|
HC RO TRTMNT LEVEL 1
|
Facility
|
OP
|
$254.15
|
|
|
Service Code
|
CPT 77402
|
| Hospital Charge Code |
33300078
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$53.17 |
| Max. Negotiated Rate |
$328.77 |
| Rate for Payer: Aetna American Axle |
$165.20
|
| Rate for Payer: Aetna Commercial |
$216.03
|
| Rate for Payer: Aetna Medicare |
$105.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$127.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$127.08
|
| Rate for Payer: BCBS Complete |
$55.83
|
| Rate for Payer: BCBS MAPPO |
$101.66
|
| Rate for Payer: BCBS Trust/PPO |
$177.80
|
| Rate for Payer: BCN Commercial |
$177.80
|
| Rate for Payer: BCN Medicare Advantage |
$101.66
|
| Rate for Payer: Cash Price |
$203.32
|
| Rate for Payer: Cash Price |
$203.32
|
| Rate for Payer: Cofinity Advantage |
$177.91
|
| Rate for Payer: Cofinity Commercial |
$218.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.66
|
| Rate for Payer: Healthscope Commercial |
$228.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$177.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.61
|
| Rate for Payer: Mclaren Medicaid |
$101.66
|
| Rate for Payer: Mclaren Medicare |
$101.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$106.74
|
| Rate for Payer: Meridian Medicaid |
$106.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$116.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$111.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.03
|
| Rate for Payer: Nomi Health Commercial |
$304.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$190.61
|
| Rate for Payer: PACE Medicare |
$96.58
|
| Rate for Payer: PACE SWMI |
$101.66
|
| Rate for Payer: PHP Commercial |
$216.03
|
| Rate for Payer: PHP Medicare Advantage |
$101.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$328.77
|
| Rate for Payer: Priority Health Medicare |
$101.66
|
| Rate for Payer: Priority Health SBD |
$160.11
|
| Rate for Payer: Priority Health Tiered Network |
$263.02
|
| Rate for Payer: Railroad Medicare Medicare |
$101.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$165.20
|
| Rate for Payer: UHC Core |
$132.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$101.66
|
| Rate for Payer: UHC Exchange |
$99.88
|
| Rate for Payer: UHC Medicaid |
$53.17
|
| Rate for Payer: UHCCP Medicaid |
$53.17
|
| Rate for Payer: UMR Bronson Commercial |
$94.04
|
| Rate for Payer: VA VA |
$101.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.61
|
|
|
HC RO TRTMNT LEVEL 2
|
Facility
|
OP
|
$960.76
|
|
|
Service Code
|
CPT 77407
|
| Hospital Charge Code |
33300079
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$177.80 |
| Max. Negotiated Rate |
$1,242.83 |
| Rate for Payer: Aetna American Axle |
$624.49
|
| Rate for Payer: Aetna Commercial |
$816.65
|
| Rate for Payer: Aetna Medicare |
$399.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$624.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$480.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$480.39
|
| Rate for Payer: BCBS Complete |
$211.06
|
| Rate for Payer: BCBS MAPPO |
$384.31
|
| Rate for Payer: BCBS Trust/PPO |
$177.80
|
| Rate for Payer: BCN Commercial |
$177.80
|
| Rate for Payer: BCN Medicare Advantage |
$384.31
|
| Rate for Payer: Cash Price |
$768.61
|
| Rate for Payer: Cash Price |
$768.61
|
| Rate for Payer: Cofinity Advantage |
$672.53
|
| Rate for Payer: Cofinity Commercial |
$826.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$768.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$384.31
|
| Rate for Payer: Healthscope Commercial |
$864.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$672.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$720.57
|
| Rate for Payer: Mclaren Medicaid |
$384.31
|
| Rate for Payer: Mclaren Medicare |
$384.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$403.53
|
| Rate for Payer: Meridian Medicaid |
$403.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$441.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$422.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$816.65
|
| Rate for Payer: Nomi Health Commercial |
$1,152.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$720.57
|
| Rate for Payer: PACE Medicare |
$365.09
|
| Rate for Payer: PACE SWMI |
$384.31
|
| Rate for Payer: PHP Commercial |
$816.65
|
| Rate for Payer: PHP Medicare Advantage |
$384.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$200.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,242.83
|
| Rate for Payer: Priority Health Medicare |
$384.31
|
| Rate for Payer: Priority Health SBD |
$605.28
|
| Rate for Payer: Priority Health Tiered Network |
$994.26
|
| Rate for Payer: Railroad Medicare Medicare |
$384.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$624.49
|
| Rate for Payer: UHC Core |
$500.56
