|
HC ORGANIC ACIDS SCREEN URINE
|
Facility
|
IP
|
$75.48
|
|
|
Service Code
|
CPT 83918
|
| Hospital Charge Code |
30100372
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.21 |
| Max. Negotiated Rate |
$67.93 |
| Rate for Payer: Aetna American Axle |
$49.06
|
| Rate for Payer: Aetna Commercial |
$64.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.06
|
| Rate for Payer: Cash Price |
$60.38
|
| Rate for Payer: Cofinity Commercial |
$52.84
|
| Rate for Payer: Cofinity Commercial |
$64.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$52.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.38
|
| Rate for Payer: Healthscope Commercial |
$67.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.16
|
| Rate for Payer: PHP Commercial |
$64.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.06
|
| Rate for Payer: Priority Health SBD |
$47.55
|
| Rate for Payer: UMR Bronson Commercial |
$33.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.61
|
|
|
HC ORGANIC ACIDS SCREEN URINE
|
Facility
|
OP
|
$75.48
|
|
|
Service Code
|
CPT 83918
|
| Hospital Charge Code |
30100372
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.65 |
| Max. Negotiated Rate |
$67.93 |
| Rate for Payer: Aetna American Axle |
$49.06
|
| Rate for Payer: Aetna Commercial |
$64.16
|
| Rate for Payer: Aetna Medicare |
$24.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.50
|
| Rate for Payer: BCBS Complete |
$13.28
|
| Rate for Payer: BCBS MAPPO |
$23.60
|
| Rate for Payer: BCN Medicare Advantage |
$23.60
|
| Rate for Payer: Cash Price |
$60.38
|
| Rate for Payer: Cash Price |
$60.38
|
| Rate for Payer: Cofinity Commercial |
$64.91
|
| Rate for Payer: Cofinity Commercial |
$52.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$52.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.60
|
| Rate for Payer: Healthscope Commercial |
$67.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.61
|
| Rate for Payer: Mclaren Medicaid |
$12.65
|
| Rate for Payer: Mclaren Medicare |
$23.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.78
|
| Rate for Payer: Meridian Medicaid |
$13.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.16
|
| Rate for Payer: PACE Medicare |
$22.42
|
| Rate for Payer: PACE SWMI |
$23.60
|
| Rate for Payer: PHP Commercial |
$64.16
|
| Rate for Payer: PHP Medicare Advantage |
$23.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.06
|
| Rate for Payer: Priority Health Medicare |
$23.60
|
| Rate for Payer: Priority Health SBD |
$47.55
|
| Rate for Payer: Railroad Medicare Medicare |
$23.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.60
|
| Rate for Payer: UHC Exchange |
$45.10
|
| Rate for Payer: UHC Medicare Advantage |
$23.60
|
| Rate for Payer: UHCCP Medicaid |
$12.65
|
| Rate for Payer: UMR Bronson Commercial |
$27.93
|
| Rate for Payer: VA VA |
$23.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.61
|
|
|
HC OR LEVEL 1 BASE CHARGE
|
Facility
|
IP
|
$275.00
|
|
| Hospital Charge Code |
36000126
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$121.00 |
| Max. Negotiated Rate |
$247.50 |
| Rate for Payer: Aetna American Axle |
$178.75
|
| Rate for Payer: Aetna Commercial |
$233.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.75
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cofinity Commercial |
$192.50
|
| Rate for Payer: Cofinity Commercial |
$236.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$192.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.00
|
| Rate for Payer: Healthscope Commercial |
$247.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$192.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.75
|
| Rate for Payer: PHP Commercial |
$233.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.75
|
| Rate for Payer: Priority Health SBD |
$173.25
|
| Rate for Payer: UMR Bronson Commercial |
$121.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.25
|
|
|
HC OR LEVEL 1 BASE CHARGE
|
Facility
|
OP
|
$275.00
|
|
| Hospital Charge Code |
36000126
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$101.75 |
| Max. Negotiated Rate |
$247.50 |
| Rate for Payer: Aetna American Axle |
$178.75
|
| Rate for Payer: Aetna Commercial |
$233.75
|
| Rate for Payer: Aetna Medicare |
$137.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.75
|
| Rate for Payer: BCBS Complete |
$110.00
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cofinity Commercial |
$192.50
|
| Rate for Payer: Cofinity Commercial |
$236.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$192.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.00
|
| Rate for Payer: Healthscope Commercial |
$247.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$192.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.75
|
