|
HC OPIOID DRUG PANEL URN. CMPT
|
Facility
|
IP
|
$94.53
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100646
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$41.59 |
| Max. Negotiated Rate |
$85.08 |
| Rate for Payer: Aetna American Axle |
$61.44
|
| Rate for Payer: Aetna Commercial |
$80.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.44
|
| Rate for Payer: Cash Price |
$75.62
|
| Rate for Payer: Cofinity Commercial |
$66.17
|
| Rate for Payer: Cofinity Commercial |
$81.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$66.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.62
|
| Rate for Payer: Healthscope Commercial |
$85.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.35
|
| Rate for Payer: PHP Commercial |
$80.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.44
|
| Rate for Payer: Priority Health SBD |
$59.55
|
| Rate for Payer: UMR Bronson Commercial |
$41.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.90
|
|
|
HC OPN AX/SUBCLA ART EXPOS DLVR EVASC PROSTH UNI
|
Facility
|
OP
|
$2,050.00
|
|
|
Service Code
|
CPT 34715
|
| Hospital Charge Code |
36000123
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$758.50 |
| Max. Negotiated Rate |
$1,845.00 |
| Rate for Payer: Aetna American Axle |
$1,332.50
|
| Rate for Payer: Aetna Commercial |
$1,742.50
|
| Rate for Payer: Aetna Medicare |
$1,025.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,332.50
|
| Rate for Payer: BCBS Complete |
$820.00
|
| Rate for Payer: Cash Price |
$1,640.00
|
| Rate for Payer: Cofinity Commercial |
$1,435.00
|
| Rate for Payer: Cofinity Commercial |
$1,763.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,435.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,640.00
|
| Rate for Payer: Healthscope Commercial |
$1,845.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,435.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,537.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,742.50
|
| Rate for Payer: PHP Commercial |
$1,742.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,332.50
|
| Rate for Payer: Priority Health SBD |
$1,291.50
|
| Rate for Payer: UMR Bronson Commercial |
$758.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,537.50
|
|
|
HC OPN AX/SUBCLA ART EXPOS DLVR EVASC PROSTH UNI
|
Facility
|
IP
|
$2,050.00
|
|
|
Service Code
|
CPT 34715
|
| Hospital Charge Code |
36000123
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$902.00 |
| Max. Negotiated Rate |
$1,845.00 |
| Rate for Payer: Aetna American Axle |
$1,332.50
|
| Rate for Payer: Aetna Commercial |
$1,742.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,332.50
|
| Rate for Payer: Cash Price |
$1,640.00
|
| Rate for Payer: Cofinity Commercial |
$1,435.00
|
| Rate for Payer: Cofinity Commercial |
$1,763.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,435.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,640.00
|
| Rate for Payer: Healthscope Commercial |
$1,845.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,435.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,537.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,742.50
|
| Rate for Payer: PHP Commercial |
$1,742.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,332.50
|
| Rate for Payer: Priority Health SBD |
$1,291.50
|
| Rate for Payer: UMR Bronson Commercial |
$902.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,537.50
|
|
|
HC OPSITE LGE SHEET
|
Facility
|
OP
|
$61.92
|
|
| Hospital Charge Code |
27000128
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$22.91 |
| Max. Negotiated Rate |
$55.73 |
| Rate for Payer: Aetna American Axle |
$40.25
|
| Rate for Payer: Aetna Commercial |
$52.63
|
| Rate for Payer: Aetna Medicare |
$30.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.25
|
| Rate for Payer: BCBS Complete |
$24.77
|
| Rate for Payer: Cash Price |
$49.54
|
| Rate for Payer: Cofinity Commercial |
$43.34
|
| Rate for Payer: Cofinity Commercial |
$53.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.54
|
| Rate for Payer: Healthscope Commercial |
$55.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.63
|
| Rate for Payer: PHP Commercial |
$52.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.25
|
| Rate for Payer: Priority Health SBD |
$39.01
|
| Rate for Payer: UMR Bronson Commercial |
$22.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.44
|
|
|
HC OPSITE LGE SHEET
|
Facility
|
IP
|
$61.92
|
|
| Hospital Charge Code |
27000128
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$27.24 |
| Max. Negotiated Rate |
$55.73 |
| Rate for Payer: Aetna American Axle |
$40.25
|
| Rate for Payer: Aetna Commercial |
$52.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.25
|
| Rate for Payer: Cash Price |
$49.54
|
| Rate for Payer: Cofinity Commercial |
$43.34
|
| Rate for Payer: Cofinity Commercial |
$53.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.54
|
| Rate for Payer: Healthscope Commercial |
$55.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.63
|
| Rate for Payer: PHP Commercial |
$52.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.25
|
| Rate for Payer: Priority Health SBD |
$39.01
|
| Rate for Payer: UMR Bronson Commercial |
