|
HC PROTEIN ELECTROPHORESIS URINE
|
Facility
|
OP
|
$105.67
|
|
|
Service Code
|
CPT 84166
|
| Hospital Charge Code |
30100411
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.56 |
| Max. Negotiated Rate |
$95.10 |
| Rate for Payer: Aetna American Axle |
$68.69
|
| Rate for Payer: Aetna Commercial |
$89.82
|
| Rate for Payer: Aetna Medicare |
$18.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.29
|
| Rate for Payer: BCBS Complete |
$10.03
|
| Rate for Payer: BCBS MAPPO |
$17.83
|
| Rate for Payer: BCBS Trust/PPO |
$12.87
|
| Rate for Payer: BCN Commercial |
$12.87
|
| Rate for Payer: BCN Medicare Advantage |
$17.83
|
| Rate for Payer: Cash Price |
$84.54
|
| Rate for Payer: Cash Price |
$84.54
|
| Rate for Payer: Cofinity Commercial |
$90.88
|
| Rate for Payer: Cofinity Commercial |
$73.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$73.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.83
|
| Rate for Payer: Healthscope Commercial |
$95.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$73.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.25
|
| Rate for Payer: Mclaren Medicaid |
$9.56
|
| Rate for Payer: Mclaren Medicare |
$17.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.72
|
| Rate for Payer: Meridian Medicaid |
$10.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.82
|
| Rate for Payer: Nomi Health Commercial |
$26.74
|
| Rate for Payer: PACE Medicare |
$16.94
|
| Rate for Payer: PACE SWMI |
$17.83
|
| Rate for Payer: PHP Commercial |
$89.82
|
| Rate for Payer: PHP Medicare Advantage |
$17.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.83
|
| Rate for Payer: Priority Health Medicare |
$17.83
|
| Rate for Payer: Priority Health Narrow Network |
$14.26
|
| Rate for Payer: Priority Health SBD |
$66.57
|
| Rate for Payer: Railroad Medicare Medicare |
$17.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.83
|
| Rate for Payer: UHC Exchange |
$17.83
|
| Rate for Payer: UHC Medicare Advantage |
$17.83
|
| Rate for Payer: UHCCP Medicaid |
$9.56
|
| Rate for Payer: UMR Bronson Commercial |
$39.10
|
| Rate for Payer: VA VA |
$17.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.25
|
|
|
HC PROTEIN S ACTIVITY
|
Facility
|
OP
|
$62.22
|
|
|
Service Code
|
CPT 85306
|
| Hospital Charge Code |
30500039
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$8.21 |
| Max. Negotiated Rate |
$56.00 |
| Rate for Payer: Aetna American Axle |
$40.44
|
| Rate for Payer: Aetna Commercial |
$52.89
|
| Rate for Payer: Aetna Medicare |
$15.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.15
|
| Rate for Payer: BCBS Complete |
$8.62
|
| Rate for Payer: BCBS MAPPO |
$15.32
|
| Rate for Payer: BCBS Trust/PPO |
$14.76
|
| Rate for Payer: BCN Commercial |
$14.76
|
| Rate for Payer: BCN Medicare Advantage |
$15.32
|
| Rate for Payer: Cash Price |
$49.78
|
| Rate for Payer: Cash Price |
$49.78
|
| Rate for Payer: Cofinity Commercial |
$53.51
|
| Rate for Payer: Cofinity Commercial |
$43.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.32
|
| Rate for Payer: Healthscope Commercial |
$56.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.66
|
| Rate for Payer: Mclaren Medicaid |
$8.21
|
| Rate for Payer: Mclaren Medicare |
$15.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.09
|
| Rate for Payer: Meridian Medicaid |
$8.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.89
|
| Rate for Payer: Nomi Health Commercial |
$22.98
|
| Rate for Payer: PACE Medicare |
$14.55
|
| Rate for Payer: PACE SWMI |
$15.32
|
| Rate for Payer: PHP Commercial |
$52.89
|
| Rate for Payer: PHP Medicare Advantage |
$15.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.77
|
| Rate for Payer: Priority Health Medicare |
$15.32
|
| Rate for Payer: Priority Health Narrow Network |
$12.62
|
| Rate for Payer: Priority Health SBD |
$39.20
|
| Rate for Payer: Railroad Medicare Medicare |
$15.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.32
|
| Rate for Payer: UHC Exchange |
$15.32
|
| Rate for Payer: UHC Medicare Advantage |
$15.32
|
| Rate for Payer: UHCCP Medicaid |
$8.21
|
| Rate for Payer: UMR Bronson Commercial |
$23.02
|
| Rate for Payer: VA VA |
$15.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.66
|
|
|
HC PROTEIN S ACTIVITY
|
Facility
|
IP
|
$62.22
|
|
|
Service Code
|
CPT 85306
|
| Hospital Charge Code |
30500039
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$27.38 |
| Max. Negotiated Rate |
$56.00 |
| Rate for Payer: Aetna American Axle |
$40.44
|
| Rate for Payer: Aetna Commercial |
$52.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.44
|
| Rate for Payer: Cash Price |
$49.78
|
| Rate for Payer: Cofinity Commercial |
$43.55
|
| Rate for Payer: Cofinity Commercial |
$53.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.78
|
| Rate for Payer: Healthscope Commercial |
$56.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.89
|
| Rate for Payer: PHP Commercial |
$52.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.44
|
| Rate for Payer: Priority Health SBD |
$39.20
|
| Rate for Payer: UMR Bronson Commercial |
$27.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.66
