|
HC NEUTROPHIL OXIDATIVE BURST CMP
|
Facility
|
IP
|
$56.18
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31000012
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$24.72 |
| Max. Negotiated Rate |
$50.56 |
| Rate for Payer: Aetna American Axle |
$36.52
|
| Rate for Payer: Aetna Commercial |
$47.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.52
|
| Rate for Payer: Cash Price |
$44.94
|
| Rate for Payer: Cofinity Commercial |
$39.33
|
| Rate for Payer: Cofinity Commercial |
$48.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$39.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.94
|
| Rate for Payer: Healthscope Commercial |
$50.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.75
|
| Rate for Payer: PHP Commercial |
$47.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.52
|
| Rate for Payer: Priority Health SBD |
$35.39
|
| Rate for Payer: UMR Bronson Commercial |
$24.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.14
|
|
|
HC NEW PATIENT VISIT 99202
|
Facility
|
IP
|
$169.02
|
|
|
Service Code
|
CPT 99202
|
| Hospital Charge Code |
51000077
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$74.37 |
| Max. Negotiated Rate |
$152.12 |
| Rate for Payer: Aetna American Axle |
$109.86
|
| Rate for Payer: Aetna Commercial |
$143.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.86
|
| Rate for Payer: Cash Price |
$135.22
|
| Rate for Payer: Cofinity Commercial |
$118.31
|
| Rate for Payer: Cofinity Commercial |
$145.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$118.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.22
|
| Rate for Payer: Healthscope Commercial |
$152.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$118.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$126.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.67
|
| Rate for Payer: PHP Commercial |
$143.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.86
|
| Rate for Payer: Priority Health SBD |
$106.48
|
| Rate for Payer: UMR Bronson Commercial |
$74.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$126.76
|
|
|
HC NEW PATIENT VISIT 99202
|
Facility
|
OP
|
$169.02
|
|
|
Service Code
|
CPT 99202
|
| Hospital Charge Code |
51000077
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$45.46 |
| Max. Negotiated Rate |
$152.12 |
| Rate for Payer: Aetna American Axle |
$109.86
|
| Rate for Payer: Aetna Commercial |
$143.67
|
| Rate for Payer: Aetna Medicare |
$84.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.86
|
| Rate for Payer: BCBS Complete |
$67.61
|
| Rate for Payer: BCBS Trust/PPO |
$114.80
|
| Rate for Payer: BCCCP Commercial |
$68.62
|
| Rate for Payer: BCN Commercial |
$114.80
|
| Rate for Payer: Cash Price |
$135.22
|
| Rate for Payer: Cash Price |
$135.22
|
| Rate for Payer: Cofinity Commercial |
$145.36
|
| Rate for Payer: Cofinity Commercial |
$118.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$118.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.22
|
| Rate for Payer: Healthscope Commercial |
$152.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$118.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$126.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.67
|
| Rate for Payer: PHP Commercial |
$143.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.86
|
| Rate for Payer: Priority Health SBD |
$106.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.01
|
| Rate for Payer: UHC Exchange |
$45.46
|
| Rate for Payer: UMR Bronson Commercial |
$62.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$126.76
|
|
|
HC NEW PATIENT VISIT 99203
|
Facility
|
OP
|
$205.10
|
|
|
Service Code
|
CPT 99203
|
| Hospital Charge Code |
51000078
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$75.89 |
| Max. Negotiated Rate |
$184.59 |
| Rate for Payer: Aetna American Axle |
$133.32
|
| Rate for Payer: Aetna Commercial |
$174.34
|
| Rate for Payer: Aetna Medicare |
$102.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$133.32
|
| Rate for Payer: BCBS Complete |
$82.04
|
| Rate for Payer: BCBS Trust/PPO |
$151.72
|
| Rate for Payer: BCCCP Commercial |
$108.06
|
| Rate for Payer: BCN Commercial |
$151.72
|
| Rate for Payer: Cash Price |
$164.08
|
| Rate for Payer: Cash Price |
$164.08
|
| Rate for Payer: Cofinity Commercial |
$176.39
|
| Rate for Payer: Cofinity Commercial |
$143.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$143.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$164.08
|