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$384.31
|
| Rate for Payer: UHC Exchange |
$377.58
|
| Rate for Payer: UHC Medicaid |
$200.99
|
| Rate for Payer: UHCCP Medicaid |
$200.99
|
| Rate for Payer: UMR Bronson Commercial |
$355.48
|
| Rate for Payer: VA VA |
$384.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$720.57
|
|
|
HC RO TRTMNT LEVEL 2
|
Facility
|
IP
|
$960.76
|
|
|
Service Code
|
CPT 77407
|
| Hospital Charge Code |
33300079
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$422.73 |
| Max. Negotiated Rate |
$864.68 |
| Rate for Payer: Aetna American Axle |
$624.49
|
| Rate for Payer: Aetna Commercial |
$816.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$624.49
|
| Rate for Payer: Cash Price |
$768.61
|
| Rate for Payer: Cofinity Advantage |
$672.53
|
| Rate for Payer: Cofinity Commercial |
$826.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$768.61
|
| Rate for Payer: Healthscope Commercial |
$864.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$672.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$720.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$816.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$720.57
|
| Rate for Payer: PHP Commercial |
$816.65
|
| Rate for Payer: Priority Health SBD |
$605.28
|
| Rate for Payer: UMR Bronson Commercial |
$422.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$720.57
|
|
|
HC RO TRTMNT LEVEL 3
|
Facility
|
OP
|
$1,376.40
|
|
|
Service Code
|
CPT 77412
|
| Hospital Charge Code |
33300080
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$287.94 |
| Max. Negotiated Rate |
$1,780.43 |
| Rate for Payer: Aetna American Axle |
$894.66
|
| Rate for Payer: Aetna Commercial |
$1,169.94
|
| Rate for Payer: Aetna Medicare |
$572.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$894.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$688.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$688.20
|
| Rate for Payer: BCBS Complete |
$302.37
|
| Rate for Payer: BCBS MAPPO |
$550.56
|
| Rate for Payer: BCBS Trust/PPO |
$313.19
|
| Rate for Payer: BCN Commercial |
$313.19
|
| Rate for Payer: BCN Medicare Advantage |
$550.56
|
| Rate for Payer: Cash Price |
$1,101.12
|
| Rate for Payer: Cash Price |
$1,101.12
|
| Rate for Payer: Cofinity Advantage |
$963.48
|
| Rate for Payer: Cofinity Commercial |
$1,183.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,101.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$550.56
|
| Rate for Payer: Healthscope Commercial |
$1,238.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$963.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,032.30
|
| Rate for Payer: Mclaren Medicaid |
$550.56
|
| Rate for Payer: Mclaren Medicare |
$550.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$578.09
|
| Rate for Payer: Meridian Medicaid |
$578.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$633.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$605.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,169.94
|
| Rate for Payer: Nomi Health Commercial |
$1,651.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,032.30
|
| Rate for Payer: PACE Medicare |
$523.03
|
| Rate for Payer: PACE SWMI |
$550.56
|
| Rate for Payer: PHP Commercial |
$1,169.94
|
| Rate for Payer: PHP Medicare Advantage |
$550.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$287.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,780.43
|
| Rate for Payer: Priority Health Medicare |
$550.56
|
| Rate for Payer: Priority Health SBD |
$867.13
|
| Rate for Payer: Priority Health Tiered Network |
$1,424.34
|
| Rate for Payer: Railroad Medicare Medicare |
$550.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$894.66
|
| Rate for Payer: UHC Core |
$717.10
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$550.56
|
| Rate for Payer: UHC Exchange |
$540.93
|
| Rate for Payer: UHC Medicaid |
$287.94
|
| Rate for Payer: UHCCP Medicaid |
$287.94
|
| Rate for Payer: UMR Bronson Commercial |
$509.27
|
| Rate for Payer: VA VA |
$550.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,032.30
|
|
|
HC RO TRTMNT LEVEL 3
|
Facility
|
IP
|
$1,376.40
|
|
|
Service Code
|
CPT 77412
|
| Hospital Charge Code |
33300080
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$605.62 |
| Max. Negotiated Rate |
$1,238.76 |
| Rate for Payer: Aetna American Axle |
$894.66
|
| Rate for Payer: Aetna Commercial |
$1,169.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$894.66
|
| Rate for Payer: Cash Price |
$1,101.12
|
| Rate for Payer: Cofinity Advantage |
$963.48
|
| Rate for Payer: Cofinity Commercial |
$1,183.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,101.12
|
| Rate for Payer: Healthscope Commercial |