|
|
|
HC PROTEIN S ANTIGEN FREE
|
Facility
|
IP
|
$86.70
|
|
|
Service Code
|
CPT 85306
|
| Hospital Charge Code |
30500074
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$38.15 |
| Max. Negotiated Rate |
$78.03 |
| Rate for Payer: Aetna American Axle |
$56.36
|
| Rate for Payer: Aetna Commercial |
$73.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.36
|
| Rate for Payer: Cash Price |
$69.36
|
| Rate for Payer: Cofinity Commercial |
$60.69
|
| Rate for Payer: Cofinity Commercial |
$74.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$60.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.36
|
| Rate for Payer: Healthscope Commercial |
$78.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$60.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.70
|
| Rate for Payer: PHP Commercial |
$73.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.36
|
| Rate for Payer: Priority Health SBD |
$54.62
|
| Rate for Payer: UMR Bronson Commercial |
$38.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.02
|
|
|
HC PROTEIN S ANTIGEN FREE
|
Facility
|
OP
|
$86.70
|
|
|
Service Code
|
CPT 85306
|
| Hospital Charge Code |
30500074
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$8.21 |
| Max. Negotiated Rate |
$78.03 |
| Rate for Payer: Aetna American Axle |
$56.36
|
| Rate for Payer: Aetna Commercial |
$73.70
|
| Rate for Payer: Aetna Medicare |
$15.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.15
|
| Rate for Payer: BCBS Complete |
$8.62
|
| Rate for Payer: BCBS MAPPO |
$15.32
|
| Rate for Payer: BCBS Trust/PPO |
$14.76
|
| Rate for Payer: BCN Commercial |
$14.76
|
| Rate for Payer: BCN Medicare Advantage |
$15.32
|
| Rate for Payer: Cash Price |
$69.36
|
| Rate for Payer: Cash Price |
$69.36
|
| Rate for Payer: Cofinity Commercial |
$74.56
|
| Rate for Payer: Cofinity Commercial |
$60.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$60.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.32
|
| Rate for Payer: Healthscope Commercial |
$78.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$60.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.02
|
| Rate for Payer: Mclaren Medicaid |
$8.21
|
| Rate for Payer: Mclaren Medicare |
$15.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.09
|
| Rate for Payer: Meridian Medicaid |
$8.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.70
|
| Rate for Payer: Nomi Health Commercial |
$22.98
|
| Rate for Payer: PACE Medicare |
$14.55
|
| Rate for Payer: PACE SWMI |
$15.32
|
| Rate for Payer: PHP Commercial |
$73.70
|
| Rate for Payer: PHP Medicare Advantage |
$15.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.77
|
| Rate for Payer: Priority Health Medicare |
$15.32
|
| Rate for Payer: Priority Health Narrow Network |
$12.62
|
| Rate for Payer: Priority Health SBD |
$54.62
|
| Rate for Payer: Railroad Medicare Medicare |
$15.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.32
|
| Rate for Payer: UHC Exchange |
$15.32
|
| Rate for Payer: UHC Medicare Advantage |
$15.32
|
| Rate for Payer: UHCCP Medicaid |
$8.21
|
| Rate for Payer: UMR Bronson Commercial |
$32.08
|
| Rate for Payer: VA VA |
$15.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.02
|
|
|
HC PROTHROMBIN TIME
|
Facility
|
OP
|
$48.96
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
30500073
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.30 |
| Max. Negotiated Rate |
$44.06 |
| Rate for Payer: Aetna American Axle |
$31.82
|
| Rate for Payer: Aetna Commercial |
$41.62
|
| Rate for Payer: Aetna Medicare |
$4.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.36
|
| Rate for Payer: BCBS Complete |
$2.41
|
| Rate for Payer: BCBS MAPPO |
$4.29
|
| Rate for Payer: BCBS Trust/PPO |
$4.14
|
| Rate for Payer: BCN Commercial |
$4.14
|
| Rate for Payer: BCN Medicare Advantage |
$4.29
|
| Rate for Payer: Cash Price |
$39.17
|
| Rate for Payer: Cash Price |
$39.17
|
| Rate for Payer: Cofinity Commercial |
$42.11
|
| Rate for Payer: Cofinity Commercial |
$34.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$34.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.29
|
| Rate for Payer: Healthscope Commercial |
$44.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.72
|
| Rate for Payer: Mclaren Medicaid |
$2.30
|
| Rate for Payer: Mclaren Medicare |
$4.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.50
|
| Rate for Payer: Meridian Medicaid |
$2.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.62
|
| Rate for Payer: Nomi Health Commercial |
$6.44
|
| Rate for Payer: PACE Medicare |
$4.08
|
| Rate for Payer: PACE SWMI |
$4.29
|
| Rate for Payer: PHP Commercial |
$41.62
|
| Rate for Payer: PHP Medicare Advantage |
$4.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.29
|
| Rate for Payer: Priority Health Medicare |
$4.29
|
| Rate for Payer: Priority Health Narrow Network |
$3.43
|
| Rate for Payer: Priority Health SBD |
$30.84
|
| Rate for Payer: Railroad Medicare Medicare |
$4.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.29
|
| Rate for Payer: UHC Exchange |
$4.29
|
| Rate for Payer: UHC Medicare Advantage |
$4.29