| Rate for Payer: Healthscope Commercial |
$184.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$143.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$153.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$174.34
|
| Rate for Payer: PHP Commercial |
$174.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.32
|
| Rate for Payer: Priority Health SBD |
$129.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$86.70
|
| Rate for Payer: UHC Exchange |
$78.82
|
| Rate for Payer: UMR Bronson Commercial |
$75.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$153.82
|
|
|
HC NEW PATIENT VISIT 99203
|
Facility
|
IP
|
$205.10
|
|
|
Service Code
|
CPT 99203
|
| Hospital Charge Code |
51000078
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$90.24 |
| Max. Negotiated Rate |
$184.59 |
| Rate for Payer: Aetna American Axle |
$133.32
|
| Rate for Payer: Aetna Commercial |
$174.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$133.32
|
| Rate for Payer: Cash Price |
$164.08
|
| Rate for Payer: Cofinity Commercial |
$143.57
|
| Rate for Payer: Cofinity Commercial |
$176.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$143.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$164.08
|
| Rate for Payer: Healthscope Commercial |
$184.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$143.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$153.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$174.34
|
| Rate for Payer: PHP Commercial |
$174.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.32
|
| Rate for Payer: Priority Health SBD |
$129.21
|
| Rate for Payer: UMR Bronson Commercial |
$90.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$153.82
|
|
|
HC NEW PATIENT VISIT 99204
|
Facility
|
IP
|
$294.53
|
|
|
Service Code
|
CPT 99204
|
| Hospital Charge Code |
51000079
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$129.59 |
| Max. Negotiated Rate |
$265.08 |
| Rate for Payer: Aetna American Axle |
$191.44
|
| Rate for Payer: Aetna Commercial |
$250.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$191.44
|
| Rate for Payer: Cash Price |
$235.62
|
| Rate for Payer: Cofinity Commercial |
$206.17
|
| Rate for Payer: Cofinity Commercial |
$253.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$206.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$235.62
|
| Rate for Payer: Healthscope Commercial |
$265.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$206.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$220.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$250.35
|
| Rate for Payer: PHP Commercial |
$250.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$191.44
|
| Rate for Payer: Priority Health SBD |
$185.55
|
| Rate for Payer: UMR Bronson Commercial |
$129.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$220.90
|
|
|
HC NEW PATIENT VISIT 99204
|
Facility
|
OP
|
$294.53
|
|
|
Service Code
|
CPT 99204
|
| Hospital Charge Code |
51000079
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$108.98 |
| Max. Negotiated Rate |
$265.08 |
| Rate for Payer: Aetna American Axle |
$191.44
|
| Rate for Payer: Aetna Commercial |
$250.35
|
| Rate for Payer: Aetna Medicare |
$147.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$191.44
|
| Rate for Payer: BCBS Complete |
$117.81
|
| Rate for Payer: BCBS Trust/PPO |
$202.95
|
| Rate for Payer: BCCCP Commercial |
$115.00
|
| Rate for Payer: BCN Commercial |
$202.95
|
| Rate for Payer: Cash Price |
$235.62
|
| Rate for Payer: Cash Price |
$235.62
|
| Rate for Payer: Cofinity Commercial |
$253.30
|
| Rate for Payer: Cofinity Commercial |
$206.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$206.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$235.62
|
| Rate for Payer: Healthscope Commercial |
$265.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$206.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$220.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$250.35
|
| Rate for Payer: PHP Commercial |
$250.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$191.44
|
| Rate for Payer: Priority Health SBD |
$185.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$140.87
|
| Rate for Payer: UHC Exchange |
$128.06
|
| Rate for Payer: UMR Bronson Commercial |
$108.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$220.90
|
|
|
HC NEW PATIENT VISIT 99205
|
Facility
|
OP
|
$490.43
|
|
|
Service Code
|
CPT 99205
|
| Hospital Charge Code |
51000080
