|
HC PEDS ECHO COMPLETE
|
Facility
|
OP
|
$2,008.38
|
|
|
Service Code
|
CPT 93306
|
| Hospital Charge Code |
48300005
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$180.64 |
| Max. Negotiated Rate |
$1,807.54 |
| Rate for Payer: Aetna American Axle |
$1,305.45
|
| Rate for Payer: Aetna Commercial |
$1,707.12
|
| Rate for Payer: Aetna Medicare |
$558.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,305.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$671.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$671.51
|
| Rate for Payer: BCBS Complete |
$302.34
|
| Rate for Payer: BCBS MAPPO |
$537.21
|
| Rate for Payer: BCBS Trust/PPO |
$545.48
|
| Rate for Payer: BCN Commercial |
$545.48
|
| Rate for Payer: BCN Medicare Advantage |
$537.21
|
| Rate for Payer: Cash Price |
$1,606.70
|
| Rate for Payer: Cash Price |
$1,606.70
|
| Rate for Payer: Cash Price |
$1,606.70
|
| Rate for Payer: Cofinity Commercial |
$1,405.87
|
| Rate for Payer: Cofinity Commercial |
$1,727.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,405.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,606.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$537.21
|
| Rate for Payer: Healthscope Commercial |
$1,807.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,405.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,506.28
|
| Rate for Payer: Mclaren Medicaid |
$287.94
|
| Rate for Payer: Mclaren Medicare |
$537.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$564.07
|
| Rate for Payer: Meridian Medicaid |
$302.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$617.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,707.12
|
| Rate for Payer: Nomi Health Commercial |
$1,611.63
|
| Rate for Payer: PACE Medicare |
$510.35
|
| Rate for Payer: PACE SWMI |
$537.21
|
| Rate for Payer: PHP Commercial |
$1,707.12
|
| Rate for Payer: PHP Medicare Advantage |
$537.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$287.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,305.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,688.45
|
| Rate for Payer: Priority Health Medicare |
$537.21
|
| Rate for Payer: Priority Health Narrow Network |
$1,350.76
|
| Rate for Payer: Priority Health SBD |
$1,265.28
|
| Rate for Payer: Railroad Medicare Medicare |
$537.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$198.70
|
| Rate for Payer: UHC Core |
$816.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$537.21
|
| Rate for Payer: UHC Exchange |
$180.64
|
| Rate for Payer: UHC Medicare Advantage |
$537.21
|
| Rate for Payer: UHCCP Medicaid |
$287.94
|
| Rate for Payer: UMR Bronson Commercial |
$743.10
|
| Rate for Payer: VA VA |
$537.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,506.28
|
|
|
HC PEDS ECHO LIMITED
|
Facility
|
IP
|
$825.55
|
|
|
Service Code
|
CPT 93308
|
| Hospital Charge Code |
48300006
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$363.24 |
| Max. Negotiated Rate |
$743.00 |
| Rate for Payer: Aetna American Axle |
$536.61
|
| Rate for Payer: Aetna Commercial |
$701.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$536.61
|
| Rate for Payer: Cash Price |
$660.44
|
| Rate for Payer: Cofinity Commercial |
$577.88
|
| Rate for Payer: Cofinity Commercial |
$709.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$577.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$660.44
|
| Rate for Payer: Healthscope Commercial |
$743.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$577.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$619.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$701.72
|
| Rate for Payer: PHP Commercial |
$701.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$536.61
|
| Rate for Payer: Priority Health SBD |
$520.10
|
| Rate for Payer: UMR Bronson Commercial |
$363.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$619.16
|
|
|
HC PEDS ECHO LIMITED
|
Facility
|
OP
|
$825.55
|
|
|
Service Code
|
CPT 93308
|
| Hospital Charge Code |
48300006
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$90.18 |
| Max. Negotiated Rate |
$816.00 |
| Rate for Payer: Aetna American Axle |
$536.61
|
| Rate for Payer: Aetna Commercial |
$701.72
|
| Rate for Payer: Aetna Medicare |
$246.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$536.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$296.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$296.04
|
| Rate for Payer: BCBS Complete |
$133.29
|
| Rate for Payer: BCBS MAPPO |
$236.83
|
| Rate for Payer: BCBS Trust/PPO |
$314.31
|
| Rate for Payer: BCN Commercial |