|
| Rate for Payer: UHCCP Medicaid |
$2.30
|
| Rate for Payer: UMR Bronson Commercial |
$18.12
|
| Rate for Payer: VA VA |
$4.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.72
|
|
|
HC PROTHROMBIN TIME
|
Facility
|
IP
|
$48.96
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
30500073
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$21.54 |
| Max. Negotiated Rate |
$44.06 |
| Rate for Payer: Aetna American Axle |
$31.82
|
| Rate for Payer: Aetna Commercial |
$41.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.82
|
| Rate for Payer: Cash Price |
$39.17
|
| Rate for Payer: Cofinity Commercial |
$34.27
|
| Rate for Payer: Cofinity Commercial |
$42.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$34.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.17
|
| Rate for Payer: Healthscope Commercial |
$44.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.62
|
| Rate for Payer: PHP Commercial |
$41.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.82
|
| Rate for Payer: Priority Health SBD |
$30.84
|
| Rate for Payer: UMR Bronson Commercial |
$21.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.72
|
|
|
HC PROTIME WITH INR
|
Facility
|
IP
|
$29.13
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
30500058
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$12.82 |
| Max. Negotiated Rate |
$26.22 |
| Rate for Payer: Aetna American Axle |
$18.93
|
| Rate for Payer: Aetna Commercial |
$24.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.93
|
| Rate for Payer: Cash Price |
$23.30
|
| Rate for Payer: Cofinity Commercial |
$20.39
|
| Rate for Payer: Cofinity Commercial |
$25.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.30
|
| Rate for Payer: Healthscope Commercial |
$26.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.76
|
| Rate for Payer: PHP Commercial |
$24.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.93
|
| Rate for Payer: Priority Health SBD |
$18.35
|
| Rate for Payer: UMR Bronson Commercial |
$12.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.85
|
|
|
HC PROTIME WITH INR
|
Facility
|
OP
|
$29.13
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
30500058
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.30 |
| Max. Negotiated Rate |
$26.22 |
| Rate for Payer: Aetna American Axle |
$18.93
|
| Rate for Payer: Aetna Commercial |
$24.76
|
| Rate for Payer: Aetna Medicare |
$4.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.36
|
| Rate for Payer: BCBS Complete |
$2.41
|
| Rate for Payer: BCBS MAPPO |
$4.29
|
| Rate for Payer: BCBS Trust/PPO |
$4.14
|
| Rate for Payer: BCN Commercial |
$4.14
|
| Rate for Payer: BCN Medicare Advantage |
$4.29
|
| Rate for Payer: Cash Price |
$23.30
|
| Rate for Payer: Cash Price |
$23.30
|
| Rate for Payer: Cofinity Commercial |
$25.05
|
| Rate for Payer: Cofinity Commercial |
$20.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.29
|
| Rate for Payer: Healthscope Commercial |
$26.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.85
|
| Rate for Payer: Mclaren Medicaid |
$2.30
|
| Rate for Payer: Mclaren Medicare |
$4.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.50
|
| Rate for Payer: Meridian Medicaid |
$2.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.76
|
| Rate for Payer: Nomi Health Commercial |
$6.44
|
| Rate for Payer: PACE Medicare |
$4.08
|
| Rate for Payer: PACE SWMI |
$4.29
|
| Rate for Payer: PHP Commercial |
$24.76
|
| Rate for Payer: PHP Medicare Advantage |
$4.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.29
|
| Rate for Payer: Priority Health Medicare |
$4.29
|
| Rate for Payer: Priority Health Narrow Network |
$3.43
|
| Rate for Payer: Priority Health SBD |
$18.35
|
| Rate for Payer: Railroad Medicare Medicare |
$4.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.29
|
| Rate for Payer: UHC Exchange |
$4.29
|
| Rate for Payer: UHC Medicare Advantage |
$4.29
|
| Rate for Payer: UHCCP Medicaid |
$2.30
|
| Rate for Payer: UMR Bronson Commercial |
$10.78
|
| Rate for Payer: VA VA |
$4.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.85
|
|
|
HC PROTOPORPHYRIN FREE WB
|
Facility
|
OP
|
$84.66
|
|
|
Service Code
|
CPT 81005
|
| Hospital Charge Code |
30100619
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.16 |
| Max. Negotiated Rate |
$76.19 |
| Rate for Payer: Aetna American Axle |
$55.03
|
| Rate for Payer: Aetna Commercial |
$71.96
|
| Rate for Payer: Aetna Medicare |
$2.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.71
|
| Rate for Payer: BCBS Complete |
$1.22
|
| Rate for Payer: BCBS MAPPO |
$2.17
|
| Rate for Payer: BCBS Trust/PPO |
$2.09
|
| Rate for Payer: BCN Commercial |
$2.09
|
| Rate for Payer: BCN Medicare Advantage |
$2.17
|
| Rate for Payer: Cash Price |
$67.73
|
| Rate for Payer: Cash Price |
$67.73
|
| Rate for Payer: Cofinity Commercial |
$72.81
|
| Rate for Payer: Cofinity Commercial |
$59.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$59.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.17
|
| Rate for Payer: Healthscope Commercial |
$76.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$59.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.50