| Rate for Payer: PHP Commercial |
$233.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.75
|
| Rate for Payer: Priority Health SBD |
$173.25
|
| Rate for Payer: UMR Bronson Commercial |
$101.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.25
|
|
|
HC OR LEVEL 1 PER MINUTE
|
Facility
|
IP
|
$60.00
|
|
| Hospital Charge Code |
36000127
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$54.00 |
| Rate for Payer: Aetna American Axle |
$39.00
|
| Rate for Payer: Aetna Commercial |
$51.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cofinity Commercial |
$42.00
|
| Rate for Payer: Cofinity Commercial |
$51.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$42.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.00
|
| Rate for Payer: Healthscope Commercial |
$54.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.00
|
| Rate for Payer: PHP Commercial |
$51.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.00
|
| Rate for Payer: Priority Health SBD |
$37.80
|
| Rate for Payer: UMR Bronson Commercial |
$26.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.00
|
|
|
HC OR LEVEL 1 PER MINUTE
|
Facility
|
OP
|
$60.00
|
|
| Hospital Charge Code |
36000127
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$22.20 |
| Max. Negotiated Rate |
$54.00 |
| Rate for Payer: Aetna American Axle |
$39.00
|
| Rate for Payer: Aetna Commercial |
$51.00
|
| Rate for Payer: Aetna Medicare |
$30.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.00
|
| Rate for Payer: BCBS Complete |
$24.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cofinity Commercial |
$42.00
|
| Rate for Payer: Cofinity Commercial |
$51.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$42.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.00
|
| Rate for Payer: Healthscope Commercial |
$54.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.00
|
| Rate for Payer: PHP Commercial |
$51.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.00
|
| Rate for Payer: Priority Health SBD |
$37.80
|
| Rate for Payer: UMR Bronson Commercial |
$22.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.00
|
|
|
HC OR LEVEL 2 BASE CHARGE
|
Facility
|
IP
|
$737.00
|
|
| Hospital Charge Code |
36000128
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$324.28 |
| Max. Negotiated Rate |
$663.30 |
| Rate for Payer: Aetna American Axle |
$479.05
|
| Rate for Payer: Aetna Commercial |
$626.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$479.05
|
| Rate for Payer: Cash Price |
$589.60
|
| Rate for Payer: Cofinity Commercial |
$515.90
|
| Rate for Payer: Cofinity Commercial |
$633.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$515.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$589.60
|
| Rate for Payer: Healthscope Commercial |
$663.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$515.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$552.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$626.45
|
| Rate for Payer: PHP Commercial |
$626.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$479.05
|
| Rate for Payer: Priority Health SBD |
$464.31
|
| Rate for Payer: UMR Bronson Commercial |
$324.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$552.75
|
|
|
HC OR LEVEL 2 BASE CHARGE
|
Facility
|
OP
|
$737.00
|
|
| Hospital Charge Code |
36000128
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$272.69 |
| Max. Negotiated Rate |
$663.30 |
| Rate for Payer: Aetna American Axle |
$479.05
|
| Rate for Payer: Aetna Commercial |
$626.45
|
| Rate for Payer: Aetna Medicare |
$368.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$479.05
|
| Rate for Payer: BCBS Complete |
$294.80
|
| Rate for Payer: Cash Price |
$589.60
|
| Rate for Payer: Cofinity Commercial |
$515.90
|
| Rate for Payer: Cofinity Commercial |
$633.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$515.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$589.60
|
| Rate for Payer: Healthscope Commercial |
$663.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$515.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$552.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$626.45
|
| Rate for Payer: PHP Commercial |
$626.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$479.05
|
| Rate for Payer: Priority Health SBD |
$464.31
|
| Rate for Payer: UMR Bronson Commercial |
$272.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$552.75
|
|
|
HC OR LEVEL 2 PER MINUTE
|
Facility
|
OP
|
$83.00
|
|
| Hospital Charge Code |
36000129
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$30.71 |
| Max. Negotiated Rate |
$74.70 |
| Rate for Payer: Aetna American Axle |
$53.95
|
| Rate for Payer: Aetna Commercial |
$70.55
|
| Rate for Payer: Aetna Medicare |