$314.31
|
| Rate for Payer: BCN Medicare Advantage |
$236.83
|
| Rate for Payer: Cash Price |
$660.44
|
| Rate for Payer: Cash Price |
$660.44
|
| Rate for Payer: Cash Price |
$660.44
|
| Rate for Payer: Cofinity Commercial |
$577.88
|
| Rate for Payer: Cofinity Commercial |
$709.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$577.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$660.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$236.83
|
| Rate for Payer: Healthscope Commercial |
$743.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$577.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$619.16
|
| Rate for Payer: Mclaren Medicaid |
$126.94
|
| Rate for Payer: Mclaren Medicare |
$236.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$248.67
|
| Rate for Payer: Meridian Medicaid |
$133.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$272.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$701.72
|
| Rate for Payer: Nomi Health Commercial |
$710.49
|
| Rate for Payer: PACE Medicare |
$224.99
|
| Rate for Payer: PACE SWMI |
$236.83
|
| Rate for Payer: PHP Commercial |
$701.72
|
| Rate for Payer: PHP Medicare Advantage |
$236.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$536.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$744.36
|
| Rate for Payer: Priority Health Medicare |
$236.83
|
| Rate for Payer: Priority Health Narrow Network |
$595.49
|
| Rate for Payer: Priority Health SBD |
$520.10
|
| Rate for Payer: Railroad Medicare Medicare |
$236.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$99.20
|
| Rate for Payer: UHC Core |
$816.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$236.83
|
| Rate for Payer: UHC Exchange |
$90.18
|
| Rate for Payer: UHC Medicare Advantage |
$236.83
|
| Rate for Payer: UHCCP Medicaid |
$126.94
|
| Rate for Payer: UMR Bronson Commercial |
$305.45
|
| Rate for Payer: VA VA |
$236.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$619.16
|
|
|
HC PEDS ECHO W/DEFINITY
|
Facility
|
IP
|
$1,663.84
|
|
|
Service Code
|
HCPCS C8921
|
| Hospital Charge Code |
48000028
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$732.09 |
| Max. Negotiated Rate |
$1,497.46 |
| Rate for Payer: Aetna American Axle |
$1,081.50
|
| Rate for Payer: Aetna Commercial |
$1,414.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,081.50
|
| Rate for Payer: Cash Price |
$1,331.07
|
| Rate for Payer: Cofinity Commercial |
$1,164.69
|
| Rate for Payer: Cofinity Commercial |
$1,430.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,164.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,331.07
|
| Rate for Payer: Healthscope Commercial |
$1,497.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,164.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,247.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,414.26
|
| Rate for Payer: PHP Commercial |
$1,414.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,081.50
|
| Rate for Payer: Priority Health SBD |
$1,048.22
|
| Rate for Payer: UMR Bronson Commercial |
$732.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,247.88
|
|
|
HC PEDS ECHO W/DEFINITY
|
Facility
|
OP
|
$1,663.84
|
|
|
Service Code
|
HCPCS C8921
|
| Hospital Charge Code |
48000028
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$414.91 |
| Max. Negotiated Rate |
$2,432.92 |
| Rate for Payer: Aetna American Axle |
$1,081.50
|
| Rate for Payer: Aetna Commercial |
$1,414.26
|
| Rate for Payer: Aetna Medicare |
$805.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,081.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$967.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$967.60
|
| Rate for Payer: BCBS Complete |
$435.65
|
| Rate for Payer: BCBS MAPPO |
$774.08
|
| Rate for Payer: BCBS Trust/PPO |
$980.00
|
| Rate for Payer: BCN Commercial |
$980.00
|
| Rate for Payer: BCN Medicare Advantage |
$774.08
|
| Rate for Payer: Cash Price |
$1,331.07
|
| Rate for Payer: Cash Price |
$1,331.07
|
| Rate for Payer: Cash Price |
$1,331.07
|
| Rate for Payer: Cofinity Commercial |
$1,164.69
|
| Rate for Payer: Cofinity Commercial |
$1,430.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,164.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,331.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$774.08
|
| Rate for Payer: Healthscope Commercial |
$1,497.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,164.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,247.88
|
| Rate for Payer: Mclaren Medicaid |
$414.91
|
| Rate for Payer: Mclaren Medicare |
