|
HC ZIKA VIRUS, PCR, URINE
|
Facility
|
IP
|
$255.00
|
|
|
Service Code
|
CPT 87662
|
| Hospital Charge Code |
30000151
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$112.20 |
| Max. Negotiated Rate |
$229.50 |
| Rate for Payer: Aetna American Axle |
$165.75
|
| Rate for Payer: Aetna Commercial |
$216.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.75
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cofinity Commercial |
$178.50
|
| Rate for Payer: Cofinity Commercial |
$219.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.00
|
| Rate for Payer: Healthscope Commercial |
$229.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$178.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$191.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$216.75
|
| Rate for Payer: PHP Commercial |
$216.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.50
|
| Rate for Payer: Priority Health SBD |
$160.65
|
| Rate for Payer: UMR Bronson Commercial |
$112.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$191.25
|
|
|
HC Z IMPLANTABLE PORT
|
Facility
|
IP
|
$3,037.66
|
|
|
Service Code
|
HCPCS C1788
|
| Hospital Charge Code |
27800039
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,336.57 |
| Max. Negotiated Rate |
$2,733.89 |
| Rate for Payer: Aetna American Axle |
$1,974.48
|
| Rate for Payer: Aetna Commercial |
$2,582.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,974.48
|
| Rate for Payer: Cash Price |
$2,430.13
|
| Rate for Payer: Cofinity Commercial |
$2,126.36
|
| Rate for Payer: Cofinity Commercial |
$2,612.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,430.13
|
| Rate for Payer: Healthscope Commercial |
$2,733.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,126.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,278.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,582.01
|
| Rate for Payer: PHP Commercial |
$2,582.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,126.36
|
| Rate for Payer: Priority Health SBD |
$1,913.73
|
| Rate for Payer: UMR Bronson Commercial |
$1,336.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,278.24
|
|
|
HC Z IMPLANTABLE PORT
|
Facility
|
OP
|
$3,037.66
|
|
|
Service Code
|
HCPCS C1788
|
| Hospital Charge Code |
27800039
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,123.93 |
| Max. Negotiated Rate |
$2,733.89 |
| Rate for Payer: Aetna American Axle |
$1,974.48
|
| Rate for Payer: Aetna Commercial |
$2,582.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,974.48
|
| Rate for Payer: BCBS Complete |
$1,215.06
|
| Rate for Payer: Cash Price |
$2,430.13
|
| Rate for Payer: Cofinity Commercial |
$2,126.36
|
| Rate for Payer: Cofinity Commercial |
$2,612.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,430.13
|
| Rate for Payer: Healthscope Commercial |
$2,733.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,126.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,278.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,582.01
|
| Rate for Payer: PHP Commercial |
$2,582.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,126.36
|
| Rate for Payer: Priority Health SBD |
$1,913.73
|
| Rate for Payer: UMR Bronson Commercial |
$1,123.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,278.24
|
|
|
HC ZINC LEVEL
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
CPT 84630
|
| Hospital Charge Code |
30100462
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.23 |
| Max. Negotiated Rate |
$44.10 |
| Rate for Payer: Aetna American Axle |
$31.85
|
| Rate for Payer: Aetna Commercial |
$41.65
|
| Rate for Payer: Aetna Medicare |
$11.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.24
|
| Rate for Payer: BCBS Complete |
$6.54
|
| Rate for Payer: BCBS MAPPO |
$11.39
|
| Rate for Payer: BCBS Trust/PPO |
$10.24
|
| Rate for Payer: BCN Medicare Advantage |
$11.39
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Cofinity Commercial |
$42.14
|
| Rate for Payer: Cofinity Commercial |
$34.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.39
|
| Rate for Payer: Healthscope Commercial |
$44.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.75
|
| Rate for Payer: Mclaren Medicaid |
$6.23
|
| Rate for Payer: Mclaren Medicare |
$11.39
|
| Rate for Payer: Meridian Medicaid |
$6.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$41.65
|
| Rate for Payer: PACE Medicare |
$10.82
|
| Rate for Payer: PACE SWMI |
$11.39
|
| Rate for Payer: PHP Commercial |
$41.65
|
| Rate for Payer: PHP Medicare Advantage |
$11.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.78
|
| Rate for Payer: Priority Health Medicare |
$11.39
|
| Rate for Payer: Priority Health Narrow Network |
$10.22
|
| Rate for Payer: Priority Health SBD |
$30.87
|
| Rate for Payer: Railroad Medicare Medicare |
$11.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.67
|
| Rate for Payer: UHC Core |
