|
HC MULBERRY IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200095
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.17 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna American Axle |
$16.50
|
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health SBD |
$16.00
|
| Rate for Payer: UMR Bronson Commercial |
$11.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.04
|
|
|
HC MULTIHANCE PER ML
|
Facility
|
IP
|
$6.68
|
|
|
Service Code
|
HCPCS A9577
|
| Hospital Charge Code |
63600016
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.94 |
| Max. Negotiated Rate |
$6.01 |
| Rate for Payer: Aetna American Axle |
$4.34
|
| Rate for Payer: Aetna Commercial |
$5.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.34
|
| Rate for Payer: Cash Price |
$5.34
|
| Rate for Payer: Cofinity Commercial |
$4.68
|
| Rate for Payer: Cofinity Commercial |
$5.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$4.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.34
|
| Rate for Payer: Healthscope Commercial |
$6.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.68
|
| Rate for Payer: PHP Commercial |
$5.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.34
|
| Rate for Payer: Priority Health SBD |
$4.21
|
| Rate for Payer: UMR Bronson Commercial |
$2.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.01
|
|
|
HC MULTIHANCE PER ML
|
Facility
|
OP
|
$6.68
|
|
|
Service Code
|
HCPCS A9577
|
| Hospital Charge Code |
63600016
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.47 |
| Max. Negotiated Rate |
$6.01 |
| Rate for Payer: Aetna American Axle |
$4.34
|
| Rate for Payer: Aetna Commercial |
$5.68
|
| Rate for Payer: Aetna Medicare |
$3.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.34
|
| Rate for Payer: BCBS Complete |
$2.67
|
| Rate for Payer: Cash Price |
$5.34
|
| Rate for Payer: Cofinity Commercial |
$4.68
|
| Rate for Payer: Cofinity Commercial |
$5.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$4.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.34
|
| Rate for Payer: Healthscope Commercial |
$6.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.68
|
| Rate for Payer: PHP Commercial |
$5.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.34
|
| Rate for Payer: Priority Health SBD |
$4.21
|
| Rate for Payer: UMR Bronson Commercial |
$2.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.01
|
|
|
HC MULTILAYER COMP DSG BK
|
Facility
|
IP
|
$641.58
|
|
|
Service Code
|
CPT 29581
|
| Hospital Charge Code |
76100020
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$282.30 |
| Max. Negotiated Rate |
$577.42 |
| Rate for Payer: Aetna American Axle |
$417.03
|
| Rate for Payer: Aetna Commercial |
$545.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$417.03
|
| Rate for Payer: Cash Price |
$513.26
|
| Rate for Payer: Cofinity Commercial |
$449.11
|
| Rate for Payer: Cofinity Commercial |
$551.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$449.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$513.26
|
| Rate for Payer: Healthscope Commercial |
$577.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$449.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$481.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$545.34
|
| Rate for Payer: PHP Commercial |
$545.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$417.03
|
| Rate for Payer: Priority Health SBD |
$404.20
|
| Rate for Payer: UMR Bronson Commercial |
$282.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$481.19
|
|
|
HC MULTILAYER COMP DSG BK
|
Facility
|
OP
|
$641.58
|
|
|
Service Code
|
CPT 29581
|
| Hospital Charge Code |
76100020
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$82.49 |
| Max. Negotiated Rate |
$577.42 |
| Rate for Payer: Aetna American Axle |
$417.03
|
| Rate for Payer: Aetna Commercial |
$545.34
|
| Rate for Payer: Aetna Medicare |
$160.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$417.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$192.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$192.36
|
| Rate for Payer: BCBS Complete |
$86.61
|
| Rate for Payer: BCBS MAPPO |
$153.89
|
| Rate for Payer: BCN Medicare Advantage |
$153.89
|
| Rate for Payer: Cash Price |
$513.26
|
| Rate for Payer: Cash Price |
$513.26
|
| Rate for Payer: Cofinity Commercial |
$551.76
|
| Rate for Payer: Cofinity Commercial |
