|
HC TAVR CONVERTED TO ON-PUMP
|
Facility
|
OP
|
$6,525.68
|
|
| Hospital Charge Code |
27000703
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2,414.50 |
| Max. Negotiated Rate |
$5,873.11 |
| Rate for Payer: Aetna American Axle |
$4,241.69
|
| Rate for Payer: Aetna Commercial |
$5,546.83
|
| Rate for Payer: Aetna Medicare |
$3,262.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,241.69
|
| Rate for Payer: BCBS Complete |
$2,610.27
|
| Rate for Payer: Cash Price |
$5,220.54
|
| Rate for Payer: Cofinity Commercial |
$4,567.98
|
| Rate for Payer: Cofinity Commercial |
$5,612.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,567.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,220.54
|
| Rate for Payer: Healthscope Commercial |
$5,873.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,567.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,894.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,546.83
|
| Rate for Payer: PHP Commercial |
$5,546.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,241.69
|
| Rate for Payer: Priority Health SBD |
$4,111.18
|
| Rate for Payer: UMR Bronson Commercial |
$2,414.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,894.26
|
|
|
HC TAVR VALVE LVL 37
|
Facility
|
OP
|
$37,500.00
|
|
| Hospital Charge Code |
27800353
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13,875.00 |
| Max. Negotiated Rate |
$33,750.00 |
| Rate for Payer: Aetna American Axle |
$24,375.00
|
| Rate for Payer: Aetna Commercial |
$31,875.00
|
| Rate for Payer: Aetna Medicare |
$18,750.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24,375.00
|
| Rate for Payer: BCBS Complete |
$15,000.00
|
| Rate for Payer: Cash Price |
$30,000.00
|
| Rate for Payer: Cofinity Commercial |
$26,250.00
|
| Rate for Payer: Cofinity Commercial |
$32,250.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$26,250.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30,000.00
|
| Rate for Payer: Healthscope Commercial |
$33,750.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26,250.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28,125.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31,875.00
|
| Rate for Payer: PHP Commercial |
$31,875.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24,375.00
|
| Rate for Payer: Priority Health SBD |
$23,625.00
|
| Rate for Payer: UMR Bronson Commercial |
$13,875.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28,125.00
|
|
|
HC TAVR VALVE LVL 37
|
Facility
|
IP
|
$37,500.00
|
|
| Hospital Charge Code |
27800353
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$16,500.00 |
| Max. Negotiated Rate |
$33,750.00 |
| Rate for Payer: Aetna American Axle |
$24,375.00
|
| Rate for Payer: Aetna Commercial |
$31,875.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24,375.00
|
| Rate for Payer: Cash Price |
$30,000.00
|
| Rate for Payer: Cofinity Commercial |
$26,250.00
|
| Rate for Payer: Cofinity Commercial |
$32,250.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$26,250.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30,000.00
|
| Rate for Payer: Healthscope Commercial |
$33,750.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26,250.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28,125.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31,875.00
|
| Rate for Payer: PHP Commercial |
$31,875.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24,375.00
|
| Rate for Payer: Priority Health SBD |
$23,625.00
|
| Rate for Payer: UMR Bronson Commercial |
$16,500.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28,125.00
|
|
|
HC TAVR VALVE LVL 40
|
Facility
|
OP
|
$40,625.00
|
|
| Hospital Charge Code |
27800354
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15,031.25 |
| Max. Negotiated Rate |
$36,562.50 |
| Rate for Payer: Aetna American Axle |
$26,406.25
|
| Rate for Payer: Aetna Commercial |
$34,531.25
|
| Rate for Payer: Aetna Medicare |
$20,312.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26,406.25
|
| Rate for Payer: BCBS Complete |
$16,250.00
|
| Rate for Payer: Cash Price |
$32,500.00
|
| Rate for Payer: Cofinity Commercial |
$28,437.50
|
| Rate for Payer: Cofinity Commercial |
$34,937.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$28,437.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32,500.00
|
| Rate for Payer: Healthscope Commercial |
