|
HC TCU OBSERVATION PER HOUR
|
Facility
|
OP
|
$145.08
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200015
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$53.68 |
| Max. Negotiated Rate |
$4,092.00 |
| Rate for Payer: Aetna American Axle |
$94.30
|
| Rate for Payer: Aetna Commercial |
$123.32
|
| Rate for Payer: Aetna Medicare |
$72.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.30
|
| Rate for Payer: BCBS Complete |
$58.03
|
| Rate for Payer: BCBS Trust/PPO |
$103.16
|
| Rate for Payer: BCN Commercial |
$103.16
|
| Rate for Payer: Cash Price |
$116.06
|
| Rate for Payer: Cash Price |
$116.06
|
| Rate for Payer: Cash Price |
$116.06
|
| Rate for Payer: Cofinity Commercial |
$124.77
|
| Rate for Payer: Cofinity Commercial |
$101.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$101.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.06
|
| Rate for Payer: Healthscope Commercial |
$130.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$101.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.81
|
| Rate for Payer: Meridian Medicaid |
$1,000.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.32
|
| Rate for Payer: PHP Commercial |
$123.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.30
|
| Rate for Payer: Priority Health SBD |
$91.40
|
| Rate for Payer: UHC Core |
$4,092.00
|
| Rate for Payer: UMR Bronson Commercial |
$53.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.81
|
|
|
HC TCU OR NCCU R&B
|
Facility
|
IP
|
$5,069.49
|
|
| Hospital Charge Code |
20800001
|
|
Hospital Revenue Code
|
208
|
| Min. Negotiated Rate |
$2,230.58 |
| Max. Negotiated Rate |
$4,562.54 |
| Rate for Payer: Aetna American Axle |
$3,295.17
|
| Rate for Payer: Aetna Commercial |
$4,309.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,295.17
|
| Rate for Payer: Cash Price |
$4,055.59
|
| Rate for Payer: Cofinity Commercial |
$3,548.64
|
| Rate for Payer: Cofinity Commercial |
$4,359.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,548.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,055.59
|
| Rate for Payer: Healthscope Commercial |
$4,562.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,548.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,802.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,309.07
|
| Rate for Payer: PHP Commercial |
$4,309.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,295.17
|
| Rate for Payer: Priority Health SBD |
$3,193.78
|
| Rate for Payer: UMR Bronson Commercial |
$2,230.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,802.12
|
|
|
HC TEE ECHOCARDIOGRAM W/DOPPLER
|
Facility
|
IP
|
$1,888.91
|
|
|
Service Code
|
CPT 93312
|
| Hospital Charge Code |
48000012
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$831.12 |
| Max. Negotiated Rate |
$1,700.02 |
| Rate for Payer: Aetna American Axle |
$1,227.79
|
| Rate for Payer: Aetna Commercial |
$1,605.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,227.79
|
| Rate for Payer: Cash Price |
$1,511.13
|
| Rate for Payer: Cofinity Commercial |
$1,322.24
|
| Rate for Payer: Cofinity Commercial |
$1,624.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,322.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,511.13
|
| Rate for Payer: Healthscope Commercial |
$1,700.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,322.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,416.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,605.57
|
| Rate for Payer: PHP Commercial |
$1,605.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,227.79
|
| Rate for Payer: Priority Health SBD |
$1,190.01
|
| Rate for Payer: UMR Bronson Commercial |
$831.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,416.68
|
|
|
HC TEE ECHOCARDIOGRAM W/DOPPLER
|
Facility
|
OP
|
$1,888.91
|
|
|
Service Code
|
CPT 93312
|
| Hospital Charge Code |
48000012
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$218.25 |
| Max. Negotiated Rate |
$1,700.02 |
| Rate for Payer: Aetna American Axle |
$1,227.79
|
| Rate for Payer: Aetna Commercial |
$1,605.57
|
| Rate for Payer: Aetna Medicare |
$558.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,227.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$671.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$671.51