$449.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$449.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$513.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$153.89
|
| Rate for Payer: Healthscope Commercial |
$577.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$449.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$481.19
|
| Rate for Payer: Mclaren Medicaid |
$82.49
|
| Rate for Payer: Mclaren Medicare |
$153.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$161.58
|
| Rate for Payer: Meridian Medicaid |
$86.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$176.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$545.34
|
| Rate for Payer: PACE Medicare |
$146.20
|
| Rate for Payer: PACE SWMI |
$153.89
|
| Rate for Payer: PHP Commercial |
$545.34
|
| Rate for Payer: PHP Medicare Advantage |
$153.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$417.03
|
| Rate for Payer: Priority Health Medicare |
$153.89
|
| Rate for Payer: Priority Health SBD |
$404.20
|
| Rate for Payer: Railroad Medicare Medicare |
$153.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$433.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$153.89
|
| Rate for Payer: UHC Exchange |
$294.10
|
| Rate for Payer: UHC Medicare Advantage |
$153.89
|
| Rate for Payer: UHCCP Medicaid |
$82.49
|
| Rate for Payer: UMR Bronson Commercial |
$237.38
|
| Rate for Payer: VA VA |
$153.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$481.19
|
|
|
HC MULTILEAF COLLIMATOR
|
Facility
|
OP
|
$853.13
|
|
|
Service Code
|
CPT 77338
|
| Hospital Charge Code |
33300016
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$191.36 |
| Max. Negotiated Rate |
$1,004.98 |
| Rate for Payer: Aetna American Axle |
$554.53
|
| Rate for Payer: Aetna Commercial |
$725.16
|
| Rate for Payer: Aetna Medicare |
$371.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$554.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$446.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$446.27
|
| Rate for Payer: BCBS Complete |
$200.93
|
| Rate for Payer: BCBS MAPPO |
$357.02
|
| Rate for Payer: BCN Medicare Advantage |
$357.02
|
| Rate for Payer: Cash Price |
$682.50
|
| Rate for Payer: Cash Price |
$682.50
|
| Rate for Payer: Cash Price |
$682.50
|
| Rate for Payer: Cofinity Commercial |
$597.19
|
| Rate for Payer: Cofinity Commercial |
$733.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$597.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$682.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$357.02
|
| Rate for Payer: Healthscope Commercial |
$767.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$597.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$639.85
|
| Rate for Payer: Mclaren Medicaid |
$191.36
|
| Rate for Payer: Mclaren Medicare |
$357.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$374.87
|
| Rate for Payer: Meridian Medicaid |
$200.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$410.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$725.16
|
| Rate for Payer: PACE Medicare |
$339.17
|
| Rate for Payer: PACE SWMI |
$357.02
|
| Rate for Payer: PHP Commercial |
$725.16
|
| Rate for Payer: PHP Medicare Advantage |
$357.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$191.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$554.53
|
| Rate for Payer: Priority Health Medicare |
$357.02
|
| Rate for Payer: Priority Health SBD |
$537.47
|
| Rate for Payer: Railroad Medicare Medicare |
$357.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,004.98
|
| Rate for Payer: UHC Core |
$979.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$357.02
|
| Rate for Payer: UHC Exchange |
$682.30
|
| Rate for Payer: UHC Medicare Advantage |
$357.02
|
| Rate for Payer: UHCCP Medicaid |
$191.36
|
| Rate for Payer: UMR Bronson Commercial |
$315.66
|
| Rate for Payer: VA VA |
$357.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$639.85
|
|
|
HC MULTILEAF COLLIMATOR
|
Facility
|
IP
|
$853.13
|
|
|
Service Code
|
CPT 77338
|
| Hospital Charge Code |
33300016
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$375.38 |
| Max. Negotiated Rate |
$767.82 |
| Rate for Payer: Aetna American Axle |
$554.53
|
| Rate for Payer: Aetna Commercial |
$725.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$554.53
|
| Rate for Payer: Cash Price |
$682.50
|
| Rate for Payer: Cofinity Commercial |
$597.19
|
| Rate for Payer: Cofinity Commercial |