$36,562.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28,437.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30,468.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34,531.25
|
| Rate for Payer: PHP Commercial |
$34,531.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26,406.25
|
| Rate for Payer: Priority Health SBD |
$25,593.75
|
| Rate for Payer: UMR Bronson Commercial |
$15,031.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30,468.75
|
|
|
HC TAVR VALVE LVL 40
|
Facility
|
IP
|
$40,625.00
|
|
| Hospital Charge Code |
27800354
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$17,875.00 |
| Max. Negotiated Rate |
$36,562.50 |
| Rate for Payer: Aetna American Axle |
$26,406.25
|
| Rate for Payer: Aetna Commercial |
$34,531.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26,406.25
|
| Rate for Payer: Cash Price |
$32,500.00
|
| Rate for Payer: Cofinity Commercial |
$28,437.50
|
| Rate for Payer: Cofinity Commercial |
$34,937.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$28,437.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32,500.00
|
| Rate for Payer: Healthscope Commercial |
$36,562.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28,437.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30,468.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34,531.25
|
| Rate for Payer: PHP Commercial |
$34,531.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26,406.25
|
| Rate for Payer: Priority Health SBD |
$25,593.75
|
| Rate for Payer: UMR Bronson Commercial |
$17,875.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30,468.75
|
|
|
HC TBS DXA/OTHER IMG CALCULATION W/I&R FX RISK
|
Facility
|
OP
|
$42.84
|
|
|
Service Code
|
CPT 77089
|
| Hospital Charge Code |
32000343
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$15.85 |
| Max. Negotiated Rate |
$262.00 |
| Rate for Payer: Aetna American Axle |
$27.85
|
| Rate for Payer: Aetna Commercial |
$36.41
|
| Rate for Payer: Aetna Medicare |
$21.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.85
|
| Rate for Payer: BCBS Complete |
$17.14
|
| Rate for Payer: Cash Price |
$34.27
|
| Rate for Payer: Cash Price |
$34.27
|
| Rate for Payer: Cofinity Commercial |
$36.84
|
| Rate for Payer: Cofinity Commercial |
$29.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$29.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.27
|
| Rate for Payer: Healthscope Commercial |
$38.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.41
|
| Rate for Payer: PHP Commercial |
$36.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.85
|
| Rate for Payer: Priority Health SBD |
$26.99
|
| Rate for Payer: UHC Core |
$262.00
|
| Rate for Payer: UMR Bronson Commercial |
$15.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.13
|
|
|
HC TBS DXA/OTHER IMG CALCULATION W/I&R FX RISK
|
Facility
|
IP
|
$42.84
|
|
|
Service Code
|
CPT 77089
|
| Hospital Charge Code |
32000343
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$18.85 |
| Max. Negotiated Rate |
$38.56 |
| Rate for Payer: Aetna American Axle |
$27.85
|
| Rate for Payer: Aetna Commercial |
$36.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.85
|
| Rate for Payer: Cash Price |
$34.27
|
| Rate for Payer: Cofinity Commercial |
$29.99
|
| Rate for Payer: Cofinity Commercial |
$36.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$29.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.27
|
| Rate for Payer: Healthscope Commercial |
$38.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.41
|
| Rate for Payer: PHP Commercial |
$36.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.85
|
| Rate for Payer: Priority Health SBD |
$26.99
|
| Rate for Payer: UMR Bronson Commercial |
$18.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.13
|
|
|
HC TBS TECHNICAL CALCULATION ONLY
|
Facility
|
OP
|
$249.90
|
|
|
Service Code
|
CPT 77091
|
| Hospital Charge Code |
32000335
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$46.03 |
| Max. Negotiated Rate |
$262.00 |
| Rate for Payer: Aetna American Axle |
$162.44
|
| Rate for Payer: Aetna Commercial |
$212.41
|
| Rate for Payer: Aetna Medicare |
$89.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$107.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$107.34
|
| Rate for Payer: BCBS Complete |
$48.33
|
| Rate for Payer: BCBS MAPPO |
$85.87
|
| Rate for Payer: BCN Medicare Advantage |
$85.87
|
| Rate for Payer: Cash Price |
$199.92
|
| Rate for Payer: Cash Price |
$199.92
|
| Rate for Payer: Cofinity Commercial |
$214.91