|
| Rate for Payer: BCBS Complete |
$302.34
|
| Rate for Payer: BCBS MAPPO |
$537.21
|
| Rate for Payer: BCBS Trust/PPO |
$556.75
|
| Rate for Payer: BCN Commercial |
$556.75
|
| Rate for Payer: BCN Medicare Advantage |
$537.21
|
| Rate for Payer: Cash Price |
$1,511.13
|
| Rate for Payer: Cash Price |
$1,511.13
|
| Rate for Payer: Cash Price |
$1,511.13
|
| Rate for Payer: Cofinity Commercial |
$1,322.24
|
| Rate for Payer: Cofinity Commercial |
$1,624.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,322.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,511.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$537.21
|
| Rate for Payer: Healthscope Commercial |
$1,700.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,322.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,416.68
|
| Rate for Payer: Mclaren Medicaid |
$287.94
|
| Rate for Payer: Mclaren Medicare |
$537.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$564.07
|
| Rate for Payer: Meridian Medicaid |
$302.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$617.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,605.57
|
| Rate for Payer: Nomi Health Commercial |
$1,611.63
|
| Rate for Payer: PACE Medicare |
$510.35
|
| Rate for Payer: PACE SWMI |
$537.21
|
| Rate for Payer: PHP Commercial |
$1,605.57
|
| Rate for Payer: PHP Medicare Advantage |
$537.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$287.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,227.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,688.45
|
| Rate for Payer: Priority Health Medicare |
$537.21
|
| Rate for Payer: Priority Health Narrow Network |
$1,350.76
|
| Rate for Payer: Priority Health SBD |
$1,190.01
|
| Rate for Payer: Railroad Medicare Medicare |
$537.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$240.08
|
| Rate for Payer: UHC Core |
$816.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$537.21
|
| Rate for Payer: UHC Exchange |
$218.25
|
| Rate for Payer: UHC Medicare Advantage |
$537.21
|
| Rate for Payer: UHCCP Medicaid |
$287.94
|
| Rate for Payer: UMR Bronson Commercial |
$698.90
|
| Rate for Payer: VA VA |
$537.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,416.68
|
|
|
HC TEE W/DEFINITY
|
Facility
|
OP
|
$1,888.91
|
|
|
Service Code
|
HCPCS C8925
|
| Hospital Charge Code |
48300010
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$414.91 |
| Max. Negotiated Rate |
$2,432.92 |
| Rate for Payer: Aetna American Axle |
$1,227.79
|
| Rate for Payer: Aetna Commercial |
$1,605.57
|
| Rate for Payer: Aetna Medicare |
$805.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,227.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$967.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$967.60
|
| Rate for Payer: BCBS Complete |
$435.65
|
| Rate for Payer: BCBS MAPPO |
$774.08
|
| Rate for Payer: BCBS Trust/PPO |
$980.00
|
| Rate for Payer: BCN Commercial |
$980.00
|
| Rate for Payer: BCN Medicare Advantage |
$774.08
|
| Rate for Payer: Cash Price |
$1,511.13
|
| Rate for Payer: Cash Price |
$1,511.13
|
| Rate for Payer: Cash Price |
$1,511.13
|
| Rate for Payer: Cofinity Commercial |
$1,322.24
|
| Rate for Payer: Cofinity Commercial |
$1,624.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,322.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,511.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$774.08
|
| Rate for Payer: Healthscope Commercial |
$1,700.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,322.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,416.68
|
| Rate for Payer: Mclaren Medicaid |
$414.91
|
| Rate for Payer: Mclaren Medicare |
$774.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$812.78
|
| Rate for Payer: Meridian Medicaid |
$435.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$890.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,605.57
|
| Rate for Payer: Nomi Health Commercial |
$2,322.24
|
| Rate for Payer: PACE Medicare |
$735.38
|
| Rate for Payer: PACE SWMI |
$774.08
|
| Rate for Payer: PHP Commercial |
$1,605.57
|
| Rate for Payer: PHP Medicare Advantage |