$774.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$812.78
|
| Rate for Payer: Meridian Medicaid |
$435.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$890.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,414.26
|
| Rate for Payer: Nomi Health Commercial |
$2,322.24
|
| Rate for Payer: PACE Medicare |
$735.38
|
| Rate for Payer: PACE SWMI |
$774.08
|
| Rate for Payer: PHP Commercial |
$1,414.26
|
| Rate for Payer: PHP Medicare Advantage |
$774.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$414.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,081.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,432.92
|
| Rate for Payer: Priority Health Medicare |
$774.08
|
| Rate for Payer: Priority Health Narrow Network |
$1,946.34
|
| Rate for Payer: Priority Health SBD |
$1,048.22
|
| Rate for Payer: Railroad Medicare Medicare |
$774.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,178.96
|
| Rate for Payer: UHC Core |
$816.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$774.08
|
| Rate for Payer: UHC Exchange |
$1,479.34
|
| Rate for Payer: UHC Medicare Advantage |
$774.08
|
| Rate for Payer: UHCCP Medicaid |
$414.91
|
| Rate for Payer: UMR Bronson Commercial |
$615.62
|
| Rate for Payer: VA VA |
$774.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,247.88
|
|
|
HC PEDS OBS OVERFLOW PER HR
|
Facility
|
IP
|
$156.38
|
|
| Hospital Charge Code |
76900003
|
|
Hospital Revenue Code
|
769
|
| Min. Negotiated Rate |
$68.81 |
| Max. Negotiated Rate |
$140.74 |
| Rate for Payer: Aetna American Axle |
$101.65
|
| Rate for Payer: Aetna Commercial |
$132.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.65
|
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: Cofinity Commercial |
$109.47
|
| Rate for Payer: Cofinity Commercial |
$134.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$109.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.10
|
| Rate for Payer: Healthscope Commercial |
$140.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$109.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$117.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.92
|
| Rate for Payer: PHP Commercial |
$132.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.65
|
| Rate for Payer: Priority Health SBD |
$98.52
|
| Rate for Payer: UMR Bronson Commercial |
$68.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117.28
|
|
|
HC PEDS OBS OVERFLOW PER HR
|
Facility
|
OP
|
$156.38
|
|
| Hospital Charge Code |
76900003
|
|
Hospital Revenue Code
|
769
|
| Min. Negotiated Rate |
$57.86 |
| Max. Negotiated Rate |
$140.74 |
| Rate for Payer: Aetna American Axle |
$101.65
|
| Rate for Payer: Aetna Commercial |
$132.92
|
| Rate for Payer: Aetna Medicare |
$78.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.65
|
| Rate for Payer: BCBS Complete |
$62.55
|
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: Cofinity Commercial |
$109.47
|
| Rate for Payer: Cofinity Commercial |
$134.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$109.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.10
|
| Rate for Payer: Healthscope Commercial |
$140.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$109.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$117.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.92
|
| Rate for Payer: PHP Commercial |
$132.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.65
|
| Rate for Payer: Priority Health SBD |
$98.52
|
| Rate for Payer: UMR Bronson Commercial |
$57.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117.28
|
|
|
HC PEDS VENT INIT DAY
|
Facility
|
IP
|
$1,521.49
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
41000035
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$669.46 |
| Max. Negotiated Rate |
$1,369.34 |
| Rate for Payer: Aetna American Axle |
$988.97
|
| Rate for Payer: Aetna Commercial |
$1,293.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$988.97
|
| Rate for Payer: Cash Price |
$1,217.19
|
| Rate for Payer: Cofinity Commercial |
$1,065.04
|
| Rate for Payer: Cofinity Commercial |
$1,308.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,065.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,217.19
|
| Rate for Payer: Healthscope Commercial |
$1,369.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,065.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,141.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,293.27
|
| Rate for Payer: PHP Commercial |
$1,293.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$988.97