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$115.00 |
| Max. Negotiated Rate |
$441.39 |
| Rate for Payer: Aetna American Axle |
$318.78
|
| Rate for Payer: Aetna Commercial |
$416.87
|
| Rate for Payer: Aetna Medicare |
$245.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$318.78
|
| Rate for Payer: BCBS Complete |
$196.17
|
| Rate for Payer: BCBS Trust/PPO |
$245.98
|
| Rate for Payer: BCCCP Commercial |
$115.00
|
| Rate for Payer: BCN Commercial |
$245.98
|
| Rate for Payer: Cash Price |
$392.34
|
| Rate for Payer: Cash Price |
$392.34
|
| Rate for Payer: Cofinity Commercial |
$421.77
|
| Rate for Payer: Cofinity Commercial |
$343.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$343.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$392.34
|
| Rate for Payer: Healthscope Commercial |
$441.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$343.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$367.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$416.87
|
| Rate for Payer: PHP Commercial |
$416.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$318.78
|
| Rate for Payer: Priority Health SBD |
$308.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$191.52
|
| Rate for Payer: UHC Exchange |
$174.11
|
| Rate for Payer: UMR Bronson Commercial |
$181.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$367.82
|
|
|
HC NEW PATIENT VISIT 99205
|
Facility
|
IP
|
$490.43
|
|
|
Service Code
|
CPT 99205
|
| Hospital Charge Code |
51000080
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$215.79 |
| Max. Negotiated Rate |
$441.39 |
| Rate for Payer: Aetna American Axle |
$318.78
|
| Rate for Payer: Aetna Commercial |
$416.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$318.78
|
| Rate for Payer: Cash Price |
$392.34
|
| Rate for Payer: Cofinity Commercial |
$343.30
|
| Rate for Payer: Cofinity Commercial |
$421.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$343.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$392.34
|
| Rate for Payer: Healthscope Commercial |
$441.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$343.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$367.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$416.87
|
| Rate for Payer: PHP Commercial |
$416.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$318.78
|
| Rate for Payer: Priority Health SBD |
$308.97
|
| Rate for Payer: UMR Bronson Commercial |
$215.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$367.82
|
|
|
HC NICOTINE AND METABOLITES BLD
|
Facility
|
OP
|
$62.22
|
|
|
Service Code
|
CPT 80323
|
| Hospital Charge Code |
30100599
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.02 |
| Max. Negotiated Rate |
$56.00 |
| Rate for Payer: Aetna American Axle |
$40.44
|
| Rate for Payer: Aetna Commercial |
$52.89
|
| Rate for Payer: Aetna Medicare |
$31.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.44
|
| Rate for Payer: BCBS Complete |
$24.89
|
| Rate for Payer: Cash Price |
$49.78
|
| Rate for Payer: Cofinity Commercial |
$43.55
|
| Rate for Payer: Cofinity Commercial |
$53.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.78
|
| Rate for Payer: Healthscope Commercial |
$56.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.89
|
| Rate for Payer: PHP Commercial |
$52.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.44
|
| Rate for Payer: Priority Health SBD |
$39.20
|
| Rate for Payer: UMR Bronson Commercial |
$23.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.66
|
|
|
HC NICOTINE AND METABOLITES BLD
|
Facility
|
IP
|
$62.22
|
|
|
Service Code
|
CPT 80323
|
| Hospital Charge Code |
30100599
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.38 |
| Max. Negotiated Rate |
$56.00 |
| Rate for Payer: Aetna American Axle |
$40.44
|
| Rate for Payer: Aetna Commercial |
$52.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.44
|
| Rate for Payer: Cash Price |
$49.78
|
| Rate for Payer: Cofinity Commercial |
$43.55
|
| Rate for Payer: Cofinity Commercial |
$53.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.78
|
| Rate for Payer: Healthscope Commercial |
$56.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.89
|
| Rate for Payer: PHP Commercial |
$52.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.44
|
| Rate for Payer: Priority Health SBD |
$39.20
|
| Rate for Payer: UMR Bronson Commercial |
$27.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.66
|
|
|
HC NICOTINE AND METABOLITES URN
