|
HC OXYCODONE LVL
|
Facility
|
OP
|
$79.56
|
|
|
Service Code
|
CPT 80365
|
| Hospital Charge Code |
30100582
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.44 |
| Max. Negotiated Rate |
$71.60 |
| Rate for Payer: Aetna American Axle |
$51.71
|
| Rate for Payer: Aetna Commercial |
$67.63
|
| Rate for Payer: Aetna Medicare |
$39.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.71
|
| Rate for Payer: BCBS Complete |
$31.82
|
| Rate for Payer: Cash Price |
$63.65
|
| Rate for Payer: Cofinity Commercial |
$55.69
|
| Rate for Payer: Cofinity Commercial |
$68.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$55.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.65
|
| Rate for Payer: Healthscope Commercial |
$71.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$55.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.63
|
| Rate for Payer: PHP Commercial |
$67.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.71
|
| Rate for Payer: Priority Health SBD |
$50.12
|
| Rate for Payer: UMR Bronson Commercial |
$29.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.67
|
|
|
HC OXYCODONE LVL
|
Facility
|
IP
|
$79.56
|
|
|
Service Code
|
CPT 80365
|
| Hospital Charge Code |
30100582
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.01 |
| Max. Negotiated Rate |
$71.60 |
| Rate for Payer: Aetna American Axle |
$51.71
|
| Rate for Payer: Aetna Commercial |
$67.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.71
|
| Rate for Payer: Cash Price |
$63.65
|
| Rate for Payer: Cofinity Commercial |
$55.69
|
| Rate for Payer: Cofinity Commercial |
$68.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$55.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.65
|
| Rate for Payer: Healthscope Commercial |
$71.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$55.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.63
|
| Rate for Payer: PHP Commercial |
$67.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.71
|
| Rate for Payer: Priority Health SBD |
$50.12
|
| Rate for Payer: UMR Bronson Commercial |
$35.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.67
|
|
|
HC OXYCODONE URINE.
|
Facility
|
OP
|
$101.66
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000153
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.31 |
| Max. Negotiated Rate |
$174.92 |
| Rate for Payer: Aetna American Axle |
$66.08
|
| Rate for Payer: Aetna Commercial |
$86.41
|
| Rate for Payer: Aetna Medicare |
$64.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.67
|
| Rate for Payer: BCBS Complete |
$34.97
|
| Rate for Payer: BCBS MAPPO |
$62.14
|
| Rate for Payer: BCN Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$81.33
|
| Rate for Payer: Cash Price |
$81.33
|
| Rate for Payer: Cofinity Commercial |
$87.43
|
| Rate for Payer: Cofinity Commercial |
$71.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$71.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Healthscope Commercial |
$91.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$71.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.25
|
| Rate for Payer: Mclaren Medicaid |
$33.31
|
| Rate for Payer: Mclaren Medicare |
$62.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.25
|
| Rate for Payer: Meridian Medicaid |
$34.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.41
|
| Rate for Payer: PACE Medicare |
$59.03
|
| Rate for Payer: PACE SWMI |
$62.14
|
| Rate for Payer: PHP Commercial |
$86.41
|
| Rate for Payer: PHP Medicare Advantage |
$62.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.08
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: Priority Health SBD |
$64.05
|
| Rate for Payer: Railroad Medicare Medicare |
$62.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$174.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.14
|
| Rate for Payer: UHC Exchange |
$118.76
|
| Rate for Payer: UHC Medicare Advantage |
$62.14
|
| Rate for Payer: UHCCP Medicaid |
$33.31
|
| Rate for Payer: UMR Bronson Commercial |
$37.61
|
| Rate for Payer: VA VA |
$62.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.25
|
|
|
HC OXYCODONE URINE.