$733.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$597.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$682.50
|
| Rate for Payer: Healthscope Commercial |
$767.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$597.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$639.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$725.16
|
| Rate for Payer: PHP Commercial |
$725.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$554.53
|
| Rate for Payer: Priority Health SBD |
$537.47
|
| Rate for Payer: UMR Bronson Commercial |
$375.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$639.85
|
|
|
HC MULTIPLE SCLEROSIS PROFILE
|
Facility
|
OP
|
$122.48
|
|
|
Service Code
|
CPT 83521
|
| Hospital Charge Code |
30100744
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.26 |
| Max. Negotiated Rate |
$110.23 |
| Rate for Payer: Aetna American Axle |
$79.61
|
| Rate for Payer: Aetna Commercial |
$104.11
|
| Rate for Payer: Aetna Medicare |
$17.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.59
|
| Rate for Payer: BCBS Complete |
$9.72
|
| Rate for Payer: BCBS MAPPO |
$17.27
|
| Rate for Payer: BCN Medicare Advantage |
$17.27
|
| Rate for Payer: Cash Price |
$97.98
|
| Rate for Payer: Cash Price |
$97.98
|
| Rate for Payer: Cofinity Commercial |
$85.74
|
| Rate for Payer: Cofinity Commercial |
$105.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$85.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.27
|
| Rate for Payer: Healthscope Commercial |
$110.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$85.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.86
|
| Rate for Payer: Mclaren Medicaid |
$9.26
|
| Rate for Payer: Mclaren Medicare |
$17.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.13
|
| Rate for Payer: Meridian Medicaid |
$9.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.11
|
| Rate for Payer: PACE Medicare |
$16.41
|
| Rate for Payer: PACE SWMI |
$17.27
|
| Rate for Payer: PHP Commercial |
$104.11
|
| Rate for Payer: PHP Medicare Advantage |
$17.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.61
|
| Rate for Payer: Priority Health Medicare |
$17.27
|
| Rate for Payer: Priority Health SBD |
$77.16
|
| Rate for Payer: Railroad Medicare Medicare |
$17.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.27
|
| Rate for Payer: UHC Exchange |
$33.00
|
| Rate for Payer: UHC Medicare Advantage |
$17.27
|
| Rate for Payer: UHCCP Medicaid |
$9.26
|
| Rate for Payer: UMR Bronson Commercial |
$45.32
|
| Rate for Payer: VA VA |
$17.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.86
|
|
|
HC MULTIPLE SCLEROSIS PROFILE
|
Facility
|
IP
|
$122.48
|
|
|
Service Code
|
CPT 83521
|
| Hospital Charge Code |
30100744
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$53.89 |
| Max. Negotiated Rate |
$110.23 |
| Rate for Payer: Aetna American Axle |
$79.61
|
| Rate for Payer: Aetna Commercial |
$104.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.61
|
| Rate for Payer: Cash Price |
$97.98
|
| Rate for Payer: Cofinity Commercial |
$105.33
|
| Rate for Payer: Cofinity Commercial |
$85.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$85.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.98
|
| Rate for Payer: Healthscope Commercial |
$110.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$85.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.11
|
| Rate for Payer: PHP Commercial |
$104.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.61
|
| Rate for Payer: Priority Health SBD |
$77.16
|
| Rate for Payer: UMR Bronson Commercial |
$53.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.86
|
|
|
HC MUMPS AB IGG
|
Facility
|
IP
|
$80.58
|
|
|
Service Code
|
CPT 86735
|
| Hospital Charge Code |
30200305
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$35.46 |
| Max. Negotiated Rate |
$72.52 |
| Rate for Payer: Aetna American Axle |
$52.38
|
| Rate for Payer: Aetna Commercial |
$68.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.38
|
| Rate for Payer: Cash Price |
$64.46
|
| Rate for Payer: Cofinity Commercial |
$56.41
|
| Rate for Payer: Cofinity Commercial |
$69.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$56.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.46
|
| Rate for Payer: Healthscope Commercial |
$72.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.49
|
| Rate for Payer: PHP Commercial |
$68.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.38
|