|
| Rate for Payer: Cofinity Commercial |
$174.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$174.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.87
|
| Rate for Payer: Healthscope Commercial |
$224.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$174.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.43
|
| Rate for Payer: Mclaren Medicaid |
$46.03
|
| Rate for Payer: Mclaren Medicare |
$85.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.16
|
| Rate for Payer: Meridian Medicaid |
$48.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$98.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.41
|
| Rate for Payer: PACE Medicare |
$81.58
|
| Rate for Payer: PACE SWMI |
$85.87
|
| Rate for Payer: PHP Commercial |
$212.41
|
| Rate for Payer: PHP Medicare Advantage |
$85.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.44
|
| Rate for Payer: Priority Health Medicare |
$85.87
|
| Rate for Payer: Priority Health SBD |
$157.44
|
| Rate for Payer: Railroad Medicare Medicare |
$85.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$241.72
|
| Rate for Payer: UHC Core |
$262.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$85.87
|
| Rate for Payer: UHC Exchange |
$164.11
|
| Rate for Payer: UHC Medicare Advantage |
$85.87
|
| Rate for Payer: UHCCP Medicaid |
$46.03
|
| Rate for Payer: UMR Bronson Commercial |
$92.46
|
| Rate for Payer: VA VA |
$85.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.43
|
|
|
HC TBS TECHNICAL CALCULATION ONLY
|
Facility
|
IP
|
$249.90
|
|
|
Service Code
|
CPT 77091
|
| Hospital Charge Code |
32000335
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$109.96 |
| Max. Negotiated Rate |
$224.91 |
| Rate for Payer: Aetna American Axle |
$162.44
|
| Rate for Payer: Aetna Commercial |
$212.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.44
|
| Rate for Payer: Cash Price |
$199.92
|
| Rate for Payer: Cofinity Commercial |
$174.93
|
| Rate for Payer: Cofinity Commercial |
$214.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$174.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.92
|
| Rate for Payer: Healthscope Commercial |
$224.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$174.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.41
|
| Rate for Payer: PHP Commercial |
$212.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.44
|
| Rate for Payer: Priority Health SBD |
$157.44
|
| Rate for Payer: UMR Bronson Commercial |
$109.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.43
|
|
|
HC TB TEST
|
Facility
|
OP
|
$24.48
|
|
|
Service Code
|
CPT 86580
|
| Hospital Charge Code |
30000069
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.06 |
| Max. Negotiated Rate |
$67.22 |
| Rate for Payer: Aetna American Axle |
$15.91
|
| Rate for Payer: Aetna Commercial |
$20.81
|
| Rate for Payer: Aetna Medicare |
$24.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.85
|
| Rate for Payer: BCBS Complete |
$13.44
|
| Rate for Payer: BCBS MAPPO |
$23.88
|
| Rate for Payer: BCN Medicare Advantage |
$23.88
|
| Rate for Payer: Cash Price |
$19.58
|
| Rate for Payer: Cash Price |
$19.58
|
| Rate for Payer: Cofinity Commercial |
$21.05
|
| Rate for Payer: Cofinity Commercial |
$17.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.88
|
| Rate for Payer: Healthscope Commercial |
$22.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.36
|
| Rate for Payer: Mclaren Medicaid |
$12.80
|
| Rate for Payer: Mclaren Medicare |
$23.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.07
|
| Rate for Payer: Meridian Medicaid |
$13.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.81
|
| Rate for Payer: PACE Medicare |
$22.69
|
| Rate for Payer: PACE SWMI |
$23.88
|
| Rate for Payer: PHP Commercial |
$20.81
|
| Rate for Payer: PHP Medicare Advantage |
$23.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.91
|
| Rate for Payer: Priority Health Medicare |
$23.88
|
| Rate for Payer: Priority Health SBD |
$15.42
|
| Rate for Payer: Railroad Medicare Medicare |
$23.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.88
|
| Rate for Payer: UHC Exchange |
$45.64
|
| Rate for Payer: UHC Medicare Advantage |
$23.88
|
| Rate for Payer: UHCCP Medicaid |
$12.80
|
| Rate for Payer: UMR Bronson Commercial |
$9.06
|
| Rate for Payer: VA VA |
$23.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.36
|
|
|
HC TB TEST
|
Facility
|
IP
|
$24.48
|
|
|
Service Code
|
CPT 86580
|
| Hospital Charge Code |