$774.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$414.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,227.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,432.92
|
| Rate for Payer: Priority Health Medicare |
$774.08
|
| Rate for Payer: Priority Health Narrow Network |
$1,946.34
|
| Rate for Payer: Priority Health SBD |
$1,190.01
|
| Rate for Payer: Railroad Medicare Medicare |
$774.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,178.96
|
| Rate for Payer: UHC Core |
$816.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$774.08
|
| Rate for Payer: UHC Exchange |
$1,479.34
|
| Rate for Payer: UHC Medicare Advantage |
$774.08
|
| Rate for Payer: UHCCP Medicaid |
$414.91
|
| Rate for Payer: UMR Bronson Commercial |
$698.90
|
| Rate for Payer: VA VA |
$774.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,416.68
|
|
|
HC TEE W/DEFINITY
|
Facility
|
IP
|
$1,888.91
|
|
|
Service Code
|
HCPCS C8925
|
| Hospital Charge Code |
48300010
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$831.12 |
| Max. Negotiated Rate |
$1,700.02 |
| Rate for Payer: Aetna American Axle |
$1,227.79
|
| Rate for Payer: Aetna Commercial |
$1,605.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,227.79
|
| Rate for Payer: Cash Price |
$1,511.13
|
| Rate for Payer: Cofinity Commercial |
$1,322.24
|
| Rate for Payer: Cofinity Commercial |
$1,624.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,322.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,511.13
|
| Rate for Payer: Healthscope Commercial |
$1,700.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,322.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,416.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,605.57
|
| Rate for Payer: PHP Commercial |
$1,605.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,227.79
|
| Rate for Payer: Priority Health SBD |
$1,190.01
|
| Rate for Payer: UMR Bronson Commercial |
$831.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,416.68
|
|
|
HC TEG COAGULATION TIME ACTIVATED
|
Facility
|
IP
|
$29.13
|
|
|
Service Code
|
CPT 85347
|
| Hospital Charge Code |
30500100
|
|
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 TEG COAGULATION TIME ACTIVATED
|
Facility
|
OP
|
$29.13
|
|
|
Service Code
|
CPT 85347
|
| Hospital Charge Code |
30500100
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.29 |
| 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 |
$4.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.35
|
| Rate for Payer: BCBS Complete |
$2.41
|
| Rate for Payer: BCBS MAPPO |
$4.28
|
| Rate for Payer: BCBS Trust/PPO |
$4.12
|
| Rate for Payer: BCN Commercial |
$4.12
|
| Rate for Payer: BCN Medicare Advantage |
$4.28
|
| 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 |
$4.28
|
| 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 |
$2.29
|
| Rate for Payer: Mclaren Medicare |
$4.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.49
|
| Rate for Payer: Meridian Medicaid |
$2.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.76
|
| Rate for Payer: Nomi Health Commercial |
$6.42
|
| Rate for Payer: PACE Medicare |
$4.07
|
| Rate for Payer: PACE SWMI |
$4.28
|
| Rate for Payer: PHP Commercial |
$24.76
|
| Rate for Payer: PHP Medicare Advantage |
$4.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.38
|
| Rate for Payer: Priority Health Medicare |
$4.28
|
| Rate for Payer: Priority Health Narrow Network |
$3.50
|
| Rate for Payer: Priority Health SBD |
$18.35
|
| Rate for Payer: Railroad Medicare Medicare |
$4.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.28
|
| Rate for Payer: UHC Exchange |
$4.28
|
| Rate for Payer: UHC Medicare Advantage |
$4.28
|
| Rate for Payer: UHCCP Medicaid |
$2.29
|
| Rate for Payer: UMR Bronson Commercial |
$10.78
|
| Rate for Payer: VA VA |
$4.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.85
|
|
|
HC TEG FIBRINOGEN ACTIVITY
|
Facility
|
IP
|
$65.28
|
|
|
Service Code
|
CPT 85384
|
| Hospital Charge Code |
30500101
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$28.72 |
| Max. Negotiated Rate |
$58.75 |
| Rate for Payer: Aetna American Axle |
$42.43
|
| Rate for Payer: Aetna Commercial |
$55.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.43