|
| Rate for Payer: Priority Health SBD |
$958.54
|
| Rate for Payer: UMR Bronson Commercial |
$669.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,141.12
|
|
|
HC PEDS VENT INIT DAY
|
Facility
|
OP
|
$1,521.49
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
41000035
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$77.51 |
| Max. Negotiated Rate |
$2,035.81 |
| Rate for Payer: Aetna American Axle |
$988.97
|
| Rate for Payer: Aetna Commercial |
$1,293.27
|
| Rate for Payer: Aetna Medicare |
$673.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$988.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$809.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$809.66
|
| Rate for Payer: BCBS Complete |
$364.54
|
| Rate for Payer: BCBS MAPPO |
$647.73
|
| Rate for Payer: BCBS Trust/PPO |
$77.51
|
| Rate for Payer: BCN Commercial |
$77.51
|
| Rate for Payer: BCN Medicare Advantage |
$647.73
|
| Rate for Payer: Cash Price |
$1,217.19
|
| Rate for Payer: Cash Price |
$1,217.19
|
| Rate for Payer: Cash Price |
$1,217.19
|
| Rate for Payer: Cofinity Commercial |
$1,065.04
|
| Rate for Payer: Cofinity Commercial |
$1,308.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,065.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,217.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$647.73
|
| Rate for Payer: Healthscope Commercial |
$1,369.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,065.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,141.12
|
| Rate for Payer: Mclaren Medicaid |
$347.18
|
| Rate for Payer: Mclaren Medicare |
$647.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$680.12
|
| Rate for Payer: Meridian Medicaid |
$364.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$744.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,293.27
|
| Rate for Payer: Nomi Health Commercial |
$1,943.19
|
| Rate for Payer: PACE Medicare |
$615.34
|
| Rate for Payer: PACE SWMI |
$647.73
|
| Rate for Payer: PHP Commercial |
$1,293.27
|
| Rate for Payer: PHP Medicare Advantage |
$647.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$347.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$988.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,035.81
|
| Rate for Payer: Priority Health Medicare |
$647.73
|
| Rate for Payer: Priority Health Narrow Network |
$1,628.65
|
| Rate for Payer: Priority Health SBD |
$958.54
|
| Rate for Payer: Railroad Medicare Medicare |
$647.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$96.48
|
| Rate for Payer: UHC Core |
$294.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$647.73
|
| Rate for Payer: UHC Exchange |
$87.71
|
| Rate for Payer: UHC Medicare Advantage |
$647.73
|
| Rate for Payer: UHCCP Medicaid |
$347.18
|
| Rate for Payer: UMR Bronson Commercial |
$562.95
|
| Rate for Payer: VA VA |
$647.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,141.12
|
|
|
HC PEDS VENT SUB DAY
|
Facility
|
IP
|
$1,315.21
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
41000036
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$578.69 |
| Max. Negotiated Rate |
$1,183.69 |
| Rate for Payer: Aetna American Axle |
$854.89
|
| Rate for Payer: Aetna Commercial |
$1,117.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$854.89
|
| Rate for Payer: Cash Price |
$1,052.17
|
| Rate for Payer: Cofinity Commercial |
$1,131.08
|
| Rate for Payer: Cofinity Commercial |
$920.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$920.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,052.17
|
| Rate for Payer: Healthscope Commercial |
$1,183.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$920.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$986.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,117.93
|
| Rate for Payer: PHP Commercial |
$1,117.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$854.89
|
| Rate for Payer: Priority Health SBD |
$828.58
|
| Rate for Payer: UMR Bronson Commercial |
$578.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$986.41
|
|
|
HC PEDS VENT SUB DAY
|
Facility
|
OP
|
$1,315.21
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
41000036
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$59.20 |
| Max. Negotiated Rate |
$2,035.81 |
| Rate for Payer: Aetna American Axle |
$854.89
|
| Rate for Payer: Aetna Commercial |
$1,117.93
|
| Rate for Payer: Aetna Medicare |
$673.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$854.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$809.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$809.66
