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.74
|
|
|
HC OR LEVEL 1 BASE CHARGE
|
Facility
|
OP
|
$219.00
|
|
| Hospital Charge Code |
36000126
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$81.03 |
| Max. Negotiated Rate |
$197.10 |
| Rate for Payer: Aetna American Axle |
$142.35
|
| Rate for Payer: Aetna Commercial |
$186.15
|
| Rate for Payer: Aetna Medicare |
$109.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.35
|
| Rate for Payer: BCBS Complete |
$87.60
|
| Rate for Payer: Cash Price |
$175.20
|
| Rate for Payer: Cofinity Advantage |
$153.30
|
| Rate for Payer: Cofinity Commercial |
$188.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.20
|
| Rate for Payer: Healthscope Commercial |
$197.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$153.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$164.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$175.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$186.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$164.25
|
| Rate for Payer: PHP Commercial |
$186.15
|
| Rate for Payer: Priority Health SBD |
$137.97
|
| Rate for Payer: UMR Bronson Commercial |
$81.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$164.25
|
|
|
HC OR LEVEL 1 BASE CHARGE
|
Facility
|
IP
|
$219.00
|
|
| Hospital Charge Code |
36000126
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$96.36 |
| Max. Negotiated Rate |
$197.10 |
| Rate for Payer: Aetna American Axle |
$142.35
|
| Rate for Payer: Aetna Commercial |
$186.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.35
|
| Rate for Payer: Cash Price |
$175.20
|
| Rate for Payer: Cofinity Advantage |
$153.30
|
| Rate for Payer: Cofinity Commercial |
$188.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.20
|
| Rate for Payer: Healthscope Commercial |
$197.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$153.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$164.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$186.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$164.25
|
| Rate for Payer: PHP Commercial |
$186.15
|
| Rate for Payer: Priority Health SBD |
$137.97
|
| Rate for Payer: UMR Bronson Commercial |
$96.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$164.25
|
|
|
HC OR LEVEL 1 PER MINUTE
|
Facility
|
OP
|
$65.00
|
|
| Hospital Charge Code |
36000127
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$24.05 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Aetna American Axle |
$42.25
|
| Rate for Payer: Aetna Commercial |
$55.25
|
| Rate for Payer: Aetna Medicare |
$32.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.25
|
| Rate for Payer: BCBS Complete |
$26.00
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cofinity Advantage |
$45.50
|
| Rate for Payer: Cofinity Commercial |
$55.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.00
|
| Rate for Payer: Healthscope Commercial |
$58.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.75
|
| Rate for Payer: PHP Commercial |
$55.25
|
| Rate for Payer: Priority Health SBD |
$40.95
|
| Rate for Payer: UMR Bronson Commercial |
$24.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.75
|
|
|
HC OR LEVEL 1 PER MINUTE
|
Facility
|
IP
|
$65.00
|
|
| Hospital Charge Code |
36000127
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$28.60 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Aetna American Axle |
$42.25
|
| Rate for Payer: Aetna Commercial |
$55.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.25
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cofinity Advantage |
$45.50
|
| Rate for Payer: Cofinity Commercial |
$55.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.00
|
| Rate for Payer: Healthscope Commercial |
$58.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.75
|
| Rate for Payer: PHP Commercial |
$55.25
|
| Rate for Payer: Priority Health SBD |
$40.95
|
| Rate for Payer: UMR Bronson Commercial |
$28.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.75
|
|
|
HC OR LEVEL 2 BASE CHARGE
|
Facility
|
OP
|
$643.00
|
|
| Hospital Charge Code |
36000128
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$237.91 |
| Max. Negotiated Rate |
$578.70 |
| Rate for Payer: Aetna American Axle |
$417.95
|
| Rate for Payer: Aetna Commercial |
$546.55
|
| Rate for Payer: Aetna Medicare |
$321.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$417.95
|
| Rate for Payer: BCBS Complete |
$257.20
|
| Rate for Payer: Cash Price |
$514.40
|
| Rate for Payer: Cofinity Advantage |
$450.10
|
| Rate for Payer: Cofinity Commercial |
$552.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$514.40
|
| Rate for Payer: Healthscope Commercial |
$578.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$450.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$482.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$514.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$546.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$482.25