30000069
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.77 |
| Max. Negotiated Rate |
$22.03 |
| Rate for Payer: Aetna American Axle |
$15.91
|
| Rate for Payer: Aetna Commercial |
$20.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.91
|
| Rate for Payer: Cash Price |
$19.58
|
| Rate for Payer: Cofinity Commercial |
$17.14
|
| Rate for Payer: Cofinity Commercial |
$21.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.58
|
| Rate for Payer: Healthscope Commercial |
$22.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.81
|
| Rate for Payer: PHP Commercial |
$20.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.91
|
| Rate for Payer: Priority Health SBD |
$15.42
|
| Rate for Payer: UMR Bronson Commercial |
$10.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.36
|
|
|
HC TC 99M ABD PER STUDY
|
Facility
|
IP
|
$157.52
|
|
|
Service Code
|
HCPCS A9500
|
| Hospital Charge Code |
34300019
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$69.31 |
| Max. Negotiated Rate |
$141.77 |
| Rate for Payer: Aetna American Axle |
$102.39
|
| Rate for Payer: Aetna Commercial |
$133.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.39
|
| Rate for Payer: Cash Price |
$126.02
|
| Rate for Payer: Cofinity Commercial |
$110.26
|
| Rate for Payer: Cofinity Commercial |
$135.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$110.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.02
|
| Rate for Payer: Healthscope Commercial |
$141.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$110.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$118.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.89
|
| Rate for Payer: PHP Commercial |
$133.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.39
|
| Rate for Payer: Priority Health SBD |
$99.24
|
| Rate for Payer: UMR Bronson Commercial |
$69.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$118.14
|
|
|
HC TC 99M ABD PER STUDY
|
Facility
|
OP
|
$157.52
|
|
|
Service Code
|
HCPCS A9500
|
| Hospital Charge Code |
34300019
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$58.28 |
| Max. Negotiated Rate |
$141.77 |
| Rate for Payer: Aetna American Axle |
$102.39
|
| Rate for Payer: Aetna Commercial |
$133.89
|
| Rate for Payer: Aetna Medicare |
$78.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.39
|
| Rate for Payer: BCBS Complete |
$63.01
|
| Rate for Payer: Cash Price |
$126.02
|
| Rate for Payer: Cofinity Commercial |
$110.26
|
| Rate for Payer: Cofinity Commercial |
$135.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$110.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.02
|
| Rate for Payer: Healthscope Commercial |
$141.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$110.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$118.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.89
|
| Rate for Payer: PHP Commercial |
$133.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.39
|
| Rate for Payer: Priority Health SBD |
$99.24
|
| Rate for Payer: UMR Bronson Commercial |
$58.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$118.14
|
|
|
HC TC-99M AUTOL WBC DIAG PER DOSE
|
Facility
|
IP
|
$1,779.91
|
|
|
Service Code
|
HCPCS A9569
|
| Hospital Charge Code |
34300027
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$783.16 |
| Max. Negotiated Rate |
$1,601.92 |
| Rate for Payer: Aetna American Axle |
$1,156.94
|
| Rate for Payer: Aetna Commercial |
$1,512.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,156.94
|
| Rate for Payer: Cash Price |
$1,423.93
|
| Rate for Payer: Cofinity Commercial |
$1,245.94
|
| Rate for Payer: Cofinity Commercial |
$1,530.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,245.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,423.93
|
| Rate for Payer: Healthscope Commercial |
$1,601.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,245.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,334.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,512.92
|
| Rate for Payer: PHP Commercial |
$1,512.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,156.94
|
| Rate for Payer: Priority Health SBD |
$1,121.34
|
| Rate for Payer: UMR Bronson Commercial |
$783.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,334.93
|
|
|
HC TC-99M AUTOL WBC DIAG PER DOSE
|
Facility
|
OP
|
$1,779.91
|
|
|
Service Code
|
HCPCS A9569
|
| Hospital Charge Code |
34300027
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$557.61 |