$1,238.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$963.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,032.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,169.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,032.30
|
| Rate for Payer: PHP Commercial |
$1,169.94
|
| Rate for Payer: Priority Health SBD |
$867.13
|
| Rate for Payer: UMR Bronson Commercial |
$605.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,032.30
|
|
|
HC ROUGH MARSH ELDER IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200058
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna American Axle |
$16.84
|
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| 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 |
$2.87
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$6.04
|
| Rate for Payer: BCN Commercial |
$6.04
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Advantage |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.43
|
| Rate for Payer: Mclaren Medicaid |
$5.22
|
| 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 |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$7.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.22
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$16.32
|
| Rate for Payer: Priority Health Tiered Network |
$4.18
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.83
|
| Rate for Payer: UHC Core |
$7.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.22
|
| Rate for Payer: UHC Exchange |
$7.83
|
| Rate for Payer: UHC Medicaid |
$2.73
|
| Rate for Payer: UHCCP Medicaid |
$2.73
|
| Rate for Payer: UMR Bronson Commercial |
$9.58
|
| Rate for Payer: VA VA |
$5.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.43
|
|
|
HC ROUGH MARSH ELDER IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200058
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.40 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna American Axle |
$16.84
|
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Advantage |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: Priority Health SBD |
$16.32
|
| Rate for Payer: UMR Bronson Commercial |
$11.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.43
|
|
|
HC RPR BLOOD VSL GRF OTH/THN VEIN UPPER EXTREMITY
|
Facility
|
IP
|
$15,687.60
|
|
|
Service Code
|
CPT 35266
|
| Hospital Charge Code |
36000124
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,902.54 |
| Max. Negotiated Rate |
$14,118.84 |
| Rate for Payer: Aetna American Axle |
$10,196.94
|
| Rate for Payer: Aetna Commercial |
$13,334.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,196.94
|
| Rate for Payer: Cash Price |
$12,550.08
|
| Rate for Payer: Cofinity Advantage |
$10,981.32
|
| Rate for Payer: Cofinity Commercial |
$13,491.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,550.08
|
| Rate for Payer: Healthscope Commercial |
$14,118.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10,981.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11,765.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,334.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11,765.70
|
| Rate for Payer: PHP Commercial |
$13,334.46
|
| Rate for Payer: Priority Health SBD |
$9,883.19
|
| Rate for Payer: UMR Bronson Commercial |
$6,902.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11,765.70
|
|
|
HC RPR BLOOD VSL GRF OTH/THN VEIN UPPER EXTREMITY
|
Facility
|
OP
|
$15,687.60
|
|
|
Service Code
|
CPT 35266
|
| Hospital Charge Code |
36000124
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,899.76 |
| Max. Negotiated Rate |
$17,930.33 |
| Rate for Payer: Aetna American Axle |
$10,196.94
|
| Rate for Payer: Aetna Commercial |
$13,334.46
|
| Rate for Payer: Aetna Medicare |
$5,766.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,196.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,930.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,930.60
|
| Rate for Payer: BCBS Complete |
$3,045.03
|
| Rate for Payer: BCBS MAPPO |
$5,544.48
|
| Rate for Payer: BCBS Trust/PPO |
$4,427.94
|
| Rate for Payer: BCN Commercial |
$4,427.94
|
| Rate for Payer: BCN Medicare Advantage |
$5,544.48
|
| Rate for Payer: Cash Price |
$12,550.08
|
| Rate for Payer: Cash Price |
$12,550.08
|
| Rate for Payer: Cash Price |
$12,550.08
|
| Rate for Payer: Cofinity Advantage |
$10,981.32
|
| Rate for Payer: Cofinity Commercial |
$13,491.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,550.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,544.48
|
| Rate for Payer: Healthscope Commercial |
$14,118.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10,981.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11,765.70
|
| Rate for Payer: Mclaren Medicaid |
$5,544.48
|
| Rate for Payer: Mclaren Medicare |
$5,544.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,821.70
|
| Rate for Payer: Meridian Medicaid |