|
| Rate for Payer: PHP Commercial |
$546.55
|
| Rate for Payer: Priority Health SBD |
$405.09
|
| Rate for Payer: UMR Bronson Commercial |
$237.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$482.25
|
|
|
HC OR LEVEL 2 BASE CHARGE
|
Facility
|
IP
|
$643.00
|
|
| Hospital Charge Code |
36000128
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$282.92 |
| Max. Negotiated Rate |
$578.70 |
| Rate for Payer: Aetna American Axle |
$417.95
|
| Rate for Payer: Aetna Commercial |
$546.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$417.95
|
| Rate for Payer: Cash Price |
$514.40
|
| Rate for Payer: Cofinity Advantage |
$450.10
|
| Rate for Payer: Cofinity Commercial |
$552.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$514.40
|
| Rate for Payer: Healthscope Commercial |
$578.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$450.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$482.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$546.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$482.25
|
| Rate for Payer: PHP Commercial |
$546.55
|
| Rate for Payer: Priority Health SBD |
$405.09
|
| Rate for Payer: UMR Bronson Commercial |
$282.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$482.25
|
|
|
HC OR LEVEL 2 PER MINUTE
|
Facility
|
OP
|
$97.00
|
|
| Hospital Charge Code |
36000129
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$35.89 |
| Max. Negotiated Rate |
$87.30 |
| Rate for Payer: Aetna American Axle |
$63.05
|
| Rate for Payer: Aetna Commercial |
$82.45
|
| Rate for Payer: Aetna Medicare |
$48.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.05
|
| Rate for Payer: BCBS Complete |
$38.80
|
| Rate for Payer: Cash Price |
$77.60
|
| Rate for Payer: Cofinity Advantage |
$67.90
|
| Rate for Payer: Cofinity Commercial |
$83.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.60
|
| Rate for Payer: Healthscope Commercial |
$87.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$67.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$77.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$72.75
|
| Rate for Payer: PHP Commercial |
$82.45
|
| Rate for Payer: Priority Health SBD |
$61.11
|
| Rate for Payer: UMR Bronson Commercial |
$35.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.75
|
|
|
HC OR LEVEL 2 PER MINUTE
|
Facility
|
IP
|
$97.00
|
|
| Hospital Charge Code |
36000129
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$42.68 |
| Max. Negotiated Rate |
$87.30 |
| Rate for Payer: Aetna American Axle |
$63.05
|
| Rate for Payer: Aetna Commercial |
$82.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.05
|
| Rate for Payer: Cash Price |
$77.60
|
| Rate for Payer: Cofinity Advantage |
$67.90
|
| Rate for Payer: Cofinity Commercial |
$83.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.60
|
| Rate for Payer: Healthscope Commercial |
$87.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$67.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$72.75
|
| Rate for Payer: PHP Commercial |
$82.45
|
| Rate for Payer: Priority Health SBD |
$61.11
|
| Rate for Payer: UMR Bronson Commercial |
$42.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.75
|
|
|
HC OR LEVEL 3 BASE CHARGE
|
Facility
|
IP
|
$857.00
|
|
| Hospital Charge Code |
36000130
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$377.08 |
| Max. Negotiated Rate |
$771.30 |
| Rate for Payer: Aetna American Axle |
$557.05
|
| Rate for Payer: Aetna Commercial |
$728.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$557.05
|
| Rate for Payer: Cash Price |
$685.60
|
| Rate for Payer: Cofinity Advantage |
$599.90
|
| Rate for Payer: Cofinity Commercial |
$737.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$685.60
|
| Rate for Payer: Healthscope Commercial |
$771.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$599.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$642.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$728.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$642.75
|
| Rate for Payer: PHP Commercial |
$728.45
|
| Rate for Payer: Priority Health SBD |
$539.91
|
| Rate for Payer: UMR Bronson Commercial |
$377.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$642.75
|
|
|
HC OR LEVEL 3 BASE CHARGE
|
Facility
|
OP
|
$857.00
|
|
| Hospital Charge Code |
36000130
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$317.09 |
| Max. Negotiated Rate |
$771.30 |
| Rate for Payer: Aetna American Axle |
$557.05
|
| Rate for Payer: Aetna Commercial |
$728.45
|
| Rate for Payer: Aetna Medicare |
$428.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$557.05
|
| Rate for Payer: BCBS Complete |
$342.80
|
| Rate for Payer: Cash Price |
$685.60
|
| Rate for Payer: Cofinity Advantage |