| Max. Negotiated Rate |
$2,928.40 |
| Rate for Payer: Aetna American Axle |
$1,156.94
|
| Rate for Payer: Aetna Commercial |
$1,512.92
|
| Rate for Payer: Aetna Medicare |
$1,081.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,156.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,300.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,300.40
|
| Rate for Payer: BCBS Complete |
$585.49
|
| Rate for Payer: BCBS MAPPO |
$1,040.32
|
| Rate for Payer: BCN Medicare Advantage |
$1,040.32
|
| Rate for Payer: Cash Price |
$1,423.93
|
| Rate for Payer: Cash Price |
$1,423.93
|
| Rate for Payer: Cofinity Commercial |
$1,530.72
|
| Rate for Payer: Cofinity Commercial |
$1,245.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,245.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,423.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,040.32
|
| Rate for Payer: Healthscope Commercial |
$1,601.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,245.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,334.93
|
| Rate for Payer: Mclaren Medicaid |
$557.61
|
| Rate for Payer: Mclaren Medicare |
$1,040.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,092.34
|
| Rate for Payer: Meridian Medicaid |
$585.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,196.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,512.92
|
| Rate for Payer: PACE Medicare |
$988.30
|
| Rate for Payer: PACE SWMI |
$1,040.32
|
| Rate for Payer: PHP Commercial |
$1,512.92
|
| Rate for Payer: PHP Medicare Advantage |
$1,040.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$557.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,156.94
|
| Rate for Payer: Priority Health Medicare |
$1,040.32
|
| Rate for Payer: Priority Health SBD |
$1,121.34
|
| Rate for Payer: Railroad Medicare Medicare |
$1,040.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,928.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,040.32
|
| Rate for Payer: UHC Exchange |
$1,988.16
|
| Rate for Payer: UHC Medicare Advantage |
$1,040.32
|
| Rate for Payer: UHCCP Medicaid |
$557.61
|
| Rate for Payer: UMR Bronson Commercial |
$658.57
|
| Rate for Payer: VA VA |
$1,040.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,334.93
|
|
|
HC TC99M DTPA AEROSOL <=75 MCI
|
Facility
|
OP
|
$134.02
|
|
|
Service Code
|
HCPCS A9567
|
| Hospital Charge Code |
34300030
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$49.59 |
| Max. Negotiated Rate |
$120.62 |
| Rate for Payer: Aetna American Axle |
$87.11
|
| Rate for Payer: Aetna Commercial |
$113.92
|
| Rate for Payer: Aetna Medicare |
$67.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.11
|
| Rate for Payer: BCBS Complete |
$53.61
|
| Rate for Payer: Cash Price |
$107.22
|
| Rate for Payer: Cofinity Commercial |
$115.26
|
| Rate for Payer: Cofinity Commercial |
$93.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$93.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.22
|
| Rate for Payer: Healthscope Commercial |
$120.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$93.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$113.92
|
| Rate for Payer: PHP Commercial |
$113.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.11
|
| Rate for Payer: Priority Health SBD |
$84.43
|
| Rate for Payer: UMR Bronson Commercial |
$49.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.52
|
|
|
HC TC99M DTPA AEROSOL <=75 MCI
|
Facility
|
IP
|
$134.02
|
|
|
Service Code
|
HCPCS A9567
|
| Hospital Charge Code |
34300030
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$58.97 |
| Max. Negotiated Rate |
$120.62 |
| Rate for Payer: Aetna American Axle |
$87.11
|
| Rate for Payer: Aetna Commercial |
$113.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.11
|
| Rate for Payer: Cash Price |
$107.22
|
| Rate for Payer: Cofinity Commercial |
$115.26
|
| Rate for Payer: Cofinity Commercial |
$93.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$93.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.22
|
| Rate for Payer: Healthscope Commercial |
$120.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$93.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$113.92
|
| Rate for Payer: PHP Commercial |
$113.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.11
|
| Rate for Payer: Priority Health SBD |
$84.43
|
| Rate for Payer: UMR Bronson Commercial |
$58.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.52