|
| Rate for Payer: BCBS Complete |
$364.54
|
| Rate for Payer: BCBS MAPPO |
$647.73
|
| Rate for Payer: BCBS Trust/PPO |
$59.20
|
| Rate for Payer: BCN Commercial |
$59.20
|
| Rate for Payer: BCN Medicare Advantage |
$647.73
|
| Rate for Payer: Cash Price |
$1,052.17
|
| Rate for Payer: Cash Price |
$1,052.17
|
| Rate for Payer: Cash Price |
$1,052.17
|
| Rate for Payer: Cofinity Commercial |
$1,131.08
|
| Rate for Payer: Cofinity Commercial |
$920.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$920.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,052.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$647.73
|
| Rate for Payer: Healthscope Commercial |
$1,183.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$920.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$986.41
|
| Rate for Payer: Mclaren Medicaid |
$347.18
|
| Rate for Payer: Mclaren Medicare |
$647.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$680.12
|
| Rate for Payer: Meridian Medicaid |
$364.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$744.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,117.93
|
| Rate for Payer: Nomi Health Commercial |
$1,943.19
|
| Rate for Payer: PACE Medicare |
$615.34
|
| Rate for Payer: PACE SWMI |
$647.73
|
| Rate for Payer: PHP Commercial |
$1,117.93
|
| Rate for Payer: PHP Medicare Advantage |
$647.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$347.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$854.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,035.81
|
| Rate for Payer: Priority Health Medicare |
$647.73
|
| Rate for Payer: Priority Health Narrow Network |
$1,628.65
|
| Rate for Payer: Priority Health SBD |
$828.58
|
| Rate for Payer: Railroad Medicare Medicare |
$647.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.77
|
| Rate for Payer: UHC Core |
$294.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$647.73
|
| Rate for Payer: UHC Exchange |
$61.61
|
| Rate for Payer: UHC Medicare Advantage |
$647.73
|
| Rate for Payer: UHCCP Medicaid |
$347.18
|
| Rate for Payer: UMR Bronson Commercial |
$486.63
|
| Rate for Payer: VA VA |
$647.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$986.41
|
|
|
HC PEG TUBE INSERTION/TRAY
|
Facility
|
OP
|
$1,210.85
|
|
| Hospital Charge Code |
36000079
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$448.01 |
| Max. Negotiated Rate |
$1,089.76 |
| Rate for Payer: Aetna American Axle |
$787.05
|
| Rate for Payer: Aetna Commercial |
$1,029.22
|
| Rate for Payer: Aetna Medicare |
$605.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$787.05
|
| Rate for Payer: BCBS Complete |
$484.34
|
| Rate for Payer: Cash Price |
$968.68
|
| Rate for Payer: Cofinity Commercial |
$1,041.33
|
| Rate for Payer: Cofinity Commercial |
$847.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$847.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$968.68
|
| Rate for Payer: Healthscope Commercial |
$1,089.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$847.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$908.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,029.22
|
| Rate for Payer: PHP Commercial |
$1,029.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$787.05
|
| Rate for Payer: Priority Health SBD |
$762.84
|
| Rate for Payer: UMR Bronson Commercial |
$448.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$908.14
|
|
|
HC PEG TUBE INSERTION/TRAY
|
Facility
|
IP
|
$1,210.85
|
|
| Hospital Charge Code |
36000079
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$532.77 |
| Max. Negotiated Rate |
$1,089.76 |
| Rate for Payer: Aetna American Axle |
$787.05
|
| Rate for Payer: Aetna Commercial |
$1,029.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$787.05
|
| Rate for Payer: Cash Price |
$968.68
|
| Rate for Payer: Cofinity Commercial |
$1,041.33
|
| Rate for Payer: Cofinity Commercial |
$847.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$847.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$968.68
|
| Rate for Payer: Healthscope Commercial |
$1,089.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$847.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$908.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,029.22
|
| Rate for Payer: PHP Commercial |
$1,029.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$787.05
|
| Rate for Payer: Priority Health SBD |
$762.84
|
| Rate for Payer: UMR Bronson Commercial |
$532.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$908.14
|
|
|
HC PEJ FDG TUBE INSERTION/REPLACE