$5,821.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,376.15
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,098.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,334.46
|
| Rate for Payer: Nomi Health Commercial |
$16,633.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11,765.70
|
| Rate for Payer: PACE Medicare |
$5,267.26
|
| Rate for Payer: PACE SWMI |
$5,544.48
|
| Rate for Payer: PHP Commercial |
$13,334.46
|
| Rate for Payer: PHP Medicare Advantage |
$5,544.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,899.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$17,930.33
|
| Rate for Payer: Priority Health Medicare |
$5,544.48
|
| Rate for Payer: Priority Health SBD |
$9,883.19
|
| Rate for Payer: Priority Health Tiered Network |
$14,344.26
|
| Rate for Payer: Railroad Medicare Medicare |
$5,544.48
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,544.48
|
| Rate for Payer: UHC Medicaid |
$2,899.76
|
| Rate for Payer: UHCCP Medicaid |
$2,899.76
|
| Rate for Payer: UMR Bronson Commercial |
$5,804.41
|
| Rate for Payer: VA VA |
$5,544.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11,765.70
|
|
|
HC RPR (SYPHILIS SEROLOGY) SERUM
|
Facility
|
OP
|
$26.53
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
30200213
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.23 |
| Max. Negotiated Rate |
$23.88 |
| Rate for Payer: Aetna American Axle |
$17.24
|
| Rate for Payer: Aetna Commercial |
$22.55
|
| Rate for Payer: Aetna Medicare |
$4.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.34
|
| Rate for Payer: BCBS Complete |
$2.35
|
| Rate for Payer: BCBS MAPPO |
$4.27
|
| Rate for Payer: BCBS Trust/PPO |
$4.93
|
| Rate for Payer: BCN Commercial |
$4.93
|
| Rate for Payer: BCN Medicare Advantage |
$4.27
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cofinity Advantage |
$18.57
|
| Rate for Payer: Cofinity Commercial |
$22.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.27
|
| Rate for Payer: Healthscope Commercial |
$23.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.90
|
| Rate for Payer: Mclaren Medicaid |
$4.27
|
| Rate for Payer: Mclaren Medicare |
$4.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.48
|
| Rate for Payer: Meridian Medicaid |
$4.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.55
|
| Rate for Payer: Nomi Health Commercial |
$12.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.90
|
| Rate for Payer: PACE Medicare |
$4.06
|
| Rate for Payer: PACE SWMI |
$4.27
|
| Rate for Payer: PHP Commercial |
$22.55
|
| Rate for Payer: PHP Medicare Advantage |
$4.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4.27
|
| Rate for Payer: Priority Health Medicare |
$4.27
|
| Rate for Payer: Priority Health SBD |
$16.71
|
| Rate for Payer: Priority Health Tiered Network |
$3.42
|
| Rate for Payer: Railroad Medicare Medicare |
$4.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.41
|
| Rate for Payer: UHC Core |
$6.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4.27
|
| Rate for Payer: UHC Exchange |
$6.41
|
| Rate for Payer: UHC Medicaid |
$2.23
|
| Rate for Payer: UHCCP Medicaid |
$2.23
|
| Rate for Payer: UMR Bronson Commercial |
$9.82
|
| Rate for Payer: VA VA |
$4.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.90
|
|
|
HC RPR (SYPHILIS SEROLOGY) SERUM
|
Facility
|
IP
|
$26.53
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
30200213
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.67 |
| Max. Negotiated Rate |
$23.88 |
| Rate for Payer: Aetna American Axle |
$17.24
|
| Rate for Payer: Aetna Commercial |
$22.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.24
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cofinity Advantage |
$18.57
|
| Rate for Payer: Cofinity Commercial |
$22.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.22
|
| Rate for Payer: Healthscope Commercial |
$23.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.90
|
| Rate for Payer: PHP Commercial |
$22.55
|
| Rate for Payer: Priority Health SBD |
$16.71
|
| Rate for Payer: UMR Bronson Commercial |
$11.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.90
|
|
|
HC RPR TITER
|
Facility
|
OP
|
$26.53
|
|
|
Service Code
|
CPT 86593
|
| Hospital Charge Code |
30200425
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.30 |
| Max. Negotiated Rate |
$23.88 |
| Rate for Payer: Aetna American Axle |
$17.24
|
| Rate for Payer: Aetna Commercial |
$22.55
|
| Rate for Payer: Aetna Medicare |
$4.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.50
|
| Rate for Payer: BCBS Complete |
$2.42
|
| Rate for Payer: BCBS MAPPO |
$4.40
|
| Rate for Payer: BCBS Trust/PPO |
$5.09
|
| Rate for Payer: BCN Commercial |
$5.09
|
| Rate for Payer: BCN Medicare Advantage |
$4.40
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cofinity Advantage |
$18.57