$18.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.39
|
| Rate for Payer: UHC Exchange |
$11.39
|
| Rate for Payer: UHC Medicare Advantage |
$11.73
|
| Rate for Payer: UMR Bronson Commercial |
$18.13
|
| Rate for Payer: VA VA |
$11.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.75
|
|
|
HC ZINC LEVEL
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
CPT 84630
|
| Hospital Charge Code |
30100462
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.56 |
| Max. Negotiated Rate |
$44.10 |
| Rate for Payer: Aetna American Axle |
$31.85
|
| Rate for Payer: Aetna Commercial |
$41.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.85
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Cofinity Commercial |
$34.30
|
| Rate for Payer: Cofinity Commercial |
$42.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.20
|
| Rate for Payer: Healthscope Commercial |
$44.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$41.65
|
| Rate for Payer: PHP Commercial |
$41.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.30
|
| Rate for Payer: Priority Health SBD |
$30.87
|
| Rate for Payer: UMR Bronson Commercial |
$21.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.75
|
|
|
HC ZINC URINE
|
Facility
|
IP
|
$68.60
|
|
|
Service Code
|
CPT 84630
|
| Hospital Charge Code |
30100463
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.18 |
| Max. Negotiated Rate |
$61.74 |
| Rate for Payer: Aetna American Axle |
$44.59
|
| Rate for Payer: Aetna Commercial |
$58.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.59
|
| Rate for Payer: Cash Price |
$54.88
|
| Rate for Payer: Cofinity Commercial |
$48.02
|
| Rate for Payer: Cofinity Commercial |
$59.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.88
|
| Rate for Payer: Healthscope Commercial |
$61.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$58.31
|
| Rate for Payer: PHP Commercial |
$58.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.02
|
| Rate for Payer: Priority Health SBD |
$43.22
|
| Rate for Payer: UMR Bronson Commercial |
$30.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.45
|
|
|
HC ZINC URINE
|
Facility
|
OP
|
$68.60
|
|
|
Service Code
|
CPT 84630
|
| Hospital Charge Code |
30100463
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.23 |
| Max. Negotiated Rate |
$61.74 |
| Rate for Payer: Aetna American Axle |
$44.59
|
| Rate for Payer: Aetna Commercial |
$58.31
|
| Rate for Payer: Aetna Medicare |
$11.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.24
|
| Rate for Payer: BCBS Complete |
$6.54
|
| Rate for Payer: BCBS MAPPO |
$11.39
|
| Rate for Payer: BCBS Trust/PPO |
$10.24
|
| Rate for Payer: BCN Medicare Advantage |
$11.39
|
| Rate for Payer: Cash Price |
$54.88
|
| Rate for Payer: Cash Price |
$54.88
|
| Rate for Payer: Cofinity Commercial |
$59.00
|
| Rate for Payer: Cofinity Commercial |
$48.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.39
|
| Rate for Payer: Healthscope Commercial |
$61.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.45
|
| Rate for Payer: Mclaren Medicaid |
$6.23
|
| Rate for Payer: Mclaren Medicare |
$11.39
|
| Rate for Payer: Meridian Medicaid |
$6.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$58.31
|
| Rate for Payer: PACE Medicare |
$10.82
|
| Rate for Payer: PACE SWMI |
$11.39
|
| Rate for Payer: PHP Commercial |
$58.31
|
| Rate for Payer: PHP Medicare Advantage |
$11.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.78
|
| Rate for Payer: Priority Health Medicare |
$11.39
|
| Rate for Payer: Priority Health Narrow Network |
$10.22
|
| Rate for Payer: Priority Health SBD |
$43.22
|
| Rate for Payer: Railroad Medicare Medicare |
$11.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.67
|
| Rate for Payer: UHC Core |
$18.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.39
|
| Rate for Payer: UHC Exchange |
$11.39
|
| Rate for Payer: UHC Medicare Advantage |
$11.73
|
| Rate for Payer: UMR Bronson Commercial |
$25.38
|
| Rate for Payer: VA VA |
$11.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.45
|
|
|
HC Z INFUSION WIRE
|
Facility
|
OP
|
$857.70
|
|
| Hospital Charge Code |
62100001
|
|
Hospital Revenue Code
|
621
|
| Min. Negotiated Rate |
$317.35 |
| Max. Negotiated Rate |
$771.93 |
| Rate for Payer: Aetna American Axle |
$557.50
|
| Rate for Payer: Aetna Commercial |
$729.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$557.50
|
| Rate for Payer: BCBS Complete |
$343.08
|
| Rate for Payer: Cash Price |
$686.16
|
| Rate for Payer: Cofinity Commercial |
$600.39
|
| Rate for Payer: Cofinity Commercial |
$737.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$686.16
|
| Rate for Payer: Healthscope Commercial |
$771.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$600.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$643.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$729.04
|
| Rate for Payer: PHP Commercial |