|
Facility
|
IP
|
$101.66
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000153
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$44.73 |
| Max. Negotiated Rate |
$91.49 |
| Rate for Payer: Aetna American Axle |
$66.08
|
| Rate for Payer: Aetna Commercial |
$86.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.08
|
| Rate for Payer: Cash Price |
$81.33
|
| Rate for Payer: Cofinity Commercial |
$71.16
|
| Rate for Payer: Cofinity Commercial |
$87.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$71.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.33
|
| Rate for Payer: Healthscope Commercial |
$91.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$71.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.41
|
| Rate for Payer: PHP Commercial |
$86.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.08
|
| Rate for Payer: Priority Health SBD |
$64.05
|
| Rate for Payer: UMR Bronson Commercial |
$44.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.25
|
|
|
HC OXYCODONE W/METABOLITE CONF, U
|
Facility
|
IP
|
$55.08
|
|
|
Service Code
|
CPT 80365
|
| Hospital Charge Code |
30100681
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.24 |
| Max. Negotiated Rate |
$49.57 |
| Rate for Payer: Aetna American Axle |
$35.80
|
| Rate for Payer: Aetna Commercial |
$46.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.80
|
| Rate for Payer: Cash Price |
$44.06
|
| Rate for Payer: Cofinity Commercial |
$38.56
|
| Rate for Payer: Cofinity Commercial |
$47.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$38.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.06
|
| Rate for Payer: Healthscope Commercial |
$49.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$38.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.82
|
| Rate for Payer: PHP Commercial |
$46.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.80
|
| Rate for Payer: Priority Health SBD |
$34.70
|
| Rate for Payer: UMR Bronson Commercial |
$24.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.31
|
|
|
HC OXYCODONE W/METABOLITE CONF, U
|
Facility
|
OP
|
$55.08
|
|
|
Service Code
|
CPT 80365
|
| Hospital Charge Code |
30100681
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.38 |
| Max. Negotiated Rate |
$49.57 |
| Rate for Payer: Aetna American Axle |
$35.80
|
| Rate for Payer: Aetna Commercial |
$46.82
|
| Rate for Payer: Aetna Medicare |
$27.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.80
|
| Rate for Payer: BCBS Complete |
$22.03
|
| Rate for Payer: Cash Price |
$44.06
|
| Rate for Payer: Cofinity Commercial |
$38.56
|
| Rate for Payer: Cofinity Commercial |
$47.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$38.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.06
|
| Rate for Payer: Healthscope Commercial |
$49.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$38.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.82
|
| Rate for Payer: PHP Commercial |
$46.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.80
|
| Rate for Payer: Priority Health SBD |
$34.70
|
| Rate for Payer: UMR Bronson Commercial |
$20.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.31
|
|
|
HC OXYGENATOR FX 15/25 STAND ALONE
|
Facility
|
OP
|
$1,468.83
|
|
| Hospital Charge Code |
27000445
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$543.47 |
| Max. Negotiated Rate |
$1,321.95 |
| Rate for Payer: Aetna American Axle |
$954.74
|
| Rate for Payer: Aetna Commercial |
$1,248.51
|
| Rate for Payer: Aetna Medicare |
$734.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$954.74
|
| Rate for Payer: BCBS Complete |
$587.53
|
| Rate for Payer: Cash Price |
$1,175.06
|
| Rate for Payer: Cofinity Commercial |
$1,028.18
|
| Rate for Payer: Cofinity Commercial |
$1,263.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,028.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,175.06
|
| Rate for Payer: Healthscope Commercial |
$1,321.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,028.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,101.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,248.51
|
| Rate for Payer: PHP Commercial |
$1,248.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$954.74
|
| Rate for Payer: Priority Health SBD |
$925.36
|
| Rate for Payer: UMR Bronson Commercial |
$543.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,101.62
|
|
|
HC OXYGENATOR FX 15/25 STAND ALONE
|
Facility
|
IP
|
$1,468.83
|
|
| Hospital Charge Code |
27000445
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$646.29 |
| Max. Negotiated Rate |
$1,321.95 |
| Rate for Payer: Aetna American Axle |
$954.74
|
| Rate for Payer: Aetna Commercial |
$1,248.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$954.74
|
| Rate for Payer: Cash Price |
$1,175.06
|
| Rate for Payer: Cofinity Commercial |
$1,028.18
|
| Rate for Payer: Cofinity Commercial |
$1,263.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,028.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,175.06