$27.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.44
|
|
|
HC OPTISON 1ST ML
|
Facility
|
IP
|
$91.56
|
|
|
Service Code
|
HCPCS Q9956
|
| Hospital Charge Code |
63600168
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.29 |
| Max. Negotiated Rate |
$82.40 |
| Rate for Payer: Aetna American Axle |
$59.51
|
| Rate for Payer: Aetna Commercial |
$77.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.51
|
| Rate for Payer: Cash Price |
$73.25
|
| Rate for Payer: Cofinity Commercial |
$64.09
|
| Rate for Payer: Cofinity Commercial |
$78.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$64.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.25
|
| Rate for Payer: Healthscope Commercial |
$82.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$64.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.83
|
| Rate for Payer: PHP Commercial |
$77.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.51
|
| Rate for Payer: Priority Health SBD |
$57.68
|
| Rate for Payer: UMR Bronson Commercial |
$40.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.67
|
|
|
HC OPTISON 1ST ML
|
Facility
|
OP
|
$91.56
|
|
|
Service Code
|
HCPCS Q9956
|
| Hospital Charge Code |
63600168
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.88 |
| Max. Negotiated Rate |
$82.40 |
| Rate for Payer: Aetna American Axle |
$59.51
|
| Rate for Payer: Aetna Commercial |
$77.83
|
| Rate for Payer: Aetna Medicare |
$45.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.51
|
| Rate for Payer: BCBS Complete |
$36.62
|
| Rate for Payer: Cash Price |
$73.25
|
| Rate for Payer: Cofinity Commercial |
$64.09
|
| Rate for Payer: Cofinity Commercial |
$78.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$64.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.25
|
| Rate for Payer: Healthscope Commercial |
$82.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$64.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.83
|
| Rate for Payer: PHP Commercial |
$77.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.51
|
| Rate for Payer: Priority Health SBD |
$57.68
|
| Rate for Payer: UMR Bronson Commercial |
$33.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.67
|
|
|
HC OPTISON 2ND ML
|
Facility
|
IP
|
$91.56
|
|
|
Service Code
|
HCPCS Q9956
|
| Hospital Charge Code |
63600169
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.29 |
| Max. Negotiated Rate |
$82.40 |
| Rate for Payer: Aetna American Axle |
$59.51
|
| Rate for Payer: Aetna Commercial |
$77.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.51
|
| Rate for Payer: Cash Price |
$73.25
|
| Rate for Payer: Cofinity Commercial |
$64.09
|
| Rate for Payer: Cofinity Commercial |
$78.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$64.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.25
|
| Rate for Payer: Healthscope Commercial |
$82.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$64.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.83
|
| Rate for Payer: PHP Commercial |
$77.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.51
|
| Rate for Payer: Priority Health SBD |
$57.68
|
| Rate for Payer: UMR Bronson Commercial |
$40.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.67
|
|
|
HC OPTISON 2ND ML
|
Facility
|
OP
|
$91.56
|
|
|
Service Code
|
HCPCS Q9956
|
| Hospital Charge Code |
63600169
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.88 |
| Max. Negotiated Rate |
$82.40 |
| Rate for Payer: Aetna American Axle |
$59.51
|
| Rate for Payer: Aetna Commercial |
$77.83
|
| Rate for Payer: Aetna Medicare |
$45.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.51
|
| Rate for Payer: BCBS Complete |
$36.62
|
| Rate for Payer: Cash Price |
$73.25
|
| Rate for Payer: Cofinity Commercial |
$64.09
|
| Rate for Payer: Cofinity Commercial |
$78.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$64.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.25
|
| Rate for Payer: Healthscope Commercial |
$82.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$64.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.83
|
| Rate for Payer: PHP Commercial |
$77.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.51
|
| Rate for Payer: Priority Health SBD |
$57.68
|
| Rate for Payer: UMR Bronson Commercial |
$33.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.67
|
|
|
HC OPTISON 3RD ML
|
Facility
|
OP
|
$91.56
|
|
|
Service Code
|
HCPCS Q9956
|
| Hospital Charge Code |
63600170
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.88 |
| Max. Negotiated Rate |
$82.40 |
| Rate for Payer: Aetna American Axle |
$59.51
|
| Rate for Payer: Aetna Commercial |
$77.83
|
| Rate for Payer: Aetna Medicare |
$45.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.51
|
| Rate for Payer: BCBS Complete |
$36.62
|
| Rate for Payer: Cash Price |
$73.25
|
| Rate for Payer: Cofinity Commercial |
$64.09
|
| Rate for Payer: Cofinity Commercial |
$78.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$64.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.25
|
| Rate for Payer: Healthscope Commercial |
$82.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$64.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.83
|
| Rate for Payer: PHP Commercial |