| Rate for Payer: Priority Health SBD |
$50.77
|
| Rate for Payer: UMR Bronson Commercial |
$35.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.44
|
|
|
HC MUMPS AB IGG
|
Facility
|
OP
|
$80.58
|
|
|
Service Code
|
CPT 86735
|
| Hospital Charge Code |
30200305
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.99 |
| Max. Negotiated Rate |
$72.52 |
| Rate for Payer: Aetna American Axle |
$52.38
|
| Rate for Payer: Aetna Commercial |
$68.49
|
| Rate for Payer: Aetna Medicare |
$13.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.31
|
| Rate for Payer: BCBS Complete |
$7.34
|
| Rate for Payer: BCBS MAPPO |
$13.05
|
| Rate for Payer: BCN Medicare Advantage |
$13.05
|
| Rate for Payer: Cash Price |
$64.46
|
| Rate for Payer: Cash Price |
$64.46
|
| Rate for Payer: Cofinity Commercial |
$69.30
|
| Rate for Payer: Cofinity Commercial |
$56.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$56.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.05
|
| Rate for Payer: Healthscope Commercial |
$72.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.44
|
| Rate for Payer: Mclaren Medicaid |
$6.99
|
| Rate for Payer: Mclaren Medicare |
$13.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.70
|
| Rate for Payer: Meridian Medicaid |
$7.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.49
|
| Rate for Payer: PACE Medicare |
$12.40
|
| Rate for Payer: PACE SWMI |
$13.05
|
| Rate for Payer: PHP Commercial |
$68.49
|
| Rate for Payer: PHP Medicare Advantage |
$13.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.38
|
| Rate for Payer: Priority Health Medicare |
$13.05
|
| Rate for Payer: Priority Health SBD |
$50.77
|
| Rate for Payer: Railroad Medicare Medicare |
$13.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.05
|
| Rate for Payer: UHC Exchange |
$24.94
|
| Rate for Payer: UHC Medicare Advantage |
$13.05
|
| Rate for Payer: UHCCP Medicaid |
$6.99
|
| Rate for Payer: UMR Bronson Commercial |
$29.81
|
| Rate for Payer: VA VA |
$13.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.44
|
|
|
HC MUMPS IGM ANTIBODY
|
Facility
|
IP
|
$77.52
|
|
|
Service Code
|
CPT 86735
|
| Hospital Charge Code |
30200306
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$34.11 |
| Max. Negotiated Rate |
$69.77 |
| Rate for Payer: Aetna American Axle |
$50.39
|
| Rate for Payer: Aetna Commercial |
$65.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.39
|
| Rate for Payer: Cash Price |
$62.02
|
| Rate for Payer: Cofinity Commercial |
$54.26
|
| Rate for Payer: Cofinity Commercial |
$66.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$54.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.02
|
| Rate for Payer: Healthscope Commercial |
$69.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$54.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.89
|
| Rate for Payer: PHP Commercial |
$65.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.39
|
| Rate for Payer: Priority Health SBD |
$48.84
|
| Rate for Payer: UMR Bronson Commercial |
$34.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.14
|
|
|
HC MUMPS IGM ANTIBODY
|
Facility
|
OP
|
$77.52
|
|
|
Service Code
|
CPT 86735
|
| Hospital Charge Code |
30200306
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.99 |
| Max. Negotiated Rate |
$69.77 |
| Rate for Payer: Aetna American Axle |
$50.39
|
| Rate for Payer: Aetna Commercial |
$65.89
|
| Rate for Payer: Aetna Medicare |
$13.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.31
|
| Rate for Payer: BCBS Complete |
$7.34
|
| Rate for Payer: BCBS MAPPO |
$13.05
|
| Rate for Payer: BCN Medicare Advantage |
$13.05
|
| Rate for Payer: Cash Price |
$62.02
|
| Rate for Payer: Cash Price |
$62.02
|
| Rate for Payer: Cofinity Commercial |
$66.67
|
| Rate for Payer: Cofinity Commercial |
$54.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$54.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.05
|
| Rate for Payer: Healthscope Commercial |
$69.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$54.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.14
|
| Rate for Payer: Mclaren Medicaid |
$6.99
|
| Rate for Payer: Mclaren Medicare |
$13.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.70
|
| Rate for Payer: Meridian Medicaid |
$7.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.89
|
| Rate for Payer: PACE Medicare |
$12.40
|
| Rate for Payer: PACE SWMI |
$13.05
|
| Rate for Payer: PHP Commercial |