|
| Rate for Payer: Healthscope Commercial |
$1,321.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,028.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,101.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,248.51
|
| Rate for Payer: PHP Commercial |
$1,248.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$954.74
|
| Rate for Payer: Priority Health SBD |
$925.36
|
| Rate for Payer: UMR Bronson Commercial |
$646.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,101.62
|
|
|
HC OXYGENATOR FX15/25 W/RESERV
|
Facility
|
IP
|
$1,239.30
|
|
| Hospital Charge Code |
27000650
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$545.29 |
| Max. Negotiated Rate |
$1,115.37 |
| Rate for Payer: Aetna American Axle |
$805.54
|
| Rate for Payer: Aetna Commercial |
$1,053.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$805.54
|
| Rate for Payer: Cash Price |
$991.44
|
| Rate for Payer: Cofinity Commercial |
$1,065.80
|
| Rate for Payer: Cofinity Commercial |
$867.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$867.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$991.44
|
| Rate for Payer: Healthscope Commercial |
$1,115.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$867.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$929.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,053.40
|
| Rate for Payer: PHP Commercial |
$1,053.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$805.54
|
| Rate for Payer: Priority Health SBD |
$780.76
|
| Rate for Payer: UMR Bronson Commercial |
$545.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$929.48
|
|
|
HC OXYGENATOR FX15/25 W/RESERV
|
Facility
|
OP
|
$1,239.30
|
|
| Hospital Charge Code |
27000650
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$458.54 |
| Max. Negotiated Rate |
$1,115.37 |
| Rate for Payer: Aetna American Axle |
$805.54
|
| Rate for Payer: Aetna Commercial |
$1,053.40
|
| Rate for Payer: Aetna Medicare |
$619.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$805.54
|
| Rate for Payer: BCBS Complete |
$495.72
|
| Rate for Payer: Cash Price |
$991.44
|
| Rate for Payer: Cofinity Commercial |
$1,065.80
|
| Rate for Payer: Cofinity Commercial |
$867.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$867.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$991.44
|
| Rate for Payer: Healthscope Commercial |
$1,115.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$867.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$929.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,053.40
|
| Rate for Payer: PHP Commercial |
$1,053.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$805.54
|
| Rate for Payer: Priority Health SBD |
$780.76
|
| Rate for Payer: UMR Bronson Commercial |
$458.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$929.48
|
|
|
HC OXYGENATOR NX EAST/WEST
|
Facility
|
OP
|
$1,254.60
|
|
| Hospital Charge Code |
27000649
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$464.20 |
| Max. Negotiated Rate |
$1,129.14 |
| Rate for Payer: Aetna American Axle |
$815.49
|
| Rate for Payer: Aetna Commercial |
$1,066.41
|
| Rate for Payer: Aetna Medicare |
$627.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$815.49
|
| Rate for Payer: BCBS Complete |
$501.84
|
| Rate for Payer: Cash Price |
$1,003.68
|
| Rate for Payer: Cofinity Commercial |
$1,078.96
|
| Rate for Payer: Cofinity Commercial |
$878.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$878.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,003.68
|
| Rate for Payer: Healthscope Commercial |
$1,129.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$878.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$940.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,066.41
|
| Rate for Payer: PHP Commercial |
$1,066.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$815.49
|
| Rate for Payer: Priority Health SBD |
$790.40
|
| Rate for Payer: UMR Bronson Commercial |
$464.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$940.95
|
|
|
HC OXYGENATOR NX EAST/WEST
|
Facility
|
IP
|
$1,254.60
|
|
| Hospital Charge Code |
27000649
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$552.02 |
| Max. Negotiated Rate |
$1,129.14 |
| Rate for Payer: Aetna American Axle |
$815.49
|
| Rate for Payer: Aetna Commercial |
$1,066.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$815.49
|
| Rate for Payer: Cash Price |
$1,003.68
|
| Rate for Payer: Cofinity Commercial |
$1,078.96
|
| Rate for Payer: Cofinity Commercial |
$878.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$878.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,003.68
|
| Rate for Payer: Healthscope Commercial |
$1,129.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$878.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$940.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,066.41
|
| Rate for Payer: PHP Commercial |