|
| Rate for Payer: Mclaren Medicaid |
$1.16
|
| Rate for Payer: Mclaren Medicare |
$2.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.28
|
| Rate for Payer: Meridian Medicaid |
$1.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.96
|
| Rate for Payer: Nomi Health Commercial |
$3.26
|
| Rate for Payer: PACE Medicare |
$2.06
|
| Rate for Payer: PACE SWMI |
$2.17
|
| Rate for Payer: PHP Commercial |
$71.96
|
| Rate for Payer: PHP Medicare Advantage |
$2.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.23
|
| Rate for Payer: Priority Health Medicare |
$2.17
|
| Rate for Payer: Priority Health Narrow Network |
$1.78
|
| Rate for Payer: Priority Health SBD |
$53.34
|
| Rate for Payer: Railroad Medicare Medicare |
$2.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.60
|
| Rate for Payer: UHC Core |
$25.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.17
|
| Rate for Payer: UHC Exchange |
$2.17
|
| Rate for Payer: UHC Medicare Advantage |
$2.17
|
| Rate for Payer: UHCCP Medicaid |
$1.16
|
| Rate for Payer: UMR Bronson Commercial |
$31.32
|
| Rate for Payer: VA VA |
$2.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.50
|
|
|
HC PROTOPORPHYRIN FREE WB
|
Facility
|
IP
|
$84.66
|
|
|
Service Code
|
CPT 81005
|
| Hospital Charge Code |
30100619
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.25 |
| Max. Negotiated Rate |
$76.19 |
| Rate for Payer: Aetna American Axle |
$55.03
|
| Rate for Payer: Aetna Commercial |
$71.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.03
|
| Rate for Payer: Cash Price |
$67.73
|
| Rate for Payer: Cofinity Commercial |
$59.26
|
| Rate for Payer: Cofinity Commercial |
$72.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$59.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.73
|
| Rate for Payer: Healthscope Commercial |
$76.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$59.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.96
|
| Rate for Payer: PHP Commercial |
$71.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.03
|
| Rate for Payer: Priority Health SBD |
$53.34
|
| Rate for Payer: UMR Bronson Commercial |
$37.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.50
|
|
|
HC PROTOPORPHYRINS, FRACTIONATION, WB
|
Facility
|
OP
|
$86.35
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
30100692
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.91 |
| Max. Negotiated Rate |
$77.72 |
| Rate for Payer: Aetna American Axle |
$56.13
|
| Rate for Payer: Aetna Commercial |
$73.40
|
| Rate for Payer: Aetna Medicare |
$25.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.11
|
| Rate for Payer: BCBS Complete |
$13.56
|
| Rate for Payer: BCBS MAPPO |
$24.09
|
| Rate for Payer: BCBS Trust/PPO |
$23.21
|
| Rate for Payer: BCN Commercial |
$23.21
|
| Rate for Payer: BCN Medicare Advantage |
$24.09
|
| Rate for Payer: Cash Price |
$69.08
|
| Rate for Payer: Cash Price |
$69.08
|
| Rate for Payer: Cofinity Commercial |
$74.26
|
| Rate for Payer: Cofinity Commercial |
$60.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$60.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.09
|
| Rate for Payer: Healthscope Commercial |
$77.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$60.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.76
|
| Rate for Payer: Mclaren Medicaid |
$12.91
|
| Rate for Payer: Mclaren Medicare |
$24.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.29
|
| Rate for Payer: Meridian Medicaid |
$13.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.40
|
| Rate for Payer: Nomi Health Commercial |
$36.14
|
| Rate for Payer: PACE Medicare |
$22.89
|
| Rate for Payer: PACE SWMI |
$24.09
|
| Rate for Payer: PHP Commercial |
$73.40
|
| Rate for Payer: PHP Medicare Advantage |
$24.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24.09
|
| Rate for Payer: Priority Health Medicare |
$24.09
|
| Rate for Payer: Priority Health Narrow Network |
$19.27
|
| Rate for Payer: Priority Health SBD |
$54.40
|
| Rate for Payer: Railroad Medicare Medicare |
$24.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.91
|
| Rate for Payer: UHC Core |
$16.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.09
|
| Rate for Payer: UHC Exchange |
$24.09
|
| Rate for Payer: UHC Medicare Advantage |
$24.09
|
| Rate for Payer: UHCCP Medicaid |
$12.91
|
| Rate for Payer: UMR Bronson Commercial |
$31.95
|
| Rate for Payer: VA VA |
$24.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.76
|
|
|
HC PROTOPORPHYRINS, FRACTIONATION, WB
|
Facility
|
IP
|
$86.35
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
30100692
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.99 |
| Max. Negotiated Rate |
$77.72 |
| Rate for Payer: Aetna American Axle |
$56.13
|
| Rate for Payer: Aetna Commercial |
$73.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.13
|
| Rate for Payer: Cash Price |
$69.08
|
| Rate for Payer: Cofinity Commercial |
$60.44
|
| Rate for Payer: Cofinity Commercial |
$74.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$60.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.08