$65.89
|
| Rate for Payer: PHP Medicare Advantage |
$13.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.39
|
| Rate for Payer: Priority Health Medicare |
$13.05
|
| Rate for Payer: Priority Health SBD |
$48.84
|
| Rate for Payer: Railroad Medicare Medicare |
$13.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.05
|
| Rate for Payer: UHC Exchange |
$24.94
|
| Rate for Payer: UHC Medicare Advantage |
$13.05
|
| Rate for Payer: UHCCP Medicaid |
$6.99
|
| Rate for Payer: UMR Bronson Commercial |
$28.68
|
| Rate for Payer: VA VA |
$13.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.14
|
|
|
HC MYCOBACTERIUM TUBERCULOSIS, RIFAMPIN RESISTANCE, AMP PROBE
|
Facility
|
IP
|
$117.50
|
|
|
Service Code
|
CPT 87564
|
| Hospital Charge Code |
30600345
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$51.70 |
| Max. Negotiated Rate |
$105.75 |
| Rate for Payer: Aetna American Axle |
$76.38
|
| Rate for Payer: Aetna Commercial |
$99.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.38
|
| Rate for Payer: Cash Price |
$94.00
|
| Rate for Payer: Cofinity Commercial |
$101.05
|
| Rate for Payer: Cofinity Commercial |
$82.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$82.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.00
|
| Rate for Payer: Healthscope Commercial |
$105.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$82.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$88.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.88
|
| Rate for Payer: PHP Commercial |
$99.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.38
|
| Rate for Payer: Priority Health SBD |
$74.03
|
| Rate for Payer: UMR Bronson Commercial |
$51.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$88.12
|
|
|
HC MYCOBACTERIUM TUBERCULOSIS, RIFAMPIN RESISTANCE, AMP PROBE
|
Facility
|
OP
|
$117.50
|
|
|
Service Code
|
CPT 87564
|
| Hospital Charge Code |
30600345
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$41.15 |
| Max. Negotiated Rate |
$216.10 |
| Rate for Payer: Aetna American Axle |
$76.38
|
| Rate for Payer: Aetna Commercial |
$99.88
|
| Rate for Payer: Aetna Medicare |
$79.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$95.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$95.96
|
| Rate for Payer: BCBS Complete |
$43.21
|
| Rate for Payer: BCBS MAPPO |
$76.77
|
| Rate for Payer: BCN Medicare Advantage |
$76.77
|
| Rate for Payer: Cash Price |
$94.00
|
| Rate for Payer: Cash Price |
$94.00
|
| Rate for Payer: Cofinity Commercial |
$82.25
|
| Rate for Payer: Cofinity Commercial |
$101.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$82.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$76.77
|
| Rate for Payer: Healthscope Commercial |
$105.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$82.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$88.12
|
| Rate for Payer: Mclaren Medicaid |
$41.15
|
| Rate for Payer: Mclaren Medicare |
$76.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$80.61
|
| Rate for Payer: Meridian Medicaid |
$43.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$88.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.88
|
| Rate for Payer: PACE Medicare |
$72.93
|
| Rate for Payer: PACE SWMI |
$76.77
|
| Rate for Payer: PHP Commercial |
$99.88
|
| Rate for Payer: PHP Medicare Advantage |
$76.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$41.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.38
|
| Rate for Payer: Priority Health Medicare |
$76.77
|
| Rate for Payer: Priority Health SBD |
$74.03
|
| Rate for Payer: Railroad Medicare Medicare |
$76.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$216.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$76.77
|
| Rate for Payer: UHC Exchange |
$146.72
|
| Rate for Payer: UHC Medicare Advantage |
$76.77
|
| Rate for Payer: UHCCP Medicaid |
$41.15
|
| Rate for Payer: UMR Bronson Commercial |
$43.48
|
| Rate for Payer: VA VA |
$76.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$88.12
|
|
|
HC MYCOPHENOLIC ACID
|
Facility
|
OP
|
$62.42
|
|
|
Service Code
|
CPT 80180
|
| Hospital Charge Code |
30100062
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.67 |
| Max. Negotiated Rate |
$56.18 |
| Rate for Payer: Aetna American Axle |
$40.57
|
| Rate for Payer: Aetna Commercial |
$53.06
|
| Rate for Payer: Aetna Medicare |
$18.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.56
|