$1,066.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$815.49
|
| Rate for Payer: Priority Health SBD |
$790.40
|
| Rate for Payer: UMR Bronson Commercial |
$552.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$940.95
|
|
|
HC OXYGENATOR QUADROX
|
Facility
|
OP
|
$3,863.25
|
|
| Hospital Charge Code |
27000652
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,429.40 |
| Max. Negotiated Rate |
$3,476.93 |
| Rate for Payer: Aetna American Axle |
$2,511.11
|
| Rate for Payer: Aetna Commercial |
$3,283.76
|
| Rate for Payer: Aetna Medicare |
$1,931.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,511.11
|
| Rate for Payer: BCBS Complete |
$1,545.30
|
| Rate for Payer: Cash Price |
$3,090.60
|
| Rate for Payer: Cofinity Commercial |
$2,704.28
|
| Rate for Payer: Cofinity Commercial |
$3,322.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,704.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,090.60
|
| Rate for Payer: Healthscope Commercial |
$3,476.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,704.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,897.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,283.76
|
| Rate for Payer: PHP Commercial |
$3,283.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,511.11
|
| Rate for Payer: Priority Health SBD |
$2,433.85
|
| Rate for Payer: UMR Bronson Commercial |
$1,429.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,897.44
|
|
|
HC OXYGENATOR QUADROX
|
Facility
|
IP
|
$3,863.25
|
|
| Hospital Charge Code |
27000652
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,699.83 |
| Max. Negotiated Rate |
$3,476.93 |
| Rate for Payer: Aetna American Axle |
$2,511.11
|
| Rate for Payer: Aetna Commercial |
$3,283.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,511.11
|
| Rate for Payer: Cash Price |
$3,090.60
|
| Rate for Payer: Cofinity Commercial |
$2,704.28
|
| Rate for Payer: Cofinity Commercial |
$3,322.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,704.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,090.60
|
| Rate for Payer: Healthscope Commercial |
$3,476.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,704.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,897.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,283.76
|
| Rate for Payer: PHP Commercial |
$3,283.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,511.11
|
| Rate for Payer: Priority Health SBD |
$2,433.85
|
| Rate for Payer: UMR Bronson Commercial |
$1,699.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,897.44
|
|
|
HC OXYTOCIN CHALLENGE TEST
|
Facility
|
IP
|
$802.21
|
|
|
Service Code
|
CPT 59020
|
| Hospital Charge Code |
92000003
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$352.97 |
| Max. Negotiated Rate |
$721.99 |
| Rate for Payer: Aetna American Axle |
$521.44
|
| Rate for Payer: Aetna Commercial |
$681.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$521.44
|
| Rate for Payer: Cash Price |
$641.77
|
| Rate for Payer: Cofinity Commercial |
$561.55
|
| Rate for Payer: Cofinity Commercial |
$689.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$561.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$641.77
|
| Rate for Payer: Healthscope Commercial |
$721.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$561.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$601.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$681.88
|
| Rate for Payer: PHP Commercial |
$681.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$521.44
|
| Rate for Payer: Priority Health SBD |
$505.39
|
| Rate for Payer: UMR Bronson Commercial |
$352.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$601.66
|
|
|
HC OXYTOCIN CHALLENGE TEST
|
Facility
|
OP
|
$802.21
|
|
|
Service Code
|
CPT 59020
|
| Hospital Charge Code |
92000003
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$105.16 |
| Max. Negotiated Rate |
$721.99 |
| Rate for Payer: Aetna American Axle |
$521.44
|
| Rate for Payer: Aetna Commercial |
$681.88
|
| Rate for Payer: Aetna Medicare |
$204.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$521.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$245.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$245.25
|
| Rate for Payer: BCBS Complete |
$110.42
|
| Rate for Payer: BCBS MAPPO |
$196.20
|
| Rate for Payer: BCN Medicare Advantage |
$196.20
|
| Rate for Payer: Cash Price |
$641.77
|
| Rate for Payer: Cash Price |
$641.77
|
| Rate for Payer: Cash Price |
$641.77
|
| Rate for Payer: Cofinity Commercial |
$561.55
|
| Rate for Payer: Cofinity Commercial |
$689.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$561.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$641.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$196.20
|
| Rate for Payer: Healthscope Commercial |
$721.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$561.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$601.66
|
| Rate for Payer: Mclaren Medicaid |