$77.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.51
|
| Rate for Payer: Priority Health SBD |
$57.68
|
| Rate for Payer: UMR Bronson Commercial |
$33.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.67
|
|
|
HC OPTISON 3RD ML
|
Facility
|
IP
|
$91.56
|
|
|
Service Code
|
HCPCS Q9956
|
| Hospital Charge Code |
63600170
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.29 |
| Max. Negotiated Rate |
$82.40 |
| Rate for Payer: Aetna American Axle |
$59.51
|
| Rate for Payer: Aetna Commercial |
$77.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.51
|
| Rate for Payer: Cash Price |
$73.25
|
| Rate for Payer: Cofinity Commercial |
$64.09
|
| Rate for Payer: Cofinity Commercial |
$78.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$64.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.25
|
| Rate for Payer: Healthscope Commercial |
$82.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$64.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.83
|
| Rate for Payer: PHP Commercial |
$77.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.51
|
| Rate for Payer: Priority Health SBD |
$57.68
|
| Rate for Payer: UMR Bronson Commercial |
$40.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.67
|
|
|
HC OP VISIT LEVEL 1
|
Facility
|
IP
|
$154.65
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000015
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$68.05 |
| Max. Negotiated Rate |
$139.19 |
| Rate for Payer: Aetna American Axle |
$100.52
|
| Rate for Payer: Aetna Commercial |
$131.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.52
|
| Rate for Payer: Cash Price |
$123.72
|
| Rate for Payer: Cofinity Commercial |
$108.25
|
| Rate for Payer: Cofinity Commercial |
$133.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$108.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.72
|
| Rate for Payer: Healthscope Commercial |
$139.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$108.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$115.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.45
|
| Rate for Payer: PHP Commercial |
$131.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.52
|
| Rate for Payer: Priority Health SBD |
$97.43
|
| Rate for Payer: UMR Bronson Commercial |
$68.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$115.99
|
|
|
HC OP VISIT LEVEL 1
|
Facility
|
OP
|
$154.65
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000015
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$57.22 |
| Max. Negotiated Rate |
$139.19 |
| Rate for Payer: Aetna American Axle |
$100.52
|
| Rate for Payer: Aetna Commercial |
$131.45
|
| Rate for Payer: Aetna Medicare |
$77.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.52
|
| Rate for Payer: BCBS Complete |
$61.86
|
| Rate for Payer: Cash Price |
$123.72
|
| Rate for Payer: Cofinity Commercial |
$108.25
|
| Rate for Payer: Cofinity Commercial |
$133.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$108.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.72
|
| Rate for Payer: Healthscope Commercial |
$139.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$108.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$115.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.45
|
| Rate for Payer: PHP Commercial |
$131.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.52
|
| Rate for Payer: Priority Health SBD |
$97.43
|
| Rate for Payer: UMR Bronson Commercial |
$57.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$115.99
|
|
|
HC OP VISIT LEVEL 2
|
Facility
|
OP
|
$174.09
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
51000020
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$64.41 |
| Max. Negotiated Rate |
$156.68 |
| Rate for Payer: Aetna American Axle |
$113.16
|
| Rate for Payer: Aetna Commercial |
$147.98
|
| Rate for Payer: Aetna Medicare |
$87.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.16
|
| Rate for Payer: BCBS Complete |
$69.64
|
| Rate for Payer: Cash Price |
$139.27
|
| Rate for Payer: Cofinity Commercial |
$121.86
|
| Rate for Payer: Cofinity Commercial |
$149.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$121.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.27
|
| Rate for Payer: Healthscope Commercial |
$156.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$121.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$130.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.98
|
| Rate for Payer: PHP Commercial |
$147.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.16
|
| Rate for Payer: Priority Health SBD |
$109.68
|
| Rate for Payer: UMR Bronson Commercial |
$64.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$130.57
|
|
|
HC OP VISIT LEVEL 2
|
Facility
|
IP
|
$174.09
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
51000020
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$76.60 |
| Max. Negotiated Rate |
$156.68 |
| Rate for Payer: Aetna American Axle |
$113.16
|
| Rate for Payer: Aetna Commercial |
$147.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.16
|
| Rate for Payer: Cash Price |
$139.27
|
| Rate for Payer: Cofinity Commercial |
$121.86
|
| Rate for Payer: Cofinity Commercial |