| Rate for Payer: BCBS Complete |
$10.16
|
| Rate for Payer: BCBS MAPPO |
$18.05
|
| Rate for Payer: BCN Medicare Advantage |
$18.05
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cofinity Commercial |
$53.68
|
| Rate for Payer: Cofinity Commercial |
$43.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.05
|
| Rate for Payer: Healthscope Commercial |
$56.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.81
|
| Rate for Payer: Mclaren Medicaid |
$9.67
|
| Rate for Payer: Mclaren Medicare |
$18.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.95
|
| Rate for Payer: Meridian Medicaid |
$10.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.06
|
| Rate for Payer: PACE Medicare |
$17.15
|
| Rate for Payer: PACE SWMI |
$18.05
|
| Rate for Payer: PHP Commercial |
$53.06
|
| Rate for Payer: PHP Medicare Advantage |
$18.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.57
|
| Rate for Payer: Priority Health Medicare |
$18.05
|
| Rate for Payer: Priority Health SBD |
$39.32
|
| Rate for Payer: Railroad Medicare Medicare |
$18.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.05
|
| Rate for Payer: UHC Exchange |
$34.50
|
| Rate for Payer: UHC Medicare Advantage |
$18.05
|
| Rate for Payer: UHCCP Medicaid |
$9.67
|
| Rate for Payer: UMR Bronson Commercial |
$23.10
|
| Rate for Payer: VA VA |
$18.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.81
|
|
|
HC MYCOPHENOLIC ACID
|
Facility
|
IP
|
$62.42
|
|
|
Service Code
|
CPT 80180
|
| Hospital Charge Code |
30100062
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.46 |
| Max. Negotiated Rate |
$56.18 |
| Rate for Payer: Aetna American Axle |
$40.57
|
| Rate for Payer: Aetna Commercial |
$53.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.57
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cofinity Commercial |
$43.69
|
| Rate for Payer: Cofinity Commercial |
$53.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.94
|
| Rate for Payer: Healthscope Commercial |
$56.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.06
|
| Rate for Payer: PHP Commercial |
$53.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.57
|
| Rate for Payer: Priority Health SBD |
$39.32
|
| Rate for Payer: UMR Bronson Commercial |
$27.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.81
|
|
|
HC MYCOPLASMA AB IGG & IGM CMPT
|
Facility
|
IP
|
$21.85
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
30200311
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.61 |
| Max. Negotiated Rate |
$19.66 |
| Rate for Payer: Aetna American Axle |
$14.20
|
| Rate for Payer: Aetna Commercial |
$18.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.20
|
| Rate for Payer: Cash Price |
$17.48
|
| Rate for Payer: Cofinity Commercial |
$15.29
|
| Rate for Payer: Cofinity Commercial |
$18.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.48
|
| Rate for Payer: Healthscope Commercial |
$19.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.57
|
| Rate for Payer: PHP Commercial |
$18.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.20
|
| Rate for Payer: Priority Health SBD |
$13.77
|
| Rate for Payer: UMR Bronson Commercial |
$9.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.39
|
|
|
HC MYCOPLASMA AB IGG & IGM CMPT
|
Facility
|
OP
|
$21.85
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
30200311
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.10 |
| Max. Negotiated Rate |
$37.27 |
| Rate for Payer: Aetna American Axle |
$14.20
|
| Rate for Payer: Aetna Commercial |
$18.57
|
| Rate for Payer: Aetna Medicare |
$13.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.55
|
| Rate for Payer: BCBS Complete |
$7.45
|
| Rate for Payer: BCBS MAPPO |
$13.24
|
| Rate for Payer: BCN Medicare Advantage |
$13.24
|
| Rate for Payer: Cash Price |
$17.48
|
| Rate for Payer: Cash Price |
$17.48
|
| Rate for Payer: Cofinity Commercial |
$18.79
|
| Rate for Payer: Cofinity Commercial |
$15.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.24
|
| Rate for Payer: Healthscope Commercial |
$19.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.39
|
| Rate for Payer: Mclaren Medicaid |
$7.10
|
| Rate for Payer: Mclaren Medicare |
$13.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.90
|
| Rate for Payer: Meridian Medicaid |
$7.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.57
|
| Rate for Payer: PACE Medicare |
$12.58
|
| Rate for Payer: PACE SWMI |
$13.24
|