$41.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.95
|
| Rate for Payer: BCBS Complete |
$33.20
|
| Rate for Payer: Cash Price |
$66.40
|
| Rate for Payer: Cofinity Commercial |
$58.10
|
| Rate for Payer: Cofinity Commercial |
$71.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$58.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.40
|
| Rate for Payer: Healthscope Commercial |
$74.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$58.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.55
|
| Rate for Payer: PHP Commercial |
$70.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.95
|
| Rate for Payer: Priority Health SBD |
$52.29
|
| Rate for Payer: UMR Bronson Commercial |
$30.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.25
|
|
|
HC OR LEVEL 2 PER MINUTE
|
Facility
|
IP
|
$83.00
|
|
| Hospital Charge Code |
36000129
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$36.52 |
| Max. Negotiated Rate |
$74.70 |
| Rate for Payer: Aetna American Axle |
$53.95
|
| Rate for Payer: Aetna Commercial |
$70.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.95
|
| Rate for Payer: Cash Price |
$66.40
|
| Rate for Payer: Cofinity Commercial |
$58.10
|
| Rate for Payer: Cofinity Commercial |
$71.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$58.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.40
|
| Rate for Payer: Healthscope Commercial |
$74.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$58.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.55
|
| Rate for Payer: PHP Commercial |
$70.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.95
|
| Rate for Payer: Priority Health SBD |
$52.29
|
| Rate for Payer: UMR Bronson Commercial |
$36.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.25
|
|
|
HC OR LEVEL 3 BASE CHARGE
|
Facility
|
IP
|
$857.00
|
|
| Hospital Charge Code |
36000130
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$377.08 |
| Max. Negotiated Rate |
$771.30 |
| Rate for Payer: Aetna American Axle |
$557.05
|
| Rate for Payer: Aetna Commercial |
$728.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$557.05
|
| Rate for Payer: Cash Price |
$685.60
|
| Rate for Payer: Cofinity Commercial |
$599.90
|
| Rate for Payer: Cofinity Commercial |
$737.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$599.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$685.60
|
| Rate for Payer: Healthscope Commercial |
$771.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$599.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$642.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$728.45
|
| Rate for Payer: PHP Commercial |
$728.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$557.05
|
| Rate for Payer: Priority Health SBD |
$539.91
|
| Rate for Payer: UMR Bronson Commercial |
$377.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$642.75
|
|
|
HC OR LEVEL 3 BASE CHARGE
|
Facility
|
OP
|
$857.00
|
|
| Hospital Charge Code |
36000130
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$317.09 |
| Max. Negotiated Rate |
$771.30 |
| Rate for Payer: Aetna American Axle |
$557.05
|
| Rate for Payer: Aetna Commercial |
$728.45
|
| Rate for Payer: Aetna Medicare |
$428.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$557.05
|
| Rate for Payer: BCBS Complete |
$342.80
|
| Rate for Payer: Cash Price |
$685.60
|
| Rate for Payer: Cofinity Commercial |
$599.90
|
| Rate for Payer: Cofinity Commercial |
$737.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$599.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$685.60
|
| Rate for Payer: Healthscope Commercial |
$771.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$599.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$642.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$728.45
|
| Rate for Payer: PHP Commercial |
$728.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$557.05
|
| Rate for Payer: Priority Health SBD |
$539.91
|
| Rate for Payer: UMR Bronson Commercial |
$317.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$642.75
|
|
|
HC OR LEVEL 3 PER MINUTE
|
Facility
|
OP
|
$99.00
|
|
| Hospital Charge Code |
36000131
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$36.63 |
| Max. Negotiated Rate |
$89.10 |
| Rate for Payer: Aetna American Axle |
$64.35
|
| Rate for Payer: Aetna Commercial |
$84.15
|
| Rate for Payer: Aetna Medicare |
$49.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.35
|
| Rate for Payer: BCBS Complete |
$39.60
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cofinity Commercial |
$69.30
|
| Rate for Payer: Cofinity Commercial |
$85.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$69.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.20
|
| Rate for Payer: Healthscope Commercial |