|
| Rate for Payer: Cofinity Commercial |
$22.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.40
|
| Rate for Payer: Healthscope Commercial |
$23.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.90
|
| Rate for Payer: Mclaren Medicaid |
$4.40
|
| Rate for Payer: Mclaren Medicare |
$4.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.62
|
| Rate for Payer: Meridian Medicaid |
$4.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.55
|
| Rate for Payer: Nomi Health Commercial |
$13.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.90
|
| Rate for Payer: PACE Medicare |
$4.18
|
| Rate for Payer: PACE SWMI |
$4.40
|
| Rate for Payer: PHP Commercial |
$22.55
|
| Rate for Payer: PHP Medicare Advantage |
$4.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4.40
|
| Rate for Payer: Priority Health Medicare |
$4.40
|
| Rate for Payer: Priority Health SBD |
$16.71
|
| Rate for Payer: Priority Health Tiered Network |
$3.52
|
| Rate for Payer: Railroad Medicare Medicare |
$4.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.60
|
| Rate for Payer: UHC Core |
$6.60
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4.40
|
| Rate for Payer: UHC Exchange |
$6.60
|
| Rate for Payer: UHC Medicaid |
$2.30
|
| Rate for Payer: UHCCP Medicaid |
$2.30
|
| Rate for Payer: UMR Bronson Commercial |
$9.82
|
| Rate for Payer: VA VA |
$4.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.90
|
|
|
HC RPR TITER
|
Facility
|
IP
|
$26.53
|
|
|
Service Code
|
CPT 86593
|
| Hospital Charge Code |
30200425
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.67 |
| Max. Negotiated Rate |
$23.88 |
| Rate for Payer: Aetna American Axle |
$17.24
|
| Rate for Payer: Aetna Commercial |
$22.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.24
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cofinity Advantage |
$18.57
|
| Rate for Payer: Cofinity Commercial |
$22.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.22
|
| Rate for Payer: Healthscope Commercial |
$23.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.90
|
| Rate for Payer: PHP Commercial |
$22.55
|
| Rate for Payer: Priority Health SBD |
$16.71
|
| Rate for Payer: UMR Bronson Commercial |
$11.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.90
|
|
|
HC RSV DNA/RNA AMP PROBE
|
Facility
|
OP
|
$79.59
|
|
|
Service Code
|
CPT 87634
|
| Hospital Charge Code |
30600315
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$29.45 |
| Max. Negotiated Rate |
$105.30 |
| Rate for Payer: Aetna American Axle |
$51.73
|
| Rate for Payer: Aetna Commercial |
$67.65
|
| Rate for Payer: Aetna Medicare |
$73.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$87.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$87.75
|
| Rate for Payer: BCBS Complete |
$38.55
|
| Rate for Payer: BCBS MAPPO |
$70.20
|
| Rate for Payer: BCBS Trust/PPO |
$81.15
|
| Rate for Payer: BCN Commercial |
$81.15
|
| Rate for Payer: BCN Medicare Advantage |
$70.20
|
| Rate for Payer: Cash Price |
$63.67
|
| Rate for Payer: Cash Price |
$63.67
|
| Rate for Payer: Cofinity Advantage |
$55.71
|
| Rate for Payer: Cofinity Commercial |
$68.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.20
|
| Rate for Payer: Healthscope Commercial |
$71.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$55.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.69
|
| Rate for Payer: Mclaren Medicaid |
$70.20
|
| Rate for Payer: Mclaren Medicare |
$70.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$73.71
|
| Rate for Payer: Meridian Medicaid |
$73.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$77.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.65
|
| Rate for Payer: Nomi Health Commercial |
$105.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.69
|
| Rate for Payer: PACE Medicare |
$66.69
|
| Rate for Payer: PACE SWMI |
$70.20
|
| Rate for Payer: PHP Commercial |
$67.65
|
| Rate for Payer: PHP Medicare Advantage |
$70.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$36.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$70.20
|
| Rate for Payer: Priority Health Medicare |
$70.20
|
| Rate for Payer: Priority Health SBD |
$50.14
|
| Rate for Payer: Priority Health Tiered Network |
$56.16
|
| Rate for Payer: Railroad Medicare Medicare |
$70.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$105.30
|
| Rate for Payer: UHC Core |
$105.30
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$70.20
|
| Rate for Payer: UHC Exchange |
$105.30
|
| Rate for Payer: UHC Medicaid |
$36.71
|
| Rate for Payer: UHCCP Medicaid |
$36.71
|
| Rate for Payer: UMR Bronson Commercial |
$29.45
|
| Rate for Payer: VA VA |
$70.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.69
|
|
|
HC RSV DNA/RNA AMP PROBE
|
Facility
|
IP
|
$79.59
|
|
|
Service Code
|
CPT 87634
|