$729.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$600.39
|
| Rate for Payer: Priority Health SBD |
$540.35
|
| Rate for Payer: UMR Bronson Commercial |
$317.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$643.28
|
|
|
HC Z INFUSION WIRE
|
Facility
|
IP
|
$857.70
|
|
| Hospital Charge Code |
62100001
|
|
Hospital Revenue Code
|
621
|
| Min. Negotiated Rate |
$377.39 |
| Max. Negotiated Rate |
$771.93 |
| Rate for Payer: Aetna American Axle |
$557.50
|
| Rate for Payer: Aetna Commercial |
$729.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$557.50
|
| Rate for Payer: Cash Price |
$686.16
|
| Rate for Payer: Cofinity Commercial |
$600.39
|
| Rate for Payer: Cofinity Commercial |
$737.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$686.16
|
| Rate for Payer: Healthscope Commercial |
$771.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$600.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$643.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$729.04
|
| Rate for Payer: PHP Commercial |
$729.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$600.39
|
| Rate for Payer: Priority Health SBD |
$540.35
|
| Rate for Payer: UMR Bronson Commercial |
$377.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$643.28
|
|
|
HC Z INTRACRANIAL STENT
|
Facility
|
OP
|
$12,880.85
|
|
| Hospital Charge Code |
27800049
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,765.91 |
| Max. Negotiated Rate |
$11,592.76 |
| Rate for Payer: Aetna American Axle |
$8,372.55
|
| Rate for Payer: Aetna Commercial |
$10,948.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,372.55
|
| Rate for Payer: BCBS Complete |
$5,152.34
|
| Rate for Payer: Cash Price |
$10,304.68
|
| Rate for Payer: Cofinity Commercial |
$11,077.53
|
| Rate for Payer: Cofinity Commercial |
$9,016.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,304.68
|
| Rate for Payer: Healthscope Commercial |
$11,592.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9,016.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,660.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10,948.72
|
| Rate for Payer: PHP Commercial |
$10,948.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,016.60
|
| Rate for Payer: Priority Health SBD |
$8,114.94
|
| Rate for Payer: UMR Bronson Commercial |
$4,765.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,660.64
|
|
|
HC Z INTRACRANIAL STENT
|
Facility
|
IP
|
$12,880.85
|
|
| Hospital Charge Code |
27800049
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,667.57 |
| Max. Negotiated Rate |
$11,592.76 |
| Rate for Payer: Aetna American Axle |
$8,372.55
|
| Rate for Payer: Aetna Commercial |
$10,948.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,372.55
|
| Rate for Payer: Cash Price |
$10,304.68
|
| Rate for Payer: Cofinity Commercial |
$11,077.53
|
| Rate for Payer: Cofinity Commercial |
$9,016.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,304.68
|
| Rate for Payer: Healthscope Commercial |
$11,592.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9,016.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,660.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10,948.72
|
| Rate for Payer: PHP Commercial |
$10,948.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,016.60
|
| Rate for Payer: Priority Health SBD |
$8,114.94
|
| Rate for Payer: UMR Bronson Commercial |
$5,667.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,660.64
|
|
|
HC Z INTRODUCER SHEATH
|
Facility
|
IP
|
$322.79
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27200090
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$142.03 |
| Max. Negotiated Rate |
$290.51 |
| Rate for Payer: Aetna American Axle |
$209.81
|
| Rate for Payer: Aetna Commercial |
$274.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$209.81
|
| Rate for Payer: Cash Price |
$258.23
|
| Rate for Payer: Cofinity Commercial |
$225.95
|
| Rate for Payer: Cofinity Commercial |
$277.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$258.23
|
| Rate for Payer: Healthscope Commercial |
$290.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$225.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$242.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$274.37
|
| Rate for Payer: PHP Commercial |
$274.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$225.95
|
| Rate for Payer: Priority Health SBD |
$203.36
|
| Rate for Payer: UMR Bronson Commercial |
$142.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$242.09
|
|
|
HC Z INTRODUCER SHEATH
|
Facility
|
OP
|
$322.79
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27200090
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$119.43 |
| Max. Negotiated Rate |
$290.51 |
| Rate for Payer: Aetna American Axle |
$209.81
|
| Rate for Payer: Aetna Commercial |
$274.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$209.81
|
| Rate for Payer: BCBS Complete |