$89.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$69.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.15
|
| Rate for Payer: PHP Commercial |
$84.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.35
|
| Rate for Payer: Priority Health SBD |
$62.37
|
| Rate for Payer: UMR Bronson Commercial |
$36.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.25
|
|
|
HC OR LEVEL 3 PER MINUTE
|
Facility
|
IP
|
$99.00
|
|
| Hospital Charge Code |
36000131
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$43.56 |
| Max. Negotiated Rate |
$89.10 |
| Rate for Payer: Aetna American Axle |
$64.35
|
| Rate for Payer: Aetna Commercial |
$84.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.35
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cofinity Commercial |
$69.30
|
| Rate for Payer: Cofinity Commercial |
$85.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$69.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.20
|
| Rate for Payer: Healthscope Commercial |
$89.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$69.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.15
|
| Rate for Payer: PHP Commercial |
$84.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.35
|
| Rate for Payer: Priority Health SBD |
$62.37
|
| Rate for Payer: UMR Bronson Commercial |
$43.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.25
|
|
|
HC OR LEVEL 4 BASE CHARGE
|
Facility
|
IP
|
$1,226.00
|
|
| Hospital Charge Code |
36000132
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$539.44 |
| Max. Negotiated Rate |
$1,103.40 |
| Rate for Payer: Aetna American Axle |
$796.90
|
| Rate for Payer: Aetna Commercial |
$1,042.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$796.90
|
| Rate for Payer: Cash Price |
$980.80
|
| Rate for Payer: Cofinity Commercial |
$1,054.36
|
| Rate for Payer: Cofinity Commercial |
$858.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$858.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$980.80
|
| Rate for Payer: Healthscope Commercial |
$1,103.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$858.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$919.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,042.10
|
| Rate for Payer: PHP Commercial |
$1,042.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$796.90
|
| Rate for Payer: Priority Health SBD |
$772.38
|
| Rate for Payer: UMR Bronson Commercial |
$539.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$919.50
|
|
|
HC OR LEVEL 4 BASE CHARGE
|
Facility
|
OP
|
$1,226.00
|
|
| Hospital Charge Code |
36000132
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$453.62 |
| Max. Negotiated Rate |
$1,103.40 |
| Rate for Payer: Aetna American Axle |
$796.90
|
| Rate for Payer: Aetna Commercial |
$1,042.10
|
| Rate for Payer: Aetna Medicare |
$613.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$796.90
|
| Rate for Payer: BCBS Complete |
$490.40
|
| Rate for Payer: Cash Price |
$980.80
|
| Rate for Payer: Cofinity Commercial |
$1,054.36
|
| Rate for Payer: Cofinity Commercial |
$858.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$858.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$980.80
|
| Rate for Payer: Healthscope Commercial |
$1,103.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$858.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$919.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,042.10
|
| Rate for Payer: PHP Commercial |
$1,042.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$796.90
|
| Rate for Payer: Priority Health SBD |
$772.38
|
| Rate for Payer: UMR Bronson Commercial |
$453.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$919.50
|
|
|
HC OR LEVEL 4 PER MINUTE
|
Facility
|
OP
|
$111.00
|
|
| Hospital Charge Code |
36000133
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$41.07 |
| Max. Negotiated Rate |
$99.90 |
| Rate for Payer: Aetna American Axle |
$72.15
|
| Rate for Payer: Aetna Commercial |
$94.35
|
| Rate for Payer: Aetna Medicare |
$55.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.15
|
| Rate for Payer: BCBS Complete |
$44.40
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cofinity Commercial |
$77.70
|
| Rate for Payer: Cofinity Commercial |
$95.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$77.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.80
|
| Rate for Payer: Healthscope Commercial |
$99.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$77.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.35
|
| Rate for Payer: PHP Commercial |
$94.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.15
|
| Rate for Payer: Priority Health SBD |
$69.93
|
| Rate for Payer: UMR Bronson Commercial |
$41.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.25