$105.16
|
| Rate for Payer: Mclaren Medicare |
$196.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$206.01
|
| Rate for Payer: Meridian Medicaid |
$110.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$225.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$681.88
|
| Rate for Payer: PACE Medicare |
$186.39
|
| Rate for Payer: PACE SWMI |
$196.20
|
| Rate for Payer: PHP Commercial |
$681.88
|
| Rate for Payer: PHP Medicare Advantage |
$196.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$105.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$521.44
|
| Rate for Payer: Priority Health Medicare |
$196.20
|
| Rate for Payer: Priority Health SBD |
$505.39
|
| Rate for Payer: Railroad Medicare Medicare |
$196.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$552.28
|
| Rate for Payer: UHC Core |
$294.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$196.20
|
| Rate for Payer: UHC Exchange |
$374.96
|
| Rate for Payer: UHC Medicare Advantage |
$196.20
|
| Rate for Payer: UHCCP Medicaid |
$105.16
|
| Rate for Payer: UMR Bronson Commercial |
$296.82
|
| Rate for Payer: VA VA |
$196.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$601.66
|
|
|
HC OYSTER IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200053
|
|
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
|
|
|
HC OYSTER IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200053
|
|
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 PACEMAKER AVIER LEADLESS DUAL CHAMBER
|
Facility
|
OP
|
$85,833.00
|
|
|
Service Code
|
HCPCS C1605
|
| Hospital Charge Code |
27500014
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$31,758.21 |
| Max. Negotiated Rate |
$77,249.70 |
| Rate for Payer: Aetna American Axle |
$55,791.45
|
| Rate for Payer: Aetna Commercial |
$72,958.05
|
| Rate for Payer: Aetna Medicare |
$42,916.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55,791.45
|
| Rate for Payer: BCBS Complete |
$34,333.20
|
| Rate for Payer: Cash Price |
$68,666.40
|
| Rate for Payer: Cofinity Commercial |
$60,083.10
|
| Rate for Payer: Cofinity Commercial |
$73,816.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$60,083.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68,666.40
|
| Rate for Payer: Healthscope Commercial |
$77,249.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$60,083.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64,374.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72,958.05
|
| Rate for Payer: PHP Commercial |
$72,958.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55,791.45
|
| Rate for Payer: Priority Health SBD |
$54,074.79
|
| Rate for Payer: UMR Bronson Commercial |
$31,758.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64,374.75
|
|
|
HC PACEMAKER AVIER LEADLESS DUAL CHAMBER
|
Facility
|
IP
|
$85,833.00
|
|
|
Service Code
|
HCPCS C1605
|
| Hospital Charge Code |
27500014
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$37,766.52 |
| Max. Negotiated Rate |
$77,249.70 |
| Rate for Payer: Aetna American Axle |
$55,791.45
|
| Rate for Payer: Aetna Commercial |
$72,958.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55,791.45
|
| Rate for Payer: Cash Price |
$68,666.40
|
| Rate for Payer: Cofinity Commercial |
$60,083.10
|
| Rate for Payer: Cofinity Commercial |
$73,816.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$60,083.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68,666.40
|
| Rate for Payer: Healthscope Commercial |
$77,249.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$60,083.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64,374.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72,958.05
|
| Rate for Payer: PHP Commercial |
$72,958.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55,791.45
|
| Rate for Payer: Priority Health SBD |
$54,074.79
|
| Rate for Payer: UMR Bronson Commercial |
$37,766.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64,374.75
|
|
|
HC PACEMAKER DUAL CHAMBER LVL 7
|
Facility
|
OP
|
$7,952.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27500354
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,942.24 |
| Max. Negotiated Rate |
$7,156.80 |
| Rate for Payer: Aetna American Axle |
$5,168.80
|
| Rate for Payer: Aetna Commercial |
$6,759.20
|
| Rate for Payer: Aetna Medicare |
$3,976.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,168.80
|
| Rate for Payer: BCBS Complete |
$3,180.80
|
| Rate for Payer: Cash Price |
$6,361.60
|
| Rate for Payer: Cofinity Commercial |
$5,566.40
|
| Rate for Payer: Cofinity Commercial |
$6,838.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,566.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,361.60
|
| Rate for Payer: Healthscope Commercial |
$7,156.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,566.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,964.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,759.20
|
| Rate for Payer: PHP Commercial |