$129.12
|
| Rate for Payer: Cash Price |
$258.23
|
| Rate for Payer: Cofinity Commercial |
$277.60
|
| Rate for Payer: Cofinity Commercial |
$225.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$258.23
|
| Rate for Payer: Healthscope Commercial |
$290.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$225.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$242.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$274.37
|
| Rate for Payer: PHP Commercial |
$274.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$225.95
|
| Rate for Payer: Priority Health SBD |
$203.36
|
| Rate for Payer: UMR Bronson Commercial |
$119.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$242.09
|
|
|
HC Z ITERPRET VISCERAL PTRA
|
Facility
|
IP
|
$3,701.46
|
|
| Hospital Charge Code |
32000272
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,628.64 |
| Max. Negotiated Rate |
$3,331.31 |
| Rate for Payer: Aetna American Axle |
$2,405.95
|
| Rate for Payer: Aetna Commercial |
$3,146.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,405.95
|
| Rate for Payer: Cash Price |
$2,961.17
|
| Rate for Payer: Cofinity Commercial |
$3,183.26
|
| Rate for Payer: Cofinity Commercial |
$2,591.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,961.17
|
| Rate for Payer: Healthscope Commercial |
$3,331.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,591.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,776.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,146.24
|
| Rate for Payer: PHP Commercial |
$3,146.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,591.02
|
| Rate for Payer: Priority Health SBD |
$2,331.92
|
| Rate for Payer: UMR Bronson Commercial |
$1,628.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,776.10
|
|
|
HC Z ITERPRET VISCERAL PTRA
|
Facility
|
OP
|
$3,701.46
|
|
| Hospital Charge Code |
32000272
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$262.00 |
| Max. Negotiated Rate |
$3,331.31 |
| Rate for Payer: Aetna American Axle |
$2,405.95
|
| Rate for Payer: Aetna Commercial |
$3,146.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,405.95
|
| Rate for Payer: BCBS Complete |
$1,480.58
|
| Rate for Payer: Cash Price |
$2,961.17
|
| Rate for Payer: Cash Price |
$2,961.17
|
| Rate for Payer: Cofinity Commercial |
$2,591.02
|
| Rate for Payer: Cofinity Commercial |
$3,183.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,961.17
|
| Rate for Payer: Healthscope Commercial |
$3,331.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,591.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,776.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,146.24
|
| Rate for Payer: PHP Commercial |
$3,146.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,591.02
|
| Rate for Payer: Priority Health SBD |
$2,331.92
|
| Rate for Payer: UHC Core |
$262.00
|
| Rate for Payer: UMR Bronson Commercial |
$1,369.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,776.10
|
|
|
HC Z NEPHROSTOMY CATH
|
Facility
|
OP
|
$760.56
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
27200092
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$684.50 |
| Rate for Payer: Aetna American Axle |
$494.36
|
| Rate for Payer: Aetna Commercial |
$646.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$494.36
|
| Rate for Payer: BCBS Complete |
$304.22
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: Cash Price |
$608.45
|
| Rate for Payer: Cash Price |
$608.45
|
| Rate for Payer: Cofinity Commercial |
$532.39
|
| Rate for Payer: Cofinity Commercial |
$654.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$608.45
|
| Rate for Payer: Healthscope Commercial |
$684.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$532.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$570.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$646.48
|
| Rate for Payer: PHP Commercial |
$646.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$532.39
|
| Rate for Payer: Priority Health SBD |
$479.15
|
| Rate for Payer: UMR Bronson Commercial |
$281.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$570.42
|
|
|
HC Z NEPHROSTOMY CATH
|
Facility
|
IP
|
$760.56
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
27200092
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$334.65 |
| Max. Negotiated Rate |
$684.50 |
| Rate for Payer: Aetna American Axle |
$494.36
|
| Rate for Payer: Aetna Commercial |
$646.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$494.36
|
| Rate for Payer: Cash Price |
$608.45
|
| Rate for Payer: Cofinity Commercial |
$532.39
|
| Rate for Payer: Cofinity Commercial |
$654.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$608.45
|
| Rate for Payer: Healthscope Commercial |
$684.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$532.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$570.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$646.48