| Hospital Charge Code |
30600315
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.02 |
| Max. Negotiated Rate |
$71.63 |
| Rate for Payer: Aetna American Axle |
$51.73
|
| Rate for Payer: Aetna Commercial |
$67.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.73
|
| Rate for Payer: Cash Price |
$63.67
|
| Rate for Payer: Cofinity Advantage |
$55.71
|
| Rate for Payer: Cofinity Commercial |
$68.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.67
|
| Rate for Payer: Healthscope Commercial |
$71.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$55.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.69
|
| Rate for Payer: PHP Commercial |
$67.65
|
| Rate for Payer: Priority Health SBD |
$50.14
|
| Rate for Payer: UMR Bronson Commercial |
$35.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.69
|
|
|
HC RSV MONOCLONAL ANTB SEASONAL 0.5ML IM
|
Facility
|
OP
|
$1,328.59
|
|
|
Service Code
|
CPT 90380
|
| Hospital Charge Code |
63600232
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$491.58 |
| Max. Negotiated Rate |
$1,893.84 |
| Rate for Payer: Aetna American Axle |
$863.58
|
| Rate for Payer: Aetna Commercial |
$1,129.30
|
| Rate for Payer: Aetna Medicare |
$664.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$863.58
|
| Rate for Payer: BCBS Complete |
$531.44
|
| Rate for Payer: BCBS Trust/PPO |
$1,893.84
|
| Rate for Payer: BCN Commercial |
$1,893.84
|
| Rate for Payer: Cash Price |
$1,062.87
|
| Rate for Payer: Cash Price |
$1,062.87
|
| Rate for Payer: Cofinity Advantage |
$930.01
|
| Rate for Payer: Cofinity Commercial |
$1,142.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,062.87
|
| Rate for Payer: Healthscope Commercial |
$1,195.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$930.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$996.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,062.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,129.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$996.44
|
| Rate for Payer: PHP Commercial |
$1,129.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$633.99
|
| Rate for Payer: Priority Health SBD |
$837.01
|
| Rate for Payer: Priority Health Tiered Network |
$507.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,178.22
|
| Rate for Payer: UHC Core |
$1,178.22
|
| Rate for Payer: UHC Exchange |
$1,178.22
|
| Rate for Payer: UMR Bronson Commercial |
$491.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$996.44
|
|
|
HC RSV MONOCLONAL ANTB SEASONAL 0.5ML IM
|
Facility
|
IP
|
$1,328.59
|
|
|
Service Code
|
CPT 90380
|
| Hospital Charge Code |
63600232
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$584.58 |
| Max. Negotiated Rate |
$1,195.73 |
| Rate for Payer: Aetna American Axle |
$863.58
|
| Rate for Payer: Aetna Commercial |
$1,129.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$863.58
|
| Rate for Payer: Cash Price |
$1,062.87
|
| Rate for Payer: Cofinity Advantage |
$930.01
|
| Rate for Payer: Cofinity Commercial |
$1,142.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,062.87
|
| Rate for Payer: Healthscope Commercial |
$1,195.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$930.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$996.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,129.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$996.44
|
| Rate for Payer: PHP Commercial |
$1,129.30
|
| Rate for Payer: Priority Health SBD |
$837.01
|
| Rate for Payer: UMR Bronson Commercial |
$584.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$996.44
|
|
|
HC RSV MONOCLONAL ANTB SEASONAL 1 ML IM
|
Facility
|
IP
|
$1,328.59
|
|
|
Service Code
|
CPT 90381
|
| Hospital Charge Code |
63600233
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$584.58 |
| Max. Negotiated Rate |
$1,195.73 |
| Rate for Payer: Aetna American Axle |
$863.58
|
| Rate for Payer: Aetna Commercial |
$1,129.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$863.58
|
| Rate for Payer: Cash Price |
$1,062.87
|
| Rate for Payer: Cofinity Advantage |
$930.01
|
| Rate for Payer: Cofinity Commercial |
$1,142.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,062.87
|
| Rate for Payer: Healthscope Commercial |
$1,195.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$930.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$996.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,129.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$996.44
|
| Rate for Payer: PHP Commercial |
$1,129.30
|
| Rate for Payer: Priority Health SBD |
$837.01
|
| Rate for Payer: UMR Bronson Commercial |
$584.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$996.44
|
|
|
HC RSV MONOCLONAL ANTB SEASONAL 1 ML IM
|
Facility
|
OP
|
$1,328.59
|
|
|
Service Code
|
CPT 90381
|
| Hospital Charge Code |
63600233