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 80323
|
| Hospital Charge Code |
30100613
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.44 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna American Axle |
$33.15
|
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.15
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$35.70
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.35
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.15
|
| Rate for Payer: Priority Health SBD |
$32.13
|
| Rate for Payer: UMR Bronson Commercial |
$22.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.25
|
|
|
HC NICOTINE AND METABOLITES URN
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 80323
|
| Hospital Charge Code |
30100613
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.87 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna American Axle |
$33.15
|
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna Medicare |
$25.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.15
|
| Rate for Payer: BCBS Complete |
$20.40
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$35.70
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.35
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.15
|
| Rate for Payer: Priority Health SBD |
$32.13
|
| Rate for Payer: UMR Bronson Commercial |
$18.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.25
|
|
|
HC NICU LEVEL 2 R&B
|
Facility
|
IP
|
$3,430.50
|
|
| Hospital Charge Code |
17200001
|
|
Hospital Revenue Code
|
172
|
| Min. Negotiated Rate |
$1,509.42 |
| Max. Negotiated Rate |
$3,087.45 |
| Rate for Payer: Aetna American Axle |
$2,229.82
|
| Rate for Payer: Aetna Commercial |
$2,915.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,229.82
|
| Rate for Payer: Cash Price |
$2,744.40
|
| Rate for Payer: Cash Price |
$2,744.40
|
| Rate for Payer: Cofinity Commercial |
$2,950.23
|
| Rate for Payer: Cofinity Commercial |
$2,401.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,401.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,744.40
|
| Rate for Payer: Healthscope Commercial |
$3,087.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,401.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,572.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,915.92
|
| Rate for Payer: PHP Commercial |
$2,915.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,229.82
|
| Rate for Payer: Priority Health SBD |
$2,161.22
|
| Rate for Payer: UHC Exchange |
$2,032.00
|
| Rate for Payer: UMR Bronson Commercial |
$1,509.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,572.88
|
|
|
HC NICU LEVEL 3 R&B
|
Facility
|
IP
|
$5,085.75
|
|
| Hospital Charge Code |
17300001
|
|
Hospital Revenue Code
|
173
|
| Min. Negotiated Rate |
$2,237.73 |
| Max. Negotiated Rate |
$4,577.18 |
| Rate for Payer: Aetna American Axle |
$3,305.74
|
| Rate for Payer: Aetna Commercial |
$4,322.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,305.74
|
| Rate for Payer: Cash Price |
$4,068.60
|
| Rate for Payer: Cash Price |
$4,068.60
|
| Rate for Payer: Cofinity Commercial |
$4,373.74
|
| Rate for Payer: Cofinity Commercial |
$3,560.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,560.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,068.60
|
| Rate for Payer: Healthscope Commercial |
$4,577.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,560.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,814.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,322.89
|
| Rate for Payer: PHP Commercial |
$4,322.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,305.74
|
| Rate for Payer: Priority Health SBD |
$3,204.02
|
| Rate for Payer: UHC Exchange |
$2,835.00
|
| Rate for Payer: UMR Bronson Commercial |
$2,237.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,814.31
|
|
|
HC NICU LEVEL 4 R&B
|
Facility
|
IP
|
$5,325.60
|
|
| Hospital Charge Code |
17400001
|
|
Hospital Revenue Code
|
174
|
| Min. Negotiated Rate |
$2,343.26 |
| Max. Negotiated Rate |
$4,793.04 |
| Rate for Payer: Aetna American Axle |
$3,461.64
|
| Rate for Payer: Aetna Commercial |
$4,526.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,461.64
|
| Rate for Payer: Cash Price |
$4,260.48
|
| Rate for Payer: Cash Price |
$4,260.48
|
| Rate for Payer: Cofinity Commercial |
$4,580.02
|
| Rate for Payer: Cofinity Commercial |
$3,727.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,727.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,260.48
|