|
| Rate for Payer: PHP Commercial |
$646.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$532.39
|
| Rate for Payer: Priority Health SBD |
$479.15
|
| Rate for Payer: UMR Bronson Commercial |
$334.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$570.42
|
|
|
HC ZONISAMIDE
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
CPT 80203
|
| Hospital Charge Code |
30100052
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.00 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Aetna American Axle |
$48.75
|
| Rate for Payer: Aetna Commercial |
$63.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.75
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cofinity Commercial |
$52.50
|
| Rate for Payer: Cofinity Commercial |
$64.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.00
|
| Rate for Payer: Healthscope Commercial |
$67.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.75
|
| Rate for Payer: PHP Commercial |
$63.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.50
|
| Rate for Payer: Priority Health SBD |
$47.25
|
| Rate for Payer: UMR Bronson Commercial |
$33.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.25
|
|
|
HC ZONISAMIDE
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
CPT 80203
|
| Hospital Charge Code |
30100052
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.25 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Aetna American Axle |
$48.75
|
| Rate for Payer: Aetna Commercial |
$63.75
|
| Rate for Payer: Aetna Medicare |
$13.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.56
|
| Rate for Payer: BCBS Complete |
$7.61
|
| Rate for Payer: BCBS MAPPO |
$13.25
|
| Rate for Payer: BCBS Trust/PPO |
$11.92
|
| Rate for Payer: BCN Medicare Advantage |
$13.25
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cofinity Commercial |
$52.50
|
| Rate for Payer: Cofinity Commercial |
$64.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.25
|
| Rate for Payer: Healthscope Commercial |
$67.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.25
|
| Rate for Payer: Mclaren Medicaid |
$7.25
|
| Rate for Payer: Mclaren Medicare |
$13.25
|
| Rate for Payer: Meridian Medicaid |
$7.61
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.75
|
| Rate for Payer: PACE Medicare |
$12.59
|
| Rate for Payer: PACE SWMI |
$13.25
|
| Rate for Payer: PHP Commercial |
$63.75
|
| Rate for Payer: PHP Medicare Advantage |
$13.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.18
|
| Rate for Payer: Priority Health Medicare |
$13.25
|
| Rate for Payer: Priority Health Narrow Network |
$14.54
|
| Rate for Payer: Priority Health SBD |
$47.25
|
| Rate for Payer: Railroad Medicare Medicare |
$13.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.90
|
| Rate for Payer: UHC Core |
$21.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.25
|
| Rate for Payer: UHC Exchange |
$13.25
|
| Rate for Payer: UHC Medicare Advantage |
$13.65
|
| Rate for Payer: UMR Bronson Commercial |
$27.75
|
| Rate for Payer: VA VA |
$13.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.25
|
|
|
HC ZOSTER VACCINE (HZV) RECOMB ADJ, IM
|
Facility
|
OP
|
$171.36
|
|
|
Service Code
|
CPT 90750
|
| Hospital Charge Code |
63600123
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$63.40 |
| Max. Negotiated Rate |
$555.87 |
| Rate for Payer: Aetna American Axle |
$111.38
|
| Rate for Payer: Aetna Commercial |
$145.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$111.38
|
| Rate for Payer: BCBS Complete |
$68.54
|
| Rate for Payer: BCBS Trust/PPO |
$555.87
|
| Rate for Payer: Cash Price |
$137.09
|
| Rate for Payer: Cash Price |
$137.09
|
| Rate for Payer: Cofinity Commercial |
$147.37
|
| Rate for Payer: Cofinity Commercial |
$119.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$137.09
|
| Rate for Payer: Healthscope Commercial |
$154.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$119.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$128.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$145.66
|
| Rate for Payer: PHP Commercial |
$145.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$209.09
|
| Rate for Payer: Priority Health Narrow Network |
$167.27
|
| Rate for Payer: Priority Health SBD |
$107.96
|
| Rate for Payer: UMR Bronson Commercial |
$63.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$128.52
|
|
|
HC ZOSTER VACCINE (HZV) RECOMB ADJ, IM
|
Facility
|
IP
|
$171.36
|
|
|
Service Code
|
CPT 90750
|
| Hospital Charge Code |
63600123
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$75.40 |
| Max. Negotiated Rate |
$154.22 |
| Rate for Payer: Aetna American Axle |
$111.38
|
| Rate for Payer: Aetna Commercial |
$145.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$111.38
|
| Rate for Payer: Cash Price |
$137.09
|
| Rate for Payer: Cofinity Commercial |
$119.95
|
| Rate for Payer: Cofinity Commercial |