|
| Rate for Payer: Healthscope Commercial |
$77.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$60.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.40
|
| Rate for Payer: PHP Commercial |
$73.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.13
|
| Rate for Payer: Priority Health SBD |
$54.40
|
| Rate for Payer: UMR Bronson Commercial |
$37.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.76
|
|
|
HC PSA ANNUAL SCREEN
|
Facility
|
OP
|
$69.68
|
|
|
Service Code
|
HCPCS G0103
|
| Hospital Charge Code |
30000044
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.35 |
| Max. Negotiated Rate |
$62.71 |
| Rate for Payer: UHC Medicare Advantage |
$19.31
|
| Rate for Payer: UHCCP Medicaid |
$10.35
|
| Rate for Payer: UMR Bronson Commercial |
$25.78
|
| Rate for Payer: VA VA |
$19.31
|
| Rate for Payer: Aetna American Axle |
$45.29
|
| Rate for Payer: Aetna Commercial |
$59.23
|
| Rate for Payer: Aetna Medicare |
$20.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.14
|
| Rate for Payer: BCBS Complete |
$10.87
|
| Rate for Payer: BCBS MAPPO |
$19.31
|
| Rate for Payer: BCBS Trust/PPO |
$18.60
|
| Rate for Payer: BCN Commercial |
$18.60
|
| Rate for Payer: BCN Medicare Advantage |
$19.31
|
| Rate for Payer: Cash Price |
$55.74
|
| Rate for Payer: Cash Price |
$55.74
|
| Rate for Payer: Cofinity Commercial |
$59.92
|
| Rate for Payer: Cofinity Commercial |
$48.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$48.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.31
|
| Rate for Payer: Healthscope Commercial |
$62.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.26
|
| Rate for Payer: Mclaren Medicaid |
$10.35
|
| Rate for Payer: Mclaren Medicare |
$19.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.28
|
| Rate for Payer: Meridian Medicaid |
$10.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.23
|
| Rate for Payer: Nomi Health Commercial |
$57.93
|
| Rate for Payer: PACE Medicare |
$18.34
|
| Rate for Payer: PACE SWMI |
$19.31
|
| Rate for Payer: PHP Commercial |
$59.23
|
| Rate for Payer: PHP Medicare Advantage |
$19.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.31
|
| Rate for Payer: Priority Health Medicare |
$19.31
|
| Rate for Payer: Priority Health Narrow Network |
$15.45
|
| Rate for Payer: Priority Health SBD |
$43.90
|
| Rate for Payer: Railroad Medicare Medicare |
$19.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.31
|
| Rate for Payer: UHC Exchange |
$19.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.26
|
|
|
HC PSA ANNUAL SCREEN
|
Facility
|
IP
|
$69.68
|
|
|
Service Code
|
HCPCS G0103
|
| Hospital Charge Code |
30000044
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.66 |
| Max. Negotiated Rate |
$62.71 |
| Rate for Payer: Aetna American Axle |
$45.29
|
| Rate for Payer: Aetna Commercial |
$59.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.29
|
| Rate for Payer: Cash Price |
$55.74
|
| Rate for Payer: Cofinity Commercial |
$48.78
|
| Rate for Payer: Cofinity Commercial |
$59.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$48.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.74
|
| Rate for Payer: Healthscope Commercial |
$62.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.23
|
| Rate for Payer: PHP Commercial |
$59.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.29
|
| Rate for Payer: Priority Health SBD |
$43.90
|
| Rate for Payer: UMR Bronson Commercial |
$30.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.26
|
|
|
HC PSA FREE
|
Facility
|
IP
|
$69.68
|
|
|
Service Code
|
CPT 84154
|
| Hospital Charge Code |
30100405
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.66 |
| Max. Negotiated Rate |
$62.71 |
| Rate for Payer: Aetna American Axle |
$45.29
|
| Rate for Payer: Aetna Commercial |
$59.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.29
|
| Rate for Payer: Cash Price |
$55.74
|
| Rate for Payer: Cofinity Commercial |
$48.78
|
| Rate for Payer: Cofinity Commercial |
$59.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$48.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.74
|
| Rate for Payer: Healthscope Commercial |
$62.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.23
|
| Rate for Payer: PHP Commercial |
$59.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.29
|
| Rate for Payer: Priority Health SBD |
$43.90
|
| Rate for Payer: UMR Bronson Commercial |
$30.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.26
|
|
|
HC PSA FREE
|
Facility
|
OP
|
$69.68
|
|
|
Service Code
|
CPT 84154
|
| Hospital Charge Code |
30100405
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.86 |
| Max. Negotiated Rate |
$62.71 |
| Rate for Payer: Aetna American Axle |
$45.29
|
| Rate for Payer: Aetna Commercial |
$59.23
|
| Rate for Payer: Aetna Medicare |
$19.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.99
|
| Rate for Payer: BCBS Complete |
$10.35
|
| Rate for Payer: BCBS MAPPO |
$18.39
|
| Rate for Payer: BCBS Trust/PPO |
$17.71
|
| Rate for Payer: BCN Commercial |
$17.71
|
| Rate for Payer: BCN Medicare Advantage |
$18.39
|
| Rate for Payer: Cash Price |