$6,759.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,168.80
|
| Rate for Payer: Priority Health SBD |
$5,009.76
|
| Rate for Payer: UMR Bronson Commercial |
$2,942.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,964.00
|
|
|
HC PACEMAKER DUAL CHAMBER LVL 7
|
Facility
|
IP
|
$7,952.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27500354
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,498.88 |
| Max. Negotiated Rate |
$7,156.80 |
| Rate for Payer: Aetna American Axle |
$5,168.80
|
| Rate for Payer: Aetna Commercial |
$6,759.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,168.80
|
| Rate for Payer: Cash Price |
$6,361.60
|
| Rate for Payer: Cofinity Commercial |
$5,566.40
|
| Rate for Payer: Cofinity Commercial |
$6,838.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,566.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,361.60
|
| Rate for Payer: Healthscope Commercial |
$7,156.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,566.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,964.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,759.20
|
| Rate for Payer: PHP Commercial |
$6,759.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,168.80
|
| Rate for Payer: Priority Health SBD |
$5,009.76
|
| Rate for Payer: UMR Bronson Commercial |
$3,498.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,964.00
|
|
|
HC PACEMAKER DUAL CHAMBER LVL 9
|
Facility
|
IP
|
$9,233.04
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27500349
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$4,062.54 |
| Max. Negotiated Rate |
$8,309.74 |
| Rate for Payer: Aetna American Axle |
$6,001.48
|
| Rate for Payer: Aetna Commercial |
$7,848.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,001.48
|
| Rate for Payer: Cash Price |
$7,386.43
|
| Rate for Payer: Cofinity Commercial |
$6,463.13
|
| Rate for Payer: Cofinity Commercial |
$7,940.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,463.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,386.43
|
| Rate for Payer: Healthscope Commercial |
$8,309.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,463.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,924.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,848.08
|
| Rate for Payer: PHP Commercial |
$7,848.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,001.48
|
| Rate for Payer: Priority Health SBD |
$5,816.82
|
| Rate for Payer: UMR Bronson Commercial |
$4,062.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,924.78
|
|
|
HC PACEMAKER DUAL CHAMBER LVL 9
|
Facility
|
OP
|
$9,233.04
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27500349
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,416.22 |
| Max. Negotiated Rate |
$8,309.74 |
| Rate for Payer: Aetna American Axle |
$6,001.48
|
| Rate for Payer: Aetna Commercial |
$7,848.08
|
| Rate for Payer: Aetna Medicare |
$4,616.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,001.48
|
| Rate for Payer: BCBS Complete |
$3,693.22
|
| Rate for Payer: Cash Price |
$7,386.43
|
| Rate for Payer: Cofinity Commercial |
$6,463.13
|
| Rate for Payer: Cofinity Commercial |
$7,940.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,463.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,386.43
|
| Rate for Payer: Healthscope Commercial |
$8,309.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,463.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,924.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,848.08
|
| Rate for Payer: PHP Commercial |
$7,848.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,001.48
|
| Rate for Payer: Priority Health SBD |
$5,816.82
|
| Rate for Payer: UMR Bronson Commercial |
$3,416.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,924.78
|
|
|
HC PACEMAKER IMPLANT, DUAL
|
Facility
|
IP
|
$19,347.05
|
|
|
Service Code
|
CPT 33208
|
| Hospital Charge Code |
36100059
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$8,512.70 |
| Max. Negotiated Rate |
$17,412.35 |
| Rate for Payer: Aetna American Axle |
$12,575.58
|
| Rate for Payer: Aetna Commercial |
$16,444.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12,575.58
|
| Rate for Payer: Cash Price |
$15,477.64
|
| Rate for Payer: Cofinity Commercial |
$13,542.93
|
| Rate for Payer: Cofinity Commercial |
$16,638.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$13,542.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,477.64
|
| Rate for Payer: Healthscope Commercial |
$17,412.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13,542.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14,510.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,444.99
|
| Rate for Payer: PHP Commercial |
$16,444.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,575.58
|
| Rate for Payer: Priority Health SBD |
$12,188.64
|
| Rate for Payer: UMR Bronson Commercial |
$8,512.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14,510.29
|
|