$147.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$137.09
|
| Rate for Payer: Healthscope Commercial |
$154.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$119.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$128.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$145.66
|
| Rate for Payer: PHP Commercial |
$145.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.95
|
| Rate for Payer: Priority Health SBD |
$107.96
|
| Rate for Payer: UMR Bronson Commercial |
$75.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$128.52
|
|
|
HC Z RETRIEVAL SNARE
|
Facility
|
OP
|
$1,306.70
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
27200094
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$483.48 |
| Max. Negotiated Rate |
$1,176.03 |
| Rate for Payer: Aetna American Axle |
$849.36
|
| Rate for Payer: Aetna Commercial |
$1,110.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$849.36
|
| Rate for Payer: BCBS Complete |
$522.68
|
| Rate for Payer: Cash Price |
$1,045.36
|
| Rate for Payer: Cofinity Commercial |
$1,123.76
|
| Rate for Payer: Cofinity Commercial |
$914.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,045.36
|
| Rate for Payer: Healthscope Commercial |
$1,176.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$914.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$980.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,110.70
|
| Rate for Payer: PHP Commercial |
$1,110.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$914.69
|
| Rate for Payer: Priority Health SBD |
$823.22
|
| Rate for Payer: UMR Bronson Commercial |
$483.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$980.02
|
|
|
HC Z RETRIEVAL SNARE
|
Facility
|
IP
|
$1,306.70
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
27200094
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$574.95 |
| Max. Negotiated Rate |
$1,176.03 |
| Rate for Payer: Aetna American Axle |
$849.36
|
| Rate for Payer: Aetna Commercial |
$1,110.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$849.36
|
| Rate for Payer: Cash Price |
$1,045.36
|
| Rate for Payer: Cofinity Commercial |
$1,123.76
|
| Rate for Payer: Cofinity Commercial |
$914.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,045.36
|
| Rate for Payer: Healthscope Commercial |
$1,176.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$914.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$980.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,110.70
|
| Rate for Payer: PHP Commercial |
$1,110.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$914.69
|
| Rate for Payer: Priority Health SBD |
$823.22
|
| Rate for Payer: UMR Bronson Commercial |
$574.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$980.02
|
|
|
HC Z STENT URETERAL
|
Facility
|
IP
|
$1,189.08
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27800041
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$523.20 |
| Max. Negotiated Rate |
$1,070.17 |
| Rate for Payer: Aetna American Axle |
$772.90
|
| Rate for Payer: Aetna Commercial |
$1,010.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$772.90
|
| Rate for Payer: Cash Price |
$951.26
|
| Rate for Payer: Cofinity Commercial |
$1,022.61
|
| Rate for Payer: Cofinity Commercial |
$832.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$951.26
|
| Rate for Payer: Healthscope Commercial |
$1,070.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$832.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$891.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,010.72
|
| Rate for Payer: PHP Commercial |
$1,010.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$832.36
|
| Rate for Payer: Priority Health SBD |
$749.12
|
| Rate for Payer: UMR Bronson Commercial |
$523.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$891.81
|
|
|
HC Z STENT URETERAL
|
Facility
|
OP
|
$1,189.08
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27800041
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$439.96 |
| Max. Negotiated Rate |
$1,070.17 |
| Rate for Payer: Aetna American Axle |
$772.90
|
| Rate for Payer: Aetna Commercial |
$1,010.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$772.90
|
| Rate for Payer: BCBS Complete |
$475.63
|
| Rate for Payer: Cash Price |
$951.26
|
| Rate for Payer: Cofinity Commercial |
$1,022.61
|
| Rate for Payer: Cofinity Commercial |
$832.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$951.26
|
| Rate for Payer: Healthscope Commercial |
$1,070.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$832.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$891.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,010.72
|
| Rate for Payer: PHP Commercial |
$1,010.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$832.36
|
| Rate for Payer: Priority Health SBD |
$749.12
|
| Rate for Payer: UMR Bronson Commercial |
$439.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$891.81
|
|