$599.90
|
| Rate for Payer: Cofinity Commercial |
$737.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$685.60
|
| Rate for Payer: Healthscope Commercial |
$771.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$599.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$642.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$685.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$728.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$642.75
|
| Rate for Payer: PHP Commercial |
$728.45
|
| Rate for Payer: Priority Health SBD |
$539.91
|
| Rate for Payer: UMR Bronson Commercial |
$317.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$642.75
|
|
|
HC OR LEVEL 3 PER MINUTE
|
Facility
|
OP
|
$108.00
|
|
| Hospital Charge Code |
36000131
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$39.96 |
| Max. Negotiated Rate |
$97.20 |
| Rate for Payer: Aetna American Axle |
$70.20
|
| Rate for Payer: Aetna Commercial |
$91.80
|
| Rate for Payer: Aetna Medicare |
$54.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.20
|
| Rate for Payer: BCBS Complete |
$43.20
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cofinity Advantage |
$75.60
|
| Rate for Payer: Cofinity Commercial |
$92.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.40
|
| Rate for Payer: Healthscope Commercial |
$97.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$75.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$86.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$81.00
|
| Rate for Payer: PHP Commercial |
$91.80
|
| Rate for Payer: Priority Health SBD |
$68.04
|
| Rate for Payer: UMR Bronson Commercial |
$39.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.00
|
|
|
HC OR LEVEL 3 PER MINUTE
|
Facility
|
IP
|
$108.00
|
|
| Hospital Charge Code |
36000131
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$47.52 |
| Max. Negotiated Rate |
$97.20 |
| Rate for Payer: Aetna American Axle |
$70.20
|
| Rate for Payer: Aetna Commercial |
$91.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.20
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cofinity Advantage |
$75.60
|
| Rate for Payer: Cofinity Commercial |
$92.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.40
|
| Rate for Payer: Healthscope Commercial |
$97.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$75.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$81.00
|
| Rate for Payer: PHP Commercial |
$91.80
|
| Rate for Payer: Priority Health SBD |
$68.04
|
| Rate for Payer: UMR Bronson Commercial |
$47.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.00
|
|
|
HC OR LEVEL 4 BASE CHARGE
|
Facility
|
OP
|
$1,372.00
|
|
| Hospital Charge Code |
36000132
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$507.64 |
| Max. Negotiated Rate |
$1,234.80 |
| Rate for Payer: Aetna American Axle |
$891.80
|
| Rate for Payer: Aetna Commercial |
$1,166.20
|
| Rate for Payer: Aetna Medicare |
$686.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$891.80
|
| Rate for Payer: BCBS Complete |
$548.80
|
| Rate for Payer: Cash Price |
$1,097.60
|
| Rate for Payer: Cofinity Advantage |
$960.40
|
| Rate for Payer: Cofinity Commercial |
$1,179.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,097.60
|
| Rate for Payer: Healthscope Commercial |
$1,234.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$960.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,029.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,097.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,166.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,029.00
|
| Rate for Payer: PHP Commercial |
$1,166.20
|
| Rate for Payer: Priority Health SBD |
$864.36
|
| Rate for Payer: UMR Bronson Commercial |
$507.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,029.00
|
|
|
HC OR LEVEL 4 BASE CHARGE
|
Facility
|
IP
|
$1,372.00
|
|
| Hospital Charge Code |
36000132
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$603.68 |
| Max. Negotiated Rate |
$1,234.80 |
| Rate for Payer: Aetna American Axle |
$891.80
|
| Rate for Payer: Aetna Commercial |
$1,166.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$891.80
|
| Rate for Payer: Cash Price |
$1,097.60
|
| Rate for Payer: Cofinity Advantage |
$960.40
|
| Rate for Payer: Cofinity Commercial |
$1,179.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,097.60
|
| Rate for Payer: Healthscope Commercial |
$1,234.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$960.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,029.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,166.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,029.00
|
| Rate for Payer: PHP Commercial |
$1,166.20
|
| Rate for Payer: Priority Health SBD |
$864.36
|
| Rate for Payer: UMR Bronson Commercial |
$603.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,029.00
|
|