|
|
|
HC OR LEVEL 4 PER MINUTE
|
Facility
|
IP
|
$111.00
|
|
| Hospital Charge Code |
36000133
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$48.84 |
| Max. Negotiated Rate |
$99.90 |
| Rate for Payer: Aetna American Axle |
$72.15
|
| Rate for Payer: Aetna Commercial |
$94.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.15
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cofinity Commercial |
$77.70
|
| Rate for Payer: Cofinity Commercial |
$95.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$77.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.80
|
| Rate for Payer: Healthscope Commercial |
$99.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$77.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.35
|
| Rate for Payer: PHP Commercial |
$94.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.15
|
| Rate for Payer: Priority Health SBD |
$69.93
|
| Rate for Payer: UMR Bronson Commercial |
$48.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.25
|
|
|
HC OR LEVEL 5 BASE CHARGE
|
Facility
|
OP
|
$1,454.00
|
|
| Hospital Charge Code |
36000134
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$537.98 |
| Max. Negotiated Rate |
$1,308.60 |
| Rate for Payer: Aetna American Axle |
$945.10
|
| Rate for Payer: Aetna Commercial |
$1,235.90
|
| Rate for Payer: Aetna Medicare |
$727.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$945.10
|
| Rate for Payer: BCBS Complete |
$581.60
|
| Rate for Payer: Cash Price |
$1,163.20
|
| Rate for Payer: Cofinity Commercial |
$1,017.80
|
| Rate for Payer: Cofinity Commercial |
$1,250.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,017.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,163.20
|
| Rate for Payer: Healthscope Commercial |
$1,308.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,017.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,090.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,235.90
|
| Rate for Payer: PHP Commercial |
$1,235.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$945.10
|
| Rate for Payer: Priority Health SBD |
$916.02
|
| Rate for Payer: UMR Bronson Commercial |
$537.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,090.50
|
|
|
HC OR LEVEL 5 BASE CHARGE
|
Facility
|
IP
|
$1,454.00
|
|
| Hospital Charge Code |
36000134
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$639.76 |
| Max. Negotiated Rate |
$1,308.60 |
| Rate for Payer: Aetna American Axle |
$945.10
|
| Rate for Payer: Aetna Commercial |
$1,235.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$945.10
|
| Rate for Payer: Cash Price |
$1,163.20
|
| Rate for Payer: Cofinity Commercial |
$1,017.80
|
| Rate for Payer: Cofinity Commercial |
$1,250.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,017.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,163.20
|
| Rate for Payer: Healthscope Commercial |
$1,308.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,017.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,090.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,235.90
|
| Rate for Payer: PHP Commercial |
$1,235.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$945.10
|
| Rate for Payer: Priority Health SBD |
$916.02
|
| Rate for Payer: UMR Bronson Commercial |
$639.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,090.50
|
|
|
HC OR LEVEL 5 PER MINUTE
|
Facility
|
IP
|
$121.00
|
|
| Hospital Charge Code |
36000135
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$53.24 |
| Max. Negotiated Rate |
$108.90 |
| Rate for Payer: Aetna American Axle |
$78.65
|
| Rate for Payer: Aetna Commercial |
$102.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.65
|
| Rate for Payer: Cash Price |
$96.80
|
| Rate for Payer: Cofinity Commercial |
$104.06
|
| Rate for Payer: Cofinity Commercial |
$84.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$84.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.80
|
| Rate for Payer: Healthscope Commercial |
$108.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$84.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.85
|
| Rate for Payer: PHP Commercial |
$102.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.65
|
| Rate for Payer: Priority Health SBD |
$76.23
|
| Rate for Payer: UMR Bronson Commercial |
$53.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.75
|
|
|
HC OR LEVEL 5 PER MINUTE
|
Facility
|
OP
|
$121.00
|
|
| Hospital Charge Code |
36000135
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$44.77 |
| Max. Negotiated Rate |
$108.90 |
| Rate for Payer: Aetna American Axle |
$78.65
|
| Rate for Payer: Aetna Commercial |
$102.85
|
| Rate for Payer: Aetna Medicare |
$60.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.65
|