| Rate for Payer: Healthscope Commercial |
$4,793.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,727.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,994.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,526.76
|
| Rate for Payer: PHP Commercial |
$4,526.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,461.64
|
| Rate for Payer: Priority Health SBD |
$3,355.13
|
| Rate for Payer: UHC Exchange |
$3,255.00
|
| Rate for Payer: UMR Bronson Commercial |
$2,343.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,994.20
|
|
|
HC NICU OBSERVATION PER HOUR
|
Facility
|
IP
|
$200.94
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200013
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$88.41 |
| Max. Negotiated Rate |
$180.85 |
| Rate for Payer: Aetna American Axle |
$130.61
|
| Rate for Payer: Aetna Commercial |
$170.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.61
|
| Rate for Payer: Cash Price |
$160.75
|
| Rate for Payer: Cofinity Commercial |
$140.66
|
| Rate for Payer: Cofinity Commercial |
$172.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$140.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.75
|
| Rate for Payer: Healthscope Commercial |
$180.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$140.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.80
|
| Rate for Payer: PHP Commercial |
$170.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.61
|
| Rate for Payer: Priority Health SBD |
$126.59
|
| Rate for Payer: UMR Bronson Commercial |
$88.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.70
|
|
|
HC NICU OBSERVATION PER HOUR
|
Facility
|
OP
|
$200.94
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200013
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$74.35 |
| Max. Negotiated Rate |
$4,092.00 |
| Rate for Payer: Aetna American Axle |
$130.61
|
| Rate for Payer: Aetna Commercial |
$170.80
|
| Rate for Payer: Aetna Medicare |
$100.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.61
|
| Rate for Payer: BCBS Complete |
$80.38
|
| Rate for Payer: BCBS Trust/PPO |
$103.16
|
| Rate for Payer: BCN Commercial |
$103.16
|
| Rate for Payer: Cash Price |
$160.75
|
| Rate for Payer: Cash Price |
$160.75
|
| Rate for Payer: Cash Price |
$160.75
|
| Rate for Payer: Cofinity Commercial |
$172.81
|
| Rate for Payer: Cofinity Commercial |
$140.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$140.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.75
|
| Rate for Payer: Healthscope Commercial |
$180.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$140.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.70
|
| Rate for Payer: Meridian Medicaid |
$1,000.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.80
|
| Rate for Payer: PHP Commercial |
$170.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.61
|
| Rate for Payer: Priority Health SBD |
$126.59
|
| Rate for Payer: UHC Core |
$4,092.00
|
| Rate for Payer: UMR Bronson Commercial |
$74.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.70
|
|
|
HC NICU OR OB NURSERY R&B
|
Facility
|
IP
|
$2,362.67
|
|
| Hospital Charge Code |
17000001
|
|
Hospital Revenue Code
|
170
|
| Min. Negotiated Rate |
$919.00 |
| Max. Negotiated Rate |
$2,126.40 |
| Rate for Payer: Aetna American Axle |
$1,535.74
|
| Rate for Payer: Aetna Commercial |
$2,008.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,535.74
|
| Rate for Payer: Cash Price |
$1,890.14
|
| Rate for Payer: Cash Price |
$1,890.14
|
| Rate for Payer: Cofinity Commercial |
$2,031.90
|
| Rate for Payer: Cofinity Commercial |
$1,653.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,653.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,890.14
|
| Rate for Payer: Healthscope Commercial |
$2,126.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,653.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,772.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,008.27
|
| Rate for Payer: PHP Commercial |
$2,008.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,535.74
|
| Rate for Payer: Priority Health SBD |
$1,488.48
|
| Rate for Payer: UHC Exchange |
$919.00
|
| Rate for Payer: UMR Bronson Commercial |
$1,039.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,772.00
|
|
|
HC NIFOMETER
|
Facility
|
OP
|
$84.13
|
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$31.13 |
| Max. Negotiated Rate |
$75.72 |
| Rate for Payer: Aetna American Axle |
$54.68
|
| Rate for Payer: Aetna Commercial |