$149.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$121.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.27
|
| Rate for Payer: Healthscope Commercial |
$156.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$121.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$130.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.98
|
| Rate for Payer: PHP Commercial |
$147.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.16
|
| Rate for Payer: Priority Health SBD |
$109.68
|
| Rate for Payer: UMR Bronson Commercial |
$76.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$130.57
|
|
|
HC OP VISIT LEVEL 3
|
Facility
|
OP
|
$211.25
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
51000026
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$78.16 |
| Max. Negotiated Rate |
$190.12 |
| Rate for Payer: Aetna American Axle |
$137.31
|
| Rate for Payer: Aetna Commercial |
$179.56
|
| Rate for Payer: Aetna Medicare |
$105.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.31
|
| Rate for Payer: BCBS Complete |
$84.50
|
| Rate for Payer: Cash Price |
$169.00
|
| Rate for Payer: Cofinity Commercial |
$147.88
|
| Rate for Payer: Cofinity Commercial |
$181.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$147.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.00
|
| Rate for Payer: Healthscope Commercial |
$190.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$147.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$179.56
|
| Rate for Payer: PHP Commercial |
$179.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.31
|
| Rate for Payer: Priority Health SBD |
$133.09
|
| Rate for Payer: UMR Bronson Commercial |
$78.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$158.44
|
|
|
HC OP VISIT LEVEL 3
|
Facility
|
IP
|
$211.25
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
51000026
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$92.95 |
| Max. Negotiated Rate |
$190.12 |
| Rate for Payer: Aetna American Axle |
$137.31
|
| Rate for Payer: Aetna Commercial |
$179.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.31
|
| Rate for Payer: Cash Price |
$169.00
|
| Rate for Payer: Cofinity Commercial |
$147.88
|
| Rate for Payer: Cofinity Commercial |
$181.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$147.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.00
|
| Rate for Payer: Healthscope Commercial |
$190.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$147.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$179.56
|
| Rate for Payer: PHP Commercial |
$179.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.31
|
| Rate for Payer: Priority Health SBD |
$133.09
|
| Rate for Payer: UMR Bronson Commercial |
$92.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$158.44
|
|
|
HC OP VISIT LEVEL 4
|
Facility
|
IP
|
$303.37
|
|
|
Service Code
|
CPT 99214
|
| Hospital Charge Code |
51000030
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$133.48 |
| Max. Negotiated Rate |
$273.03 |
| Rate for Payer: Aetna American Axle |
$197.19
|
| Rate for Payer: Aetna Commercial |
$257.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$197.19
|
| Rate for Payer: Cash Price |
$242.70
|
| Rate for Payer: Cofinity Commercial |
$212.36
|
| Rate for Payer: Cofinity Commercial |
$260.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$212.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.70
|
| Rate for Payer: Healthscope Commercial |
$273.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$212.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$227.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$257.86
|
| Rate for Payer: PHP Commercial |
$257.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$197.19
|
| Rate for Payer: Priority Health SBD |
$191.12
|
| Rate for Payer: UMR Bronson Commercial |
$133.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$227.53
|
|
|
HC OP VISIT LEVEL 4
|
Facility
|
OP
|
$303.37
|
|
|
Service Code
|
CPT 99214
|
| Hospital Charge Code |
51000030
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$112.25 |
| Max. Negotiated Rate |
$273.03 |
| Rate for Payer: Aetna American Axle |
$197.19
|
| Rate for Payer: Aetna Commercial |
$257.86
|
| Rate for Payer: Aetna Medicare |
$151.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$197.19
|
| Rate for Payer: BCBS Complete |
$121.35
|
| Rate for Payer: Cash Price |
$242.70
|
| Rate for Payer: Cofinity Commercial |
$212.36
|
| Rate for Payer: Cofinity Commercial |
$260.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$212.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.70
|
| Rate for Payer: Healthscope Commercial |
$273.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$212.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$227.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$257.86
|
| Rate for Payer: PHP Commercial |
$257.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$197.19
|
| Rate for Payer: Priority Health SBD |
$191.12
|
| Rate for Payer: UMR Bronson Commercial |
$112.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$227.53
|
|
|
HC OP VISIT LEVEL 5
|
Facility
|
IP
|
$505.14
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
51000037