| Rate for Payer: BCBS Complete |
$48.40
|
| Rate for Payer: Cash Price |
$96.80
|
| Rate for Payer: Cofinity Commercial |
$104.06
|
| Rate for Payer: Cofinity Commercial |
$84.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$84.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.80
|
| Rate for Payer: Healthscope Commercial |
$108.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$84.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.85
|
| Rate for Payer: PHP Commercial |
$102.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.65
|
| Rate for Payer: Priority Health SBD |
$76.23
|
| Rate for Payer: UMR Bronson Commercial |
$44.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.75
|
|
|
HC ORPHENADRINE INJECTION, PER 60MG
|
Facility
|
IP
|
$30.17
|
|
|
Service Code
|
HCPCS J2360
|
| Hospital Charge Code |
63600143
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.27 |
| Max. Negotiated Rate |
$27.15 |
| Rate for Payer: Aetna American Axle |
$19.61
|
| Rate for Payer: Aetna Commercial |
$25.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.61
|
| Rate for Payer: Cash Price |
$24.14
|
| Rate for Payer: Cofinity Commercial |
$21.12
|
| Rate for Payer: Cofinity Commercial |
$25.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.14
|
| Rate for Payer: Healthscope Commercial |
$27.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.64
|
| Rate for Payer: PHP Commercial |
$25.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.61
|
| Rate for Payer: Priority Health SBD |
$19.01
|
| Rate for Payer: UMR Bronson Commercial |
$13.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.63
|
|
|
HC ORPHENADRINE INJECTION, PER 60MG
|
Facility
|
OP
|
$30.17
|
|
|
Service Code
|
HCPCS J2360
|
| Hospital Charge Code |
63600143
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.16 |
| Max. Negotiated Rate |
$27.15 |
| Rate for Payer: Aetna American Axle |
$19.61
|
| Rate for Payer: Aetna Commercial |
$25.64
|
| Rate for Payer: Aetna Medicare |
$15.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.61
|
| Rate for Payer: BCBS Complete |
$12.07
|
| Rate for Payer: Cash Price |
$24.14
|
| Rate for Payer: Cofinity Commercial |
$21.12
|
| Rate for Payer: Cofinity Commercial |
$25.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.14
|
| Rate for Payer: Healthscope Commercial |
$27.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.64
|
| Rate for Payer: PHP Commercial |
$25.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.61
|
| Rate for Payer: Priority Health SBD |
$19.01
|
| Rate for Payer: UMR Bronson Commercial |
$11.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.63
|
|
|
HC ORTHOPOX (AKA MONKEY)
|
Facility
|
OP
|
$123.27
|
|
|
Service Code
|
CPT 87593
|
| Hospital Charge Code |
30600334
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$27.50 |
| Max. Negotiated Rate |
$144.43 |
| Rate for Payer: Aetna American Axle |
$80.13
|
| Rate for Payer: Aetna Commercial |
$104.78
|
| Rate for Payer: Aetna Medicare |
$53.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$64.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$64.14
|
| Rate for Payer: BCBS Complete |
$28.88
|
| Rate for Payer: BCBS MAPPO |
$51.31
|
| Rate for Payer: BCN Medicare Advantage |
$51.31
|
| Rate for Payer: Cash Price |
$98.62
|
| Rate for Payer: Cash Price |
$98.62
|
| Rate for Payer: Cofinity Commercial |
$86.29
|
| Rate for Payer: Cofinity Commercial |
$106.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$86.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.31
|
| Rate for Payer: Healthscope Commercial |
$110.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$86.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$92.45
|
| Rate for Payer: Mclaren Medicaid |
$27.50
|
| Rate for Payer: Mclaren Medicare |
$51.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53.88
|
| Rate for Payer: Meridian Medicaid |
$28.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.78
|
| Rate for Payer: PACE Medicare |
$48.74
|
| Rate for Payer: PACE SWMI |
$51.31
|
| Rate for Payer: PHP Commercial |
$104.78
|
| Rate for Payer: PHP Medicare Advantage |
$51.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.13
|
| Rate for Payer: Priority Health Medicare |
$51.31
|
| Rate for Payer: Priority Health SBD |
$77.66
|
| Rate for Payer: Railroad Medicare Medicare |
$51.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$144.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.31
|
| Rate for Payer: UHC Exchange |
$98.06
|
| Rate for Payer: UHC Medicare Advantage |
$51.31
|
| Rate for Payer: UHCCP Medicaid |
$27.50
|
| Rate for Payer: UMR Bronson Commercial |
$45.61
|
| Rate for Payer: VA VA |
$51.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$92.45
|
|