$55.74
|
| Rate for Payer: Cash Price |
$55.74
|
| Rate for Payer: Cofinity Commercial |
$59.92
|
| Rate for Payer: Cofinity Commercial |
$48.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$48.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.39
|
| Rate for Payer: Healthscope Commercial |
$62.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.26
|
| Rate for Payer: Mclaren Medicaid |
$9.86
|
| Rate for Payer: Mclaren Medicare |
$18.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.31
|
| Rate for Payer: Meridian Medicaid |
$10.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.23
|
| Rate for Payer: Nomi Health Commercial |
$27.58
|
| Rate for Payer: PACE Medicare |
$17.47
|
| Rate for Payer: PACE SWMI |
$18.39
|
| Rate for Payer: PHP Commercial |
$59.23
|
| Rate for Payer: PHP Medicare Advantage |
$18.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.92
|
| Rate for Payer: Priority Health Medicare |
$18.39
|
| Rate for Payer: Priority Health Narrow Network |
$15.14
|
| Rate for Payer: Priority Health SBD |
$43.90
|
| Rate for Payer: Railroad Medicare Medicare |
$18.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.39
|
| Rate for Payer: UHC Exchange |
$18.39
|
| Rate for Payer: UHC Medicare Advantage |
$18.39
|
| Rate for Payer: UHCCP Medicaid |
$9.86
|
| Rate for Payer: UMR Bronson Commercial |
$25.78
|
| Rate for Payer: VA VA |
$18.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.26
|
|
|
HC PSA TOTAL
|
Facility
|
OP
|
$69.68
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
30100403
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.86 |
| Max. Negotiated Rate |
$62.71 |
| Rate for Payer: Aetna American Axle |
$45.29
|
| Rate for Payer: Aetna Commercial |
$59.23
|
| Rate for Payer: Aetna Medicare |
$19.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.99
|
| Rate for Payer: BCBS Complete |
$10.35
|
| Rate for Payer: BCBS MAPPO |
$18.39
|
| Rate for Payer: BCBS Trust/PPO |
$17.71
|
| Rate for Payer: BCN Commercial |
$17.71
|
| Rate for Payer: BCN Medicare Advantage |
$18.39
|
| Rate for Payer: Cash Price |
$55.74
|
| Rate for Payer: Cash Price |
$55.74
|
| Rate for Payer: Cofinity Commercial |
$59.92
|
| Rate for Payer: Cofinity Commercial |
$48.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$48.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.39
|
| Rate for Payer: Healthscope Commercial |
$62.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.26
|
| Rate for Payer: Mclaren Medicaid |
$9.86
|
| Rate for Payer: Mclaren Medicare |
$18.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.31
|
| Rate for Payer: Meridian Medicaid |
$10.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.23
|
| Rate for Payer: Nomi Health Commercial |
$27.58
|
| Rate for Payer: PACE Medicare |
$17.47
|
| Rate for Payer: PACE SWMI |
$18.39
|
| Rate for Payer: PHP Commercial |
$59.23
|
| Rate for Payer: PHP Medicare Advantage |
$18.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.92
|
| Rate for Payer: Priority Health Medicare |
$18.39
|
| Rate for Payer: Priority Health Narrow Network |
$15.14
|
| Rate for Payer: Priority Health SBD |
$43.90
|
| Rate for Payer: Railroad Medicare Medicare |
$18.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.39
|
| Rate for Payer: UHC Exchange |
$18.39
|
| Rate for Payer: UHC Medicare Advantage |
$18.39
|
| Rate for Payer: UHCCP Medicaid |
$9.86
|
| Rate for Payer: UMR Bronson Commercial |
$25.78
|
| Rate for Payer: VA VA |
$18.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.26
|
|
|
HC PSA TOTAL
|
Facility
|
IP
|
$69.68
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
30100403
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.66 |
| Max. Negotiated Rate |
$62.71 |
| Rate for Payer: Aetna American Axle |
$45.29
|
| Rate for Payer: Aetna Commercial |
$59.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.29
|
| Rate for Payer: Cash Price |
$55.74
|
| Rate for Payer: Cofinity Commercial |
$48.78
|
| Rate for Payer: Cofinity Commercial |
$59.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$48.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.74
|
| Rate for Payer: Healthscope Commercial |
$62.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.23
|
| Rate for Payer: PHP Commercial |
$59.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.29
|
| Rate for Payer: Priority Health SBD |
$43.90
|
| Rate for Payer: UMR Bronson Commercial |
$30.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.26
|
|
|
HC PSEUDOANEURYSM INJECTION
|
Facility
|
OP
|
$1,039.96
|
|
|
Service Code
|
CPT 36002
|
| Hospital Charge Code |
36100094
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$99.65 |
| Max. Negotiated Rate |
$1,903.90 |
| Rate for Payer: Aetna American Axle |
$675.97
|
| Rate for Payer: Aetna Commercial |
$883.97
|
| Rate for Payer: Aetna Medicare |
$629.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$675.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$757.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$757.20
|
| Rate for Payer: BCBS Complete |
$340.92
|
| Rate for Payer: BCBS MAPPO |