|
Facility
|
OP
|
$1,525.03
|
|
| Hospital Charge Code |
36000059
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$564.26 |
| Max. Negotiated Rate |
$1,372.53 |
| Rate for Payer: Aetna American Axle |
$991.27
|
| Rate for Payer: Aetna Commercial |
$1,296.28
|
| Rate for Payer: Aetna Medicare |
$762.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$991.27
|
| Rate for Payer: BCBS Complete |
$610.01
|
| Rate for Payer: Cash Price |
$1,220.02
|
| Rate for Payer: Cofinity Commercial |
$1,067.52
|
| Rate for Payer: Cofinity Commercial |
$1,311.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,067.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,220.02
|
| Rate for Payer: Healthscope Commercial |
$1,372.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,067.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,143.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,296.28
|
| Rate for Payer: PHP Commercial |
$1,296.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$991.27
|
| Rate for Payer: Priority Health SBD |
$960.77
|
| Rate for Payer: UMR Bronson Commercial |
$564.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,143.77
|
|
|
HC PEJ FDG TUBE INSERTION/REPLACE
|
Facility
|
IP
|
$1,525.03
|
|
| Hospital Charge Code |
36000059
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$671.01 |
| Max. Negotiated Rate |
$1,372.53 |
| Rate for Payer: Aetna American Axle |
$991.27
|
| Rate for Payer: Aetna Commercial |
$1,296.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$991.27
|
| Rate for Payer: Cash Price |
$1,220.02
|
| Rate for Payer: Cofinity Commercial |
$1,067.52
|
| Rate for Payer: Cofinity Commercial |
$1,311.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,067.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,220.02
|
| Rate for Payer: Healthscope Commercial |
$1,372.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,067.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,143.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,296.28
|
| Rate for Payer: PHP Commercial |
$1,296.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$991.27
|
| Rate for Payer: Priority Health SBD |
$960.77
|
| Rate for Payer: UMR Bronson Commercial |
$671.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,143.77
|
|
|
HC PELVIC EXAMINATION
|
Facility
|
OP
|
$47.00
|
|
|
Service Code
|
CPT 99459
|
| Hospital Charge Code |
51000129
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$17.39 |
| Max. Negotiated Rate |
$95.85 |
| Rate for Payer: Aetna American Axle |
$30.55
|
| Rate for Payer: Aetna Commercial |
$39.95
|
| Rate for Payer: Aetna Medicare |
$23.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.55
|
| Rate for Payer: BCBS Complete |
$18.80
|
| Rate for Payer: BCBS Trust/PPO |
$95.85
|
| Rate for Payer: BCCCP Commercial |
$19.64
|
| Rate for Payer: BCN Commercial |
$95.85
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cofinity Commercial |
$40.42
|
| Rate for Payer: Cofinity Commercial |
$32.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$32.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.60
|
| Rate for Payer: Healthscope Commercial |
$42.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.95
|
| Rate for Payer: PHP Commercial |
$39.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.55
|
| Rate for Payer: Priority Health SBD |
$29.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.31
|
| Rate for Payer: UHC Exchange |
$20.28
|
| Rate for Payer: UMR Bronson Commercial |
$17.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.25
|
|
|
HC PELVIC EXAMINATION
|
Facility
|
IP
|
$47.00
|
|
|
Service Code
|
CPT 99459
|
| Hospital Charge Code |
51000129
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$20.68 |
| Max. Negotiated Rate |
$42.30 |
| Rate for Payer: Aetna American Axle |
$30.55
|
| Rate for Payer: Aetna Commercial |
$39.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.55
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cofinity Commercial |
$32.90
|
| Rate for Payer: Cofinity Commercial |
$40.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$32.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.60
|
| Rate for Payer: Healthscope Commercial |
$42.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.95
|
| Rate for Payer: PHP Commercial |
$39.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.55
|
| Rate for Payer: Priority Health SBD |
$29.61
|
| Rate for Payer: UMR Bronson Commercial |
$20.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.25