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$491.58 |
| Max. Negotiated Rate |
$1,893.84 |
| Rate for Payer: Aetna American Axle |
$863.58
|
| Rate for Payer: Aetna Commercial |
$1,129.30
|
| Rate for Payer: Aetna Medicare |
$664.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$863.58
|
| Rate for Payer: BCBS Complete |
$531.44
|
| Rate for Payer: BCBS Trust/PPO |
$1,893.84
|
| Rate for Payer: BCN Commercial |
$1,893.84
|
| Rate for Payer: Cash Price |
$1,062.87
|
| Rate for Payer: Cash Price |
$1,062.87
|
| Rate for Payer: Cofinity Advantage |
$930.01
|
| Rate for Payer: Cofinity Commercial |
$1,142.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,062.87
|
| Rate for Payer: Healthscope Commercial |
$1,195.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$930.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$996.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,062.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,129.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$996.44
|
| Rate for Payer: PHP Commercial |
$1,129.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$633.99
|
| Rate for Payer: Priority Health SBD |
$837.01
|
| Rate for Payer: Priority Health Tiered Network |
$507.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,178.22
|
| Rate for Payer: UHC Core |
$1,178.22
|
| Rate for Payer: UHC Exchange |
$1,178.22
|
| Rate for Payer: UMR Bronson Commercial |
$491.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$996.44
|
|
|
HC RT ANGLE BALL COR CANN
|
Facility
|
IP
|
$72.10
|
|
| Hospital Charge Code |
27000268
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$31.72 |
| Max. Negotiated Rate |
$64.89 |
| Rate for Payer: Aetna American Axle |
$46.87
|
| Rate for Payer: Aetna Commercial |
$61.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.87
|
| Rate for Payer: Cash Price |
$57.68
|
| Rate for Payer: Cofinity Advantage |
$50.47
|
| Rate for Payer: Cofinity Commercial |
$62.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.68
|
| Rate for Payer: Healthscope Commercial |
$64.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.08
|
| Rate for Payer: PHP Commercial |
$61.28
|
| Rate for Payer: Priority Health SBD |
$45.42
|
| Rate for Payer: UMR Bronson Commercial |
$31.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.08
|
|
|
HC RT ANGLE BALL COR CANN
|
Facility
|
OP
|
$72.10
|
|
| Hospital Charge Code |
27000268
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$26.68 |
| Max. Negotiated Rate |
$64.89 |
| Rate for Payer: Aetna American Axle |
$46.87
|
| Rate for Payer: Aetna Commercial |
$61.28
|
| Rate for Payer: Aetna Medicare |
$36.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.87
|
| Rate for Payer: BCBS Complete |
$28.84
|
| Rate for Payer: Cash Price |
$57.68
|
| Rate for Payer: Cofinity Advantage |
$50.47
|
| Rate for Payer: Cofinity Commercial |
$62.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.68
|
| Rate for Payer: Healthscope Commercial |
$64.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.08
|
| Rate for Payer: PHP Commercial |
$61.28
|
| Rate for Payer: Priority Health SBD |
$45.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.87
|
| Rate for Payer: UHC Core |
$37.56
|
| Rate for Payer: UHC Exchange |
$28.34
|
| Rate for Payer: UMR Bronson Commercial |
$26.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.08
|
|
|
HC RUBELLA ANTIBODY IGC
|
Facility
|
IP
|
$42.45
|
|
|
Service Code
|
CPT 86762
|
| Hospital Charge Code |
30200315
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.68 |
| Max. Negotiated Rate |
$38.20 |
| Rate for Payer: Aetna American Axle |
$27.59
|
| Rate for Payer: Aetna Commercial |
$36.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.59
|
| Rate for Payer: Cash Price |
$33.96
|
| Rate for Payer: Cofinity Advantage |
$29.71
|
| Rate for Payer: Cofinity Commercial |
$36.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.96
|
| Rate for Payer: Healthscope Commercial |
$38.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.84
|
| Rate for Payer: PHP Commercial |
$36.08
|
| Rate for Payer: Priority Health SBD |
$26.74
|
| Rate for Payer: UMR Bronson Commercial |
$18.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.84
|
|
|
HC RUBELLA ANTIBODY IGC
|
Facility
|
OP
|
$42.45
|
|
|
Service Code
|
CPT 86762
|
| Hospital Charge Code |
30200315
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.53 |
| Max. Negotiated Rate |
$38.20 |
| Rate for Payer: Aetna American Axle |
$27.59
|
| Rate for Payer: Aetna Commercial |
$36.08
|
| Rate for Payer: Aetna Medicare |
$14.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.99
|
| Rate for Payer: BCBS Complete |
$7.90
|
| Rate for Payer: BCBS MAPPO |
$14.39
|
| Rate for Payer: BCBS Trust/PPO |
$16.63
|
| Rate for Payer: BCN Commercial |