$605.76
|
| Rate for Payer: BCBS Trust/PPO |
$575.80
|
| Rate for Payer: BCN Commercial |
$575.80
|
| Rate for Payer: BCN Medicare Advantage |
$605.76
|
| Rate for Payer: Cash Price |
$831.97
|
| Rate for Payer: Cash Price |
$831.97
|
| Rate for Payer: Cash Price |
$831.97
|
| Rate for Payer: Cofinity Commercial |
$894.37
|
| Rate for Payer: Cofinity Commercial |
$727.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$727.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$831.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$605.76
|
| Rate for Payer: Healthscope Commercial |
$935.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$727.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$779.97
|
| Rate for Payer: Mclaren Medicaid |
$324.69
|
| Rate for Payer: Mclaren Medicare |
$605.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$636.05
|
| Rate for Payer: Meridian Medicaid |
$340.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$696.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$883.97
|
| Rate for Payer: Nomi Health Commercial |
$1,272.10
|
| Rate for Payer: PACE Medicare |
$575.47
|
| Rate for Payer: PACE SWMI |
$605.76
|
| Rate for Payer: PHP Commercial |
$883.97
|
| Rate for Payer: PHP Medicare Advantage |
$605.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$324.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$675.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,903.90
|
| Rate for Payer: Priority Health Medicare |
$605.76
|
| Rate for Payer: Priority Health Narrow Network |
$1,523.12
|
| Rate for Payer: Priority Health SBD |
$655.17
|
| Rate for Payer: Railroad Medicare Medicare |
$605.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$109.62
|
| Rate for Payer: UHC Core |
$981.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$605.76
|
| Rate for Payer: UHC Exchange |
$99.65
|
| Rate for Payer: UHC Medicare Advantage |
$605.76
|
| Rate for Payer: UHCCP Medicaid |
$324.69
|
| Rate for Payer: UMR Bronson Commercial |
$384.79
|
| Rate for Payer: VA VA |
$605.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$779.97
|
|
|
HC PSEUDOANEURYSM INJECTION
|
Facility
|
IP
|
$1,039.96
|
|
|
Service Code
|
CPT 36002
|
| Hospital Charge Code |
36100094
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$457.58 |
| Max. Negotiated Rate |
$935.96 |
| Rate for Payer: Aetna American Axle |
$675.97
|
| Rate for Payer: Aetna Commercial |
$883.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$675.97
|
| Rate for Payer: Cash Price |
$831.97
|
| Rate for Payer: Cofinity Commercial |
$727.97
|
| Rate for Payer: Cofinity Commercial |
$894.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$727.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$831.97
|
| Rate for Payer: Healthscope Commercial |
$935.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$727.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$779.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$883.97
|
| Rate for Payer: PHP Commercial |
$883.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$675.97
|
| Rate for Payer: Priority Health SBD |
$655.17
|
| Rate for Payer: UMR Bronson Commercial |
$457.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$779.97
|
|
|
HC PSEUDOCHOLINESTERASE
|
Facility
|
OP
|
$52.02
|
|
|
Service Code
|
CPT 82480
|
| Hospital Charge Code |
30100156
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.22 |
| Max. Negotiated Rate |
$46.82 |
| Rate for Payer: UHC Dual Complete DSNP |
$7.87
|
| Rate for Payer: UHC Exchange |
$7.87
|
| Rate for Payer: UHC Medicare Advantage |
$7.87
|
| Rate for Payer: UHCCP Medicaid |
$4.22
|
| Rate for Payer: UMR Bronson Commercial |
$19.25
|
| Rate for Payer: VA VA |
$7.87
|
| Rate for Payer: Aetna American Axle |
$33.81
|
| Rate for Payer: Aetna Commercial |
$44.22
|
| Rate for Payer: Aetna Medicare |
$8.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.84
|
| Rate for Payer: BCBS Complete |
$4.43
|
| Rate for Payer: BCBS MAPPO |
$7.87
|
| Rate for Payer: BCBS Trust/PPO |
$7.58
|
| Rate for Payer: BCN Commercial |
$7.58
|
| Rate for Payer: BCN Medicare Advantage |
$7.87
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$44.74
|
| Rate for Payer: Cofinity Commercial |
$36.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$36.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.87
|
| Rate for Payer: Healthscope Commercial |
$46.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$36.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.02
|
| Rate for Payer: Mclaren Medicaid |
$4.22
|
| Rate for Payer: Mclaren Medicare |
$7.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.26
|
| Rate for Payer: Meridian Medicaid |
$4.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: Nomi Health Commercial |
$11.80
|
| Rate for Payer: PACE Medicare |
$7.48
|
| Rate for Payer: PACE SWMI |
$7.87
|
| Rate for Payer: PHP Commercial |
$44.22
|
| Rate for Payer: PHP Medicare Advantage |
$7.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7.87
|
| Rate for Payer: Priority Health Medicare |
$7.87
|
| Rate for Payer: Priority Health Narrow Network |