| Rate for Payer: PHP Commercial |
$18.57
|
| Rate for Payer: PHP Medicare Advantage |
$13.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.20
|
| Rate for Payer: Priority Health Medicare |
$13.24
|
| Rate for Payer: Priority Health SBD |
$13.77
|
| Rate for Payer: Railroad Medicare Medicare |
$13.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.24
|
| Rate for Payer: UHC Exchange |
$25.30
|
| Rate for Payer: UHC Medicare Advantage |
$13.24
|
| Rate for Payer: UHCCP Medicaid |
$7.10
|
| Rate for Payer: UMR Bronson Commercial |
$8.08
|
| Rate for Payer: VA VA |
$13.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.39
|
|
|
HC MYCOPLASMA AB IGM
|
Facility
|
IP
|
$21.66
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
30200312
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.53 |
| Max. Negotiated Rate |
$19.49 |
| Rate for Payer: Aetna American Axle |
$14.08
|
| Rate for Payer: Aetna Commercial |
$18.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.08
|
| Rate for Payer: Cash Price |
$17.33
|
| Rate for Payer: Cofinity Commercial |
$15.16
|
| Rate for Payer: Cofinity Commercial |
$18.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.33
|
| Rate for Payer: Healthscope Commercial |
$19.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.41
|
| Rate for Payer: PHP Commercial |
$18.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.08
|
| Rate for Payer: Priority Health SBD |
$13.65
|
| Rate for Payer: UMR Bronson Commercial |
$9.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.25
|
|
|
HC MYCOPLASMA AB IGM
|
Facility
|
OP
|
$21.66
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
30200312
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.10 |
| Max. Negotiated Rate |
$37.27 |
| Rate for Payer: Aetna American Axle |
$14.08
|
| Rate for Payer: Aetna Commercial |
$18.41
|
| Rate for Payer: Aetna Medicare |
$13.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.55
|
| Rate for Payer: BCBS Complete |
$7.45
|
| Rate for Payer: BCBS MAPPO |
$13.24
|
| Rate for Payer: BCN Medicare Advantage |
$13.24
|
| Rate for Payer: Cash Price |
$17.33
|
| Rate for Payer: Cash Price |
$17.33
|
| Rate for Payer: Cofinity Commercial |
$18.63
|
| Rate for Payer: Cofinity Commercial |
$15.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.24
|
| Rate for Payer: Healthscope Commercial |
$19.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.25
|
| Rate for Payer: Mclaren Medicaid |
$7.10
|
| Rate for Payer: Mclaren Medicare |
$13.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.90
|
| Rate for Payer: Meridian Medicaid |
$7.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.41
|
| Rate for Payer: PACE Medicare |
$12.58
|
| Rate for Payer: PACE SWMI |
$13.24
|
| Rate for Payer: PHP Commercial |
$18.41
|
| Rate for Payer: PHP Medicare Advantage |
$13.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.08
|
| Rate for Payer: Priority Health Medicare |
$13.24
|
| Rate for Payer: Priority Health SBD |
$13.65
|
| Rate for Payer: Railroad Medicare Medicare |
$13.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.24
|
| Rate for Payer: UHC Exchange |
$25.30
|
| Rate for Payer: UHC Medicare Advantage |
$13.24
|
| Rate for Payer: UHCCP Medicaid |
$7.10
|
| Rate for Payer: UMR Bronson Commercial |
$8.01
|
| Rate for Payer: VA VA |
$13.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.25
|
|
|
HC MYCOPLASMA CULTURE
|
Facility
|
IP
|
$109.75
|
|
|
Service Code
|
CPT 87109
|
| Hospital Charge Code |
30600086
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$48.29 |
| Max. Negotiated Rate |
$98.78 |
| Rate for Payer: Aetna American Axle |
$71.34
|
| Rate for Payer: Aetna Commercial |
$93.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.34
|
| Rate for Payer: Cash Price |
$87.80
|
| Rate for Payer: Cofinity Commercial |
$76.83
|
| Rate for Payer: Cofinity Commercial |
$94.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$76.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.80
|
| Rate for Payer: Healthscope Commercial |
$98.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$76.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.29
|
| Rate for Payer: PHP Commercial |
$93.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.34
|
| Rate for Payer: Priority Health SBD |
$69.14
|
| Rate for Payer: UMR Bronson Commercial |
$48.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.31
|
|
|