$71.51
|
| Rate for Payer: Aetna Medicare |
$42.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.68
|
| Rate for Payer: BCBS Complete |
$33.65
|
| Rate for Payer: Cash Price |
$67.30
|
| Rate for Payer: Cofinity Commercial |
$58.89
|
| Rate for Payer: Cofinity Commercial |
$72.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$58.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.30
|
| Rate for Payer: Healthscope Commercial |
$75.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$58.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.51
|
| Rate for Payer: PHP Commercial |
$71.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.68
|
| Rate for Payer: Priority Health SBD |
$53.00
|
| Rate for Payer: UMR Bronson Commercial |
$31.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.10
|
|
|
HC NIFOMETER
|
Facility
|
IP
|
$84.13
|
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$37.02 |
| Max. Negotiated Rate |
$75.72 |
| Rate for Payer: Aetna American Axle |
$54.68
|
| Rate for Payer: Aetna Commercial |
$71.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.68
|
| Rate for Payer: Cash Price |
$67.30
|
| Rate for Payer: Cofinity Commercial |
$58.89
|
| Rate for Payer: Cofinity Commercial |
$72.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$58.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.30
|
| Rate for Payer: Healthscope Commercial |
$75.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$58.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.51
|
| Rate for Payer: PHP Commercial |
$71.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.68
|
| Rate for Payer: Priority Health SBD |
$53.00
|
| Rate for Payer: UMR Bronson Commercial |
$37.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.10
|
|
|
HC NITRIC OXIDE EXPIRED GAS DETERMINATION
|
Facility
|
IP
|
$50.12
|
|
|
Service Code
|
CPT 95012
|
| Hospital Charge Code |
46000031
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$22.05 |
| Max. Negotiated Rate |
$45.11 |
| Rate for Payer: Aetna American Axle |
$32.58
|
| Rate for Payer: Aetna Commercial |
$42.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.58
|
| Rate for Payer: Cash Price |
$40.10
|
| Rate for Payer: Cofinity Commercial |
$35.08
|
| Rate for Payer: Cofinity Commercial |
$43.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.10
|
| Rate for Payer: Healthscope Commercial |
$45.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.60
|
| Rate for Payer: PHP Commercial |
$42.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.58
|
| Rate for Payer: Priority Health SBD |
$31.58
|
| Rate for Payer: UMR Bronson Commercial |
$22.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.59
|
|
|
HC NITRIC OXIDE EXPIRED GAS DETERMINATION
|
Facility
|
OP
|
$50.12
|
|
|
Service Code
|
CPT 95012
|
| Hospital Charge Code |
46000031
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$17.09 |
| Max. Negotiated Rate |
$294.00 |
| Rate for Payer: Cofinity Commercial |
$35.08
|
| Rate for Payer: Aetna American Axle |
$32.58
|
| Rate for Payer: Aetna Commercial |
$42.60
|
| Rate for Payer: Aetna Medicare |
$40.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$48.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$48.08
|
| Rate for Payer: BCBS Complete |
$21.65
|
| Rate for Payer: BCBS MAPPO |
$38.46
|
| Rate for Payer: BCBS Trust/PPO |
$29.25
|
| Rate for Payer: BCN Commercial |
$29.25
|
| Rate for Payer: BCN Medicare Advantage |
$38.46
|
| Rate for Payer: Cash Price |
$40.10
|
| Rate for Payer: Cash Price |
$40.10
|
| Rate for Payer: Cash Price |
$40.10
|
| Rate for Payer: Cofinity Commercial |
$43.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.46
|
| Rate for Payer: Healthscope Commercial |
$45.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.59
|
| Rate for Payer: Mclaren Medicaid |
$20.61
|
| Rate for Payer: Mclaren Medicare |
$38.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.38
|
| Rate for Payer: Meridian Medicaid |
$21.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.60
|
| Rate for Payer: Nomi Health Commercial |
$115.38
|
| Rate for Payer: PACE Medicare |
$36.54
|
| Rate for Payer: PACE SWMI |
$38.46
|
| Rate for Payer: PHP Commercial |
$42.60
|
| Rate for Payer: PHP Medicare Advantage |
$38.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$120.87
|
| Rate for Payer: Priority Health Medicare |
$38.46
|
| Rate for Payer: Priority Health Narrow Network |
$96.70
|