|
|
|
HC PENICILLIUM IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200055
|
|
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 |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$5.04
|
| Rate for Payer: BCN Commercial |
$5.04
|
| 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: Nomi Health Commercial |
$7.83
|
| 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 HMO/PPO/Tiered Network |
$5.37
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$4.30
|
| Rate for Payer: Priority Health SBD |
$16.00
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$5.22
|
| 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 PENICILLIUM IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200055
|
|
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 PENTAMIDINE THERAPY
|
Facility
|
OP
|
$1,033.55
|
|
|
Service Code
|
CPT 94642
|
| Hospital Charge Code |
41000005
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$106.81 |
| Max. Negotiated Rate |
$930.20 |
| Rate for Payer: Aetna American Axle |
$671.81
|
| Rate for Payer: Aetna Commercial |
$878.52
|
| Rate for Payer: Aetna Medicare |
$207.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$671.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$249.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$249.10
|
| Rate for Payer: BCBS Complete |
$112.15
|
| Rate for Payer: BCBS MAPPO |
$199.28
|
| Rate for Payer: BCBS Trust/PPO |
$537.80
|
| Rate for Payer: BCN Commercial |
$537.80
|
| Rate for Payer: BCN Medicare Advantage |
$199.28
|
| Rate for Payer: Cash Price |
$826.84
|
| Rate for Payer: Cash Price |
$826.84
|
| Rate for Payer: Cash Price |
$826.84
|
| Rate for Payer: Cofinity Commercial |
$723.48
|
| Rate for Payer: Cofinity Commercial |
$888.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$723.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$826.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.28
|
| Rate for Payer: Healthscope Commercial |
$930.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$723.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$775.16
|
| Rate for Payer: Mclaren Medicaid |
$106.81
|
| Rate for Payer: Mclaren Medicare |
$199.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$209.24
|
| Rate for Payer: Meridian Medicaid |
$112.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$229.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$878.52
|
| Rate for Payer: Nomi Health Commercial |
$597.84
|
| Rate for Payer: PACE Medicare |
$189.32
|
| Rate for Payer: PACE SWMI |
$199.28
|
| Rate for Payer: PHP Commercial |
$878.52
|
| Rate for Payer: PHP Medicare Advantage |
$199.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$106.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$671.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$626.34
|
| Rate for Payer: Priority Health Medicare |
$199.28
|
| Rate for Payer: Priority Health Narrow Network |
$501.07
|
| Rate for Payer: Priority Health SBD |
$651.14
|
| Rate for Payer: Railroad Medicare Medicare |
$199.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$560.95
|
| Rate for Payer: UHC Core |
$294.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$199.28
|
| Rate for Payer: UHC Exchange |
$380.84
|
| Rate for Payer: UHC Medicare Advantage |
$199.28
|
| Rate for Payer: UHCCP Medicaid |
$106.81
|
| Rate for Payer: UMR Bronson Commercial |
$382.41
|
| Rate for Payer: VA VA |
$199.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$775.16
|
|
|
HC PENTAMIDINE THERAPY
|
Facility
|
IP
|
$1,033.55
|
|
|
Service Code
|
CPT 94642
|
| Hospital Charge Code |
41000005
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$454.76 |
| Max. Negotiated Rate |
$930.20 |
| Rate for Payer: Aetna American Axle |
$671.81
|
| Rate for Payer: Aetna Commercial |
$878.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$671.81
|
| Rate for Payer: Cash Price |
$826.84
|
| Rate for Payer: Cofinity Commercial |
$723.48
|
| Rate for Payer: Cofinity Commercial |
$888.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$723.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$826.84
|
| Rate for Payer: Healthscope Commercial |
$930.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$723.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$775.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$878.52
|
| Rate for Payer: PHP Commercial |
$878.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$671.81
|
| Rate for Payer: Priority Health SBD |
$651.14
|
| Rate for Payer: UMR Bronson Commercial |