|
|
|
HC TC 99M MAA PER STUDY
|
Facility
|
IP
|
$137.64
|
|
|
Service Code
|
HCPCS A9540
|
| Hospital Charge Code |
34300017
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$60.56 |
| Max. Negotiated Rate |
$123.88 |
| Rate for Payer: Aetna American Axle |
$89.47
|
| Rate for Payer: Aetna Commercial |
$116.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.47
|
| Rate for Payer: Cash Price |
$110.11
|
| Rate for Payer: Cofinity Commercial |
$118.37
|
| Rate for Payer: Cofinity Commercial |
$96.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$96.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.11
|
| Rate for Payer: Healthscope Commercial |
$123.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$96.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.99
|
| Rate for Payer: PHP Commercial |
$116.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.47
|
| Rate for Payer: Priority Health SBD |
$86.71
|
| Rate for Payer: UMR Bronson Commercial |
$60.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.23
|
|
|
HC TC 99M MAA PER STUDY
|
Facility
|
OP
|
$137.64
|
|
|
Service Code
|
HCPCS A9540
|
| Hospital Charge Code |
34300017
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$50.93 |
| Max. Negotiated Rate |
$123.88 |
| Rate for Payer: Aetna American Axle |
$89.47
|
| Rate for Payer: Aetna Commercial |
$116.99
|
| Rate for Payer: Aetna Medicare |
$68.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.47
|
| Rate for Payer: BCBS Complete |
$55.06
|
| Rate for Payer: Cash Price |
$110.11
|
| Rate for Payer: Cofinity Commercial |
$118.37
|
| Rate for Payer: Cofinity Commercial |
$96.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$96.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.11
|
| Rate for Payer: Healthscope Commercial |
$123.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$96.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.99
|
| Rate for Payer: PHP Commercial |
$116.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.47
|
| Rate for Payer: Priority Health SBD |
$86.71
|
| Rate for Payer: UMR Bronson Commercial |
$50.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.23
|
|
|
HC TC 99M MDP PER STUDY
|
Facility
|
OP
|
$142.83
|
|
|
Service Code
|
HCPCS A9503
|
| Hospital Charge Code |
34300018
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$52.85 |
| Max. Negotiated Rate |
$128.55 |
| Rate for Payer: Aetna American Axle |
$92.84
|
| Rate for Payer: Aetna Commercial |
$121.41
|
| Rate for Payer: Aetna Medicare |
$71.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$92.84
|
| Rate for Payer: BCBS Complete |
$57.13
|
| Rate for Payer: Cash Price |
$114.26
|
| Rate for Payer: Cofinity Commercial |
$122.83
|
| Rate for Payer: Cofinity Commercial |
$99.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$99.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.26
|
| Rate for Payer: Healthscope Commercial |
$128.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$99.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$107.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.41
|
| Rate for Payer: PHP Commercial |
$121.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.84
|
| Rate for Payer: Priority Health SBD |
$89.98
|
| Rate for Payer: UMR Bronson Commercial |
$52.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.12
|
|
|
HC TC 99M MDP PER STUDY
|
Facility
|
IP
|
$142.83
|
|
|
Service Code
|
HCPCS A9503
|
| Hospital Charge Code |
34300018
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$62.85 |
| Max. Negotiated Rate |
$128.55 |
| Rate for Payer: Aetna American Axle |
$92.84
|
| Rate for Payer: Aetna Commercial |
$121.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$92.84
|
| Rate for Payer: Cash Price |
$114.26
|
| Rate for Payer: Cofinity Commercial |
$122.83
|
| Rate for Payer: Cofinity Commercial |
$99.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$99.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.26
|
| Rate for Payer: Healthscope Commercial |
$128.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$99.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$107.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.41
|
| Rate for Payer: PHP Commercial |
$121.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.84
|
| Rate for Payer: Priority Health SBD |
$89.98
|
| Rate for Payer: UMR Bronson Commercial |
$62.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.12