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$222.26 |
| Max. Negotiated Rate |
$454.63 |
| Rate for Payer: Aetna American Axle |
$328.34
|
| Rate for Payer: Aetna Commercial |
$429.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$328.34
|
| Rate for Payer: Cash Price |
$404.11
|
| Rate for Payer: Cofinity Commercial |
$353.60
|
| Rate for Payer: Cofinity Commercial |
$434.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$353.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$404.11
|
| Rate for Payer: Healthscope Commercial |
$454.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$353.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$378.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$429.37
|
| Rate for Payer: PHP Commercial |
$429.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$328.34
|
| Rate for Payer: Priority Health SBD |
$318.24
|
| Rate for Payer: UMR Bronson Commercial |
$222.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$378.86
|
|
|
HC OP VISIT LEVEL 5
|
Facility
|
OP
|
$505.14
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
51000037
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$186.90 |
| Max. Negotiated Rate |
$454.63 |
| Rate for Payer: Aetna American Axle |
$328.34
|
| Rate for Payer: Aetna Commercial |
$429.37
|
| Rate for Payer: Aetna Medicare |
$252.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$328.34
|
| Rate for Payer: BCBS Complete |
$202.06
|
| Rate for Payer: Cash Price |
$404.11
|
| Rate for Payer: Cofinity Commercial |
$353.60
|
| Rate for Payer: Cofinity Commercial |
$434.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$353.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$404.11
|
| Rate for Payer: Healthscope Commercial |
$454.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$353.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$378.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$429.37
|
| Rate for Payer: PHP Commercial |
$429.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$328.34
|
| Rate for Payer: Priority Health SBD |
$318.24
|
| Rate for Payer: UMR Bronson Commercial |
$186.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$378.86
|
|
|
HC ORAL CHEMO ADMINISTRATION
|
Facility
|
OP
|
$134.71
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000089
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$49.84 |
| Max. Negotiated Rate |
$121.24 |
| Rate for Payer: Aetna American Axle |
$87.56
|
| Rate for Payer: Aetna Commercial |
$114.50
|
| Rate for Payer: Aetna Medicare |
$67.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.56
|
| Rate for Payer: BCBS Complete |
$53.88
|
| Rate for Payer: Cash Price |
$107.77
|
| Rate for Payer: Cofinity Commercial |
$115.85
|
| Rate for Payer: Cofinity Commercial |
$94.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$94.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.77
|
| Rate for Payer: Healthscope Commercial |
$121.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$94.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$101.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.50
|
| Rate for Payer: PHP Commercial |
$114.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.56
|
| Rate for Payer: Priority Health SBD |
$84.87
|
| Rate for Payer: UMR Bronson Commercial |
$49.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$101.03
|
|
|
HC ORAL CHEMO ADMINISTRATION
|
Facility
|
IP
|
$134.71
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000089
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$59.27 |
| Max. Negotiated Rate |
$121.24 |
| Rate for Payer: Aetna American Axle |
$87.56
|
| Rate for Payer: Aetna Commercial |
$114.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.56
|
| Rate for Payer: Cash Price |
$107.77
|
| Rate for Payer: Cofinity Commercial |
$115.85
|
| Rate for Payer: Cofinity Commercial |
$94.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$94.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.77
|
| Rate for Payer: Healthscope Commercial |
$121.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$94.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$101.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.50
|
| Rate for Payer: PHP Commercial |
$114.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.56
|
| Rate for Payer: Priority Health SBD |
$84.87
|
| Rate for Payer: UMR Bronson Commercial |
$59.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$101.03
|
|
|
HC ORCHARD GRASS IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200052
|
|
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 ORCHARD GRASS IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200052
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna American Axle |
$16.50
|
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| 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: Mclaren Medicaid |
$2.80
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$16.00
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$9.98
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.80
|
| Rate for Payer: UMR Bronson Commercial |
$9.39
|
| Rate for Payer: VA VA |
$5.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.04
|
|