$6.30
|
| Rate for Payer: Priority Health SBD |
$32.77
|
| Rate for Payer: Railroad Medicare Medicare |
$7.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.44
|
| Rate for Payer: UHC Core |
$23.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.02
|
|
|
HC PSEUDOCHOLINESTERASE
|
Facility
|
IP
|
$52.02
|
|
|
Service Code
|
CPT 82480
|
| Hospital Charge Code |
30100156
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.89 |
| Max. Negotiated Rate |
$46.82 |
| Rate for Payer: Aetna American Axle |
$33.81
|
| Rate for Payer: Aetna Commercial |
$44.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.81
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$36.41
|
| Rate for Payer: Cofinity Commercial |
$44.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$36.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Healthscope Commercial |
$46.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$36.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: PHP Commercial |
$44.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: Priority Health SBD |
$32.77
|
| Rate for Payer: UMR Bronson Commercial |
$22.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.02
|
|
|
HC PSG PEDS 5 AND UNDER
|
Facility
|
OP
|
$5,794.25
|
|
|
Service Code
|
CPT 95782
|
| Hospital Charge Code |
92000017
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$534.30 |
| Max. Negotiated Rate |
$5,214.82 |
| Rate for Payer: Aetna American Axle |
$3,766.26
|
| Rate for Payer: Aetna Commercial |
$4,925.11
|
| Rate for Payer: Aetna Medicare |
$1,036.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,766.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,246.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,246.02
|
| Rate for Payer: BCBS Complete |
$561.01
|
| Rate for Payer: BCBS MAPPO |
$996.82
|
| Rate for Payer: BCBS Trust/PPO |
$3,629.41
|
| Rate for Payer: BCN Commercial |
$3,629.41
|
| Rate for Payer: BCN Medicare Advantage |
$996.82
|
| Rate for Payer: Cash Price |
$4,635.40
|
| Rate for Payer: Cash Price |
$4,635.40
|
| Rate for Payer: Cash Price |
$4,635.40
|
| Rate for Payer: Cofinity Commercial |
$4,055.98
|
| Rate for Payer: Cofinity Commercial |
$4,983.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,055.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,635.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$996.82
|
| Rate for Payer: Healthscope Commercial |
$5,214.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,055.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,345.69
|
| Rate for Payer: Mclaren Medicaid |
$534.30
|
| Rate for Payer: Mclaren Medicare |
$996.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,046.66
|
| Rate for Payer: Meridian Medicaid |
$561.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,146.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,925.11
|
| Rate for Payer: Nomi Health Commercial |
$2,990.46
|
| Rate for Payer: PACE Medicare |
$946.98
|
| Rate for Payer: PACE SWMI |
$996.82
|
| Rate for Payer: PHP Commercial |
$4,925.11
|
| Rate for Payer: PHP Medicare Advantage |
$996.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$534.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,766.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,132.99
|
| Rate for Payer: Priority Health Medicare |
$996.82
|
| Rate for Payer: Priority Health Narrow Network |
$2,506.39
|
| Rate for Payer: Priority Health SBD |
$3,650.38
|
| Rate for Payer: Railroad Medicare Medicare |
$996.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$975.59
|
| Rate for Payer: UHC Core |
$4,571.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$996.82
|
| Rate for Payer: UHC Exchange |
$886.90
|
| Rate for Payer: UHC Medicare Advantage |
$996.82
|
| Rate for Payer: UHCCP Medicaid |
$534.30
|
| Rate for Payer: UMR Bronson Commercial |
$2,143.87
|
| Rate for Payer: VA VA |
$996.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,345.69
|
|
|
HC PSG PEDS 5 AND UNDER
|
Facility
|
IP
|
$5,794.25
|
|
|
Service Code
|
CPT 95782
|
| Hospital Charge Code |
92000017
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$2,549.47 |
| Max. Negotiated Rate |
$5,214.82 |
| Rate for Payer: Aetna American Axle |
$3,766.26
|
| Rate for Payer: Aetna Commercial |
$4,925.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,766.26
|
| Rate for Payer: Cash Price |
$4,635.40
|
| Rate for Payer: Cofinity Commercial |
$4,055.98
|
| Rate for Payer: Cofinity Commercial |
$4,983.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,055.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,635.40
|
| Rate for Payer: Healthscope Commercial |
$5,214.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,055.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,345.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,925.11
|
| Rate for Payer: PHP Commercial |
$4,925.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,766.26
|
| Rate for Payer: Priority Health SBD |
$3,650.38
|
| Rate for Payer: UMR Bronson Commercial |
$2,549.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,345.69
|
|