| Rate for Payer: Priority Health SBD |
$31.58
|
| Rate for Payer: Railroad Medicare Medicare |
$38.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.80
|
| Rate for Payer: UHC Core |
$294.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.46
|
| Rate for Payer: UHC Exchange |
$17.09
|
| Rate for Payer: UHC Medicare Advantage |
$38.46
|
| Rate for Payer: UHCCP Medicaid |
$20.61
|
| Rate for Payer: UMR Bronson Commercial |
$18.54
|
| Rate for Payer: VA VA |
$38.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.59
|
|
|
HC NJX NONCMPND SCLEROSANT MULTIPLE INCMPTNT VEINS
|
Facility
|
OP
|
$4,896.00
|
|
|
Service Code
|
CPT 36466
|
| Hospital Charge Code |
76100402
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$146.55 |
| Max. Negotiated Rate |
$5,632.99 |
| Rate for Payer: Aetna American Axle |
$3,182.40
|
| Rate for Payer: Aetna Commercial |
$4,161.60
|
| Rate for Payer: Aetna Medicare |
$1,863.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,182.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,240.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,240.30
|
| Rate for Payer: BCBS Complete |
$1,008.67
|
| Rate for Payer: BCBS MAPPO |
$1,792.24
|
| Rate for Payer: BCBS Trust/PPO |
$1,699.42
|
| Rate for Payer: BCN Commercial |
$1,699.42
|
| Rate for Payer: BCN Medicare Advantage |
$1,792.24
|
| Rate for Payer: Cash Price |
$3,916.80
|
| Rate for Payer: Cash Price |
$3,916.80
|
| Rate for Payer: Cash Price |
$3,916.80
|
| Rate for Payer: Cofinity Commercial |
$4,210.56
|
| Rate for Payer: Cofinity Commercial |
$3,427.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,427.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,916.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,792.24
|
| Rate for Payer: Healthscope Commercial |
$4,406.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,427.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,672.00
|
| Rate for Payer: Mclaren Medicaid |
$960.64
|
| Rate for Payer: Mclaren Medicare |
$1,792.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,881.85
|
| Rate for Payer: Meridian Medicaid |
$1,008.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,061.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,161.60
|
| Rate for Payer: Nomi Health Commercial |
$3,763.70
|
| Rate for Payer: PACE Medicare |
$1,702.63
|
| Rate for Payer: PACE SWMI |
$1,792.24
|
| Rate for Payer: PHP Commercial |
$4,161.60
|
| Rate for Payer: PHP Medicare Advantage |
$1,792.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$960.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,182.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,632.99
|
| Rate for Payer: Priority Health Medicare |
$1,792.24
|
| Rate for Payer: Priority Health Narrow Network |
$4,506.39
|
| Rate for Payer: Priority Health SBD |
$3,084.48
|
| Rate for Payer: Railroad Medicare Medicare |
$1,792.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$161.20
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,792.24
|
| Rate for Payer: UHC Exchange |
$146.55
|
| Rate for Payer: UHC Medicare Advantage |
$1,792.24
|
| Rate for Payer: UHCCP Medicaid |
$960.64
|
| Rate for Payer: UMR Bronson Commercial |
$1,811.52
|
| Rate for Payer: VA VA |
$1,792.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,672.00
|
|
|
HC NJX NONCMPND SCLEROSANT MULTIPLE INCMPTNT VEINS
|
Facility
|
IP
|
$4,896.00
|
|
|
Service Code
|
CPT 36466
|
| Hospital Charge Code |
76100402
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,154.24 |
| Max. Negotiated Rate |
$4,406.40 |
| Rate for Payer: Aetna American Axle |
$3,182.40
|
| Rate for Payer: Aetna Commercial |
$4,161.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,182.40
|
| Rate for Payer: Cash Price |
$3,916.80
|
| Rate for Payer: Cofinity Commercial |
$3,427.20
|
| Rate for Payer: Cofinity Commercial |
$4,210.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,427.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,916.80
|
| Rate for Payer: Healthscope Commercial |
$4,406.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,427.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,672.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,161.60
|
| Rate for Payer: PHP Commercial |
$4,161.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,182.40
|
| Rate for Payer: Priority Health SBD |
$3,084.48
|
| Rate for Payer: UMR Bronson Commercial |
$2,154.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,672.00
|
|