$16.63
|
| Rate for Payer: BCN Medicare Advantage |
$14.39
|
| Rate for Payer: Cash Price |
$33.96
|
| Rate for Payer: Cash Price |
$33.96
|
| Rate for Payer: Cofinity Advantage |
$29.71
|
| Rate for Payer: Cofinity Commercial |
$36.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.39
|
| Rate for Payer: Healthscope Commercial |
$38.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.84
|
| Rate for Payer: Mclaren Medicaid |
$14.39
|
| Rate for Payer: Mclaren Medicare |
$14.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.11
|
| Rate for Payer: Meridian Medicaid |
$15.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$15.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.08
|
| Rate for Payer: Nomi Health Commercial |
$21.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.84
|
| Rate for Payer: PACE Medicare |
$13.67
|
| Rate for Payer: PACE SWMI |
$14.39
|
| Rate for Payer: PHP Commercial |
$36.08
|
| Rate for Payer: PHP Medicare Advantage |
$14.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$14.39
|
| Rate for Payer: Priority Health Medicare |
$14.39
|
| Rate for Payer: Priority Health SBD |
$26.74
|
| Rate for Payer: Priority Health Tiered Network |
$11.51
|
| Rate for Payer: Railroad Medicare Medicare |
$14.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.59
|
| Rate for Payer: UHC Core |
$21.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14.39
|
| Rate for Payer: UHC Exchange |
$21.59
|
| Rate for Payer: UHC Medicaid |
$7.53
|
| Rate for Payer: UHCCP Medicaid |
$7.53
|
| Rate for Payer: UMR Bronson Commercial |
$15.71
|
| Rate for Payer: VA VA |
$14.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.84
|
|
|
HC RUBELLA ANTIBODY IGM
|
Facility
|
IP
|
$42.45
|
|
|
Service Code
|
CPT 86762
|
| Hospital Charge Code |
30200423
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.68 |
| Max. Negotiated Rate |
$38.20 |
| Rate for Payer: Aetna American Axle |
$27.59
|
| Rate for Payer: Aetna Commercial |
$36.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.59
|
| Rate for Payer: Cash Price |
$33.96
|
| Rate for Payer: Cofinity Advantage |
$29.71
|
| Rate for Payer: Cofinity Commercial |
$36.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.96
|
| Rate for Payer: Healthscope Commercial |
$38.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.84
|
| Rate for Payer: PHP Commercial |
$36.08
|
| Rate for Payer: Priority Health SBD |
$26.74
|
| Rate for Payer: UMR Bronson Commercial |
$18.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.84
|
|
|
HC RUBELLA ANTIBODY IGM
|
Facility
|
OP
|
$42.45
|
|
|
Service Code
|
CPT 86762
|
| Hospital Charge Code |
30200423
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.53 |
| Max. Negotiated Rate |
$38.20 |
| Rate for Payer: Aetna American Axle |
$27.59
|
| Rate for Payer: Aetna Commercial |
$36.08
|
| Rate for Payer: Aetna Medicare |
$14.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.99
|
| Rate for Payer: BCBS Complete |
$7.90
|
| Rate for Payer: BCBS MAPPO |
$14.39
|
| Rate for Payer: BCBS Trust/PPO |
$16.63
|
| Rate for Payer: BCN Commercial |
$16.63
|
| Rate for Payer: BCN Medicare Advantage |
$14.39
|
| Rate for Payer: Cash Price |
$33.96
|
| Rate for Payer: Cash Price |
$33.96
|
| Rate for Payer: Cofinity Advantage |
$29.71
|
| Rate for Payer: Cofinity Commercial |
$36.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.39
|
| Rate for Payer: Healthscope Commercial |
$38.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.84
|
| Rate for Payer: Mclaren Medicaid |
$14.39
|
| Rate for Payer: Mclaren Medicare |
$14.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.11
|
| Rate for Payer: Meridian Medicaid |
$15.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$15.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.08
|
| Rate for Payer: Nomi Health Commercial |
$21.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.84
|
| Rate for Payer: PACE Medicare |
$13.67
|
| Rate for Payer: PACE SWMI |
$14.39
|
| Rate for Payer: PHP Commercial |
$36.08
|
| Rate for Payer: PHP Medicare Advantage |
$14.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$14.39
|
| Rate for Payer: Priority Health Medicare |
$14.39
|
| Rate for Payer: Priority Health SBD |
$26.74
|
| Rate for Payer: Priority Health Tiered Network |
$11.51
|
| Rate for Payer: Railroad Medicare Medicare |
$14.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.59
|
| Rate for Payer: UHC Core |
$21.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14.39
|
| Rate for Payer: UHC Exchange |
$21.59
|
| Rate for Payer: UHC Medicaid |
$7.53
|
| Rate for Payer: UHCCP Medicaid |
$7.53
|
| Rate for Payer: UMR Bronson Commercial |
$15.71
|
| Rate for Payer: VA VA |
$14.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.84
|
|