$454.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$775.16
|
|
|
HC PENTOBARBITOL NEMBUTAL LVL
|
Facility
|
OP
|
$178.50
|
|
|
Service Code
|
CPT 80345
|
| Hospital Charge Code |
30100572
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$66.04 |
| Max. Negotiated Rate |
$160.65 |
| Rate for Payer: Aetna American Axle |
$116.02
|
| Rate for Payer: Aetna Commercial |
$151.72
|
| Rate for Payer: Aetna Medicare |
$89.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.02
|
| Rate for Payer: BCBS Complete |
$71.40
|
| Rate for Payer: Cash Price |
$142.80
|
| Rate for Payer: Cash Price |
$142.80
|
| Rate for Payer: Cofinity Commercial |
$153.51
|
| Rate for Payer: Cofinity Commercial |
$124.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$124.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.80
|
| Rate for Payer: Healthscope Commercial |
$160.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$124.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$133.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$151.72
|
| Rate for Payer: PHP Commercial |
$151.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.02
|
| Rate for Payer: Priority Health SBD |
$112.46
|
| Rate for Payer: UHC Core |
$122.36
|
| Rate for Payer: UMR Bronson Commercial |
$66.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$133.88
|
|
|
HC PENTOBARBITOL NEMBUTAL LVL
|
Facility
|
IP
|
$178.50
|
|
|
Service Code
|
CPT 80345
|
| Hospital Charge Code |
30100572
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$78.54 |
| Max. Negotiated Rate |
$160.65 |
| Rate for Payer: Aetna American Axle |
$116.02
|
| Rate for Payer: Aetna Commercial |
$151.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.02
|
| Rate for Payer: Cash Price |
$142.80
|
| Rate for Payer: Cofinity Commercial |
$124.95
|
| Rate for Payer: Cofinity Commercial |
$153.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$124.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.80
|
| Rate for Payer: Healthscope Commercial |
$160.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$124.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$133.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$151.72
|
| Rate for Payer: PHP Commercial |
$151.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.02
|
| Rate for Payer: Priority Health SBD |
$112.46
|
| Rate for Payer: UMR Bronson Commercial |
$78.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$133.88
|
|
|
HC PEP VALVE SUPPLY
|
Facility
|
OP
|
$54.58
|
|
| Hospital Charge Code |
27000134
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$20.19 |
| Max. Negotiated Rate |
$49.12 |
| Rate for Payer: Aetna American Axle |
$35.48
|
| Rate for Payer: Aetna Commercial |
$46.39
|
| Rate for Payer: Aetna Medicare |
$27.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.48
|
| Rate for Payer: BCBS Complete |
$21.83
|
| Rate for Payer: Cash Price |
$43.66
|
| Rate for Payer: Cofinity Commercial |
$38.21
|
| Rate for Payer: Cofinity Commercial |
$46.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$38.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.66
|
| Rate for Payer: Healthscope Commercial |
$49.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$38.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.39
|
| Rate for Payer: PHP Commercial |
$46.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.48
|
| Rate for Payer: Priority Health SBD |
$34.39
|
| Rate for Payer: UMR Bronson Commercial |
$20.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.94
|
|
|
HC PEP VALVE SUPPLY
|
Facility
|
IP
|
$54.58
|
|
| Hospital Charge Code |
27000134
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.02 |
| Max. Negotiated Rate |
$49.12 |
| Rate for Payer: Aetna American Axle |
$35.48
|
| Rate for Payer: Aetna Commercial |
$46.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.48
|
| Rate for Payer: Cash Price |
$43.66
|
| Rate for Payer: Cofinity Commercial |
$38.21
|
| Rate for Payer: Cofinity Commercial |
$46.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$38.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.66
|
| Rate for Payer: Healthscope Commercial |
$49.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$38.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.39
|
| Rate for Payer: PHP Commercial |
$46.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.48
|
| Rate for Payer: Priority Health SBD |
$34.39
|
| Rate for Payer: UMR Bronson Commercial |
$24.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.94
|
|