|
|
|
HC TC 99M PERTECHNETATE PER MCI
|
Facility
|
OP
|
$47.61
|
|
|
Service Code
|
HCPCS A9512
|
| Hospital Charge Code |
34300029
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$17.62 |
| Max. Negotiated Rate |
$42.85 |
| Rate for Payer: Aetna American Axle |
$30.95
|
| Rate for Payer: Aetna Commercial |
$40.47
|
| Rate for Payer: Aetna Medicare |
$23.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.95
|
| Rate for Payer: BCBS Complete |
$19.04
|
| Rate for Payer: Cash Price |
$38.09
|
| Rate for Payer: Cofinity Commercial |
$33.33
|
| Rate for Payer: Cofinity Commercial |
$40.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$33.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.09
|
| Rate for Payer: Healthscope Commercial |
$42.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.47
|
| Rate for Payer: PHP Commercial |
$40.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.95
|
| Rate for Payer: Priority Health SBD |
$29.99
|
| Rate for Payer: UMR Bronson Commercial |
$17.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.71
|
|
|
HC TC 99M PERTECHNETATE PER MCI
|
Facility
|
IP
|
$47.61
|
|
|
Service Code
|
HCPCS A9512
|
| Hospital Charge Code |
34300029
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$20.95 |
| Max. Negotiated Rate |
$42.85 |
| Rate for Payer: Aetna American Axle |
$30.95
|
| Rate for Payer: Aetna Commercial |
$40.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.95
|
| Rate for Payer: Cash Price |
$38.09
|
| Rate for Payer: Cofinity Commercial |
$33.33
|
| Rate for Payer: Cofinity Commercial |
$40.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$33.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.09
|
| Rate for Payer: Healthscope Commercial |
$42.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.47
|
| Rate for Payer: PHP Commercial |
$40.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.95
|
| Rate for Payer: Priority Health SBD |
$29.99
|
| Rate for Payer: UMR Bronson Commercial |
$20.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.71
|
|
|
HC TC 99M PYROPHOSPHATE PER STUDY UP TO 25 MILLICURIES
|
Facility
|
OP
|
$236.17
|
|
|
Service Code
|
CPT A9538
|
| Hospital Charge Code |
34300037
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$87.38 |
| Max. Negotiated Rate |
$212.55 |
| Rate for Payer: Aetna American Axle |
$153.51
|
| Rate for Payer: Aetna Commercial |
$200.74
|
| Rate for Payer: Aetna Medicare |
$118.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.51
|
| Rate for Payer: BCBS Complete |
$94.47
|
| Rate for Payer: Cash Price |
$188.94
|
| Rate for Payer: Cofinity Commercial |
$165.32
|
| Rate for Payer: Cofinity Commercial |
$203.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$165.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.94
|
| Rate for Payer: Healthscope Commercial |
$212.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$165.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$177.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.74
|
| Rate for Payer: PHP Commercial |
$200.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$153.51
|
| Rate for Payer: Priority Health SBD |
$148.79
|
| Rate for Payer: UMR Bronson Commercial |
$87.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$177.13
|
|
|
HC TC 99M PYROPHOSPHATE PER STUDY UP TO 25 MILLICURIES
|
Facility
|
IP
|
$236.17
|
|
|
Service Code
|
CPT A9538
|
| Hospital Charge Code |
34300037
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$103.91 |
| Max. Negotiated Rate |
$212.55 |
| Rate for Payer: Aetna American Axle |
$153.51
|
| Rate for Payer: Aetna Commercial |
$200.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.51
|
| Rate for Payer: Cash Price |
$188.94
|
| Rate for Payer: Cofinity Commercial |
$165.32
|
| Rate for Payer: Cofinity Commercial |
$203.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$165.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.94
|
| Rate for Payer: Healthscope Commercial |
$212.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$165.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$177.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.74
|
| Rate for Payer: PHP Commercial |
$200.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$153.51
|
| Rate for Payer: Priority Health SBD |
$148.79
|
| Rate for Payer: UMR Bronson Commercial |
$103.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$177.13
|
|