HC MYCOPLASMA CULTURE
|
Facility
|
OP
|
$109.75
|
|
|
Service Code
|
CPT 87109
|
| Hospital Charge Code |
30600086
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.25 |
| Max. Negotiated Rate |
$98.78 |
| Rate for Payer: Aetna American Axle |
$71.34
|
| Rate for Payer: Aetna Commercial |
$93.29
|
| Rate for Payer: Aetna Medicare |
$16.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.24
|
| Rate for Payer: BCBS Complete |
$8.66
|
| Rate for Payer: BCBS MAPPO |
$15.39
|
| Rate for Payer: BCN Medicare Advantage |
$15.39
|
| Rate for Payer: Cash Price |
$87.80
|
| Rate for Payer: Cash Price |
$87.80
|
| Rate for Payer: Cofinity Commercial |
$94.39
|
| Rate for Payer: Cofinity Commercial |
$76.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$76.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.39
|
| Rate for Payer: Healthscope Commercial |
$98.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$76.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.31
|
| Rate for Payer: Mclaren Medicaid |
$8.25
|
| Rate for Payer: Mclaren Medicare |
$15.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.16
|
| Rate for Payer: Meridian Medicaid |
$8.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.29
|
| Rate for Payer: PACE Medicare |
$14.62
|
| Rate for Payer: PACE SWMI |
$15.39
|
| Rate for Payer: PHP Commercial |
$93.29
|
| Rate for Payer: PHP Medicare Advantage |
$15.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.34
|
| Rate for Payer: Priority Health Medicare |
$15.39
|
| Rate for Payer: Priority Health SBD |
$69.14
|
| Rate for Payer: Railroad Medicare Medicare |
$15.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.39
|
| Rate for Payer: UHC Exchange |
$29.41
|
| Rate for Payer: UHC Medicare Advantage |
$15.39
|
| Rate for Payer: UHCCP Medicaid |
$8.25
|
| Rate for Payer: UMR Bronson Commercial |
$40.61
|
| Rate for Payer: VA VA |
$15.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.31
|
|
|
HC MYCOPLASMA GENITALIUM
|
Facility
|
OP
|
$61.20
|
|
|
Service Code
|
CPT 87563
|
| Hospital Charge Code |
30600338
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.81 |
| Max. Negotiated Rate |
$98.77 |
| Rate for Payer: Aetna American Axle |
$39.78
|
| Rate for Payer: Aetna Commercial |
$52.02
|
| Rate for Payer: Aetna Medicare |
$36.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: BCBS Complete |
$19.75
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cofinity Commercial |
$52.63
|
| Rate for Payer: Cofinity Commercial |
$42.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$42.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$55.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.90
|
| Rate for Payer: Mclaren Medicaid |
$18.81
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: Meridian Medicaid |
$19.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.02
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$52.02
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.78
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health SBD |
$38.56
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$98.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.09
|
| Rate for Payer: UHC Exchange |
$67.06
|
| Rate for Payer: UHC Medicare Advantage |
$35.09
|
| Rate for Payer: UHCCP Medicaid |
$18.81
|
| Rate for Payer: UMR Bronson Commercial |
$22.64
|
| Rate for Payer: VA VA |
$35.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.90
|
|
|
HC MYCOPLASMA GENITALIUM
|
Facility
|
IP
|
$61.20
|
|
|
Service Code
|
CPT 87563
|
| Hospital Charge Code |
30600338
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$26.93 |
| Max. Negotiated Rate |
$55.08 |
| Rate for Payer: Aetna American Axle |
$39.78
|
| Rate for Payer: Aetna Commercial |
$52.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.78
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cofinity Commercial |
$42.84
|
| Rate for Payer: Cofinity Commercial |
$52.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$42.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.96
|
| Rate for Payer: Healthscope Commercial |
$55.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.02
|
| Rate for Payer: PHP Commercial |
$52.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.78
|
| Rate for Payer: Priority Health SBD |
$38.56
|
| Rate for Payer: UMR Bronson Commercial |
$26.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.90
|
|