|
| Rate for Payer: Cash Price |
$52.22
|
| Rate for Payer: Cofinity Commercial |
$45.70
|
| Rate for Payer: Cofinity Commercial |
$56.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$45.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.22
|
| Rate for Payer: Healthscope Commercial |
$58.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.49
|
| Rate for Payer: PHP Commercial |
$55.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.43
|
| Rate for Payer: Priority Health SBD |
$41.13
|
| Rate for Payer: UMR Bronson Commercial |
$28.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.96
|
|
|
HC TEG FIBRINOGEN ACTIVITY
|
Facility
|
OP
|
$65.28
|
|
|
Service Code
|
CPT 85384
|
| Hospital Charge Code |
30500101
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.21 |
| Max. Negotiated Rate |
$58.75 |
| Rate for Payer: Aetna American Axle |
$42.43
|
| Rate for Payer: Aetna Commercial |
$55.49
|
| Rate for Payer: Aetna Medicare |
$10.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.15
|
| Rate for Payer: BCBS Complete |
$5.47
|
| Rate for Payer: BCBS MAPPO |
$9.72
|
| Rate for Payer: BCBS Trust/PPO |
$9.36
|
| Rate for Payer: BCN Commercial |
$9.36
|
| Rate for Payer: BCN Medicare Advantage |
$9.72
|
| Rate for Payer: Cash Price |
$52.22
|
| Rate for Payer: Cash Price |
$52.22
|
| Rate for Payer: Cofinity Commercial |
$56.14
|
| Rate for Payer: Cofinity Commercial |
$45.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$45.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.72
|
| Rate for Payer: Healthscope Commercial |
$58.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.96
|
| Rate for Payer: Mclaren Medicaid |
$5.21
|
| Rate for Payer: Mclaren Medicare |
$9.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.21
|
| Rate for Payer: Meridian Medicaid |
$5.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.49
|
| Rate for Payer: Nomi Health Commercial |
$14.58
|
| Rate for Payer: PACE Medicare |
$9.23
|
| Rate for Payer: PACE SWMI |
$9.72
|
| Rate for Payer: PHP Commercial |
$55.49
|
| Rate for Payer: PHP Medicare Advantage |
$9.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.72
|
| Rate for Payer: Priority Health Medicare |
$9.72
|
| Rate for Payer: Priority Health Narrow Network |
$7.78
|
| Rate for Payer: Priority Health SBD |
$41.13
|
| Rate for Payer: Railroad Medicare Medicare |
$9.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.72
|
| Rate for Payer: UHC Exchange |
$9.72
|
| Rate for Payer: UHC Medicare Advantage |
$9.72
|
| Rate for Payer: UHCCP Medicaid |
$5.21
|
| Rate for Payer: UMR Bronson Commercial |
$24.15
|
| Rate for Payer: VA VA |
$9.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.96
|
|
|
HC TEG PLATELET AGGREGATION IN VITRO EACH
|
Facility
|
OP
|
$124.85
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
30500102
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$13.35 |
| Max. Negotiated Rate |
$112.36 |
| Rate for Payer: Aetna American Axle |
$81.15
|
| Rate for Payer: Aetna Commercial |
$106.12
|
| Rate for Payer: Aetna Medicare |
$25.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.14
|
| Rate for Payer: BCBS Complete |
$14.02
|
| Rate for Payer: BCBS MAPPO |
$24.91
|
| Rate for Payer: BCBS Trust/PPO |
$18.00
|
| Rate for Payer: BCN Commercial |
$18.00
|
| Rate for Payer: BCN Medicare Advantage |
$24.91
|
| Rate for Payer: Cash Price |
$99.88
|
| Rate for Payer: Cash Price |
$99.88
|
| Rate for Payer: Cofinity Commercial |
$87.40
|
| Rate for Payer: Cofinity Commercial |
$107.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$87.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.91
|
| Rate for Payer: Healthscope Commercial |
$112.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$87.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.64
|
| Rate for Payer: Mclaren Medicaid |
$13.35
|
| Rate for Payer: Mclaren Medicare |
$24.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.16
|
| Rate for Payer: Meridian Medicaid |
$14.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.12
|
| Rate for Payer: Nomi Health Commercial |
$37.36
|
| Rate for Payer: PACE Medicare |
$23.66
|
| Rate for Payer: PACE SWMI |
$24.91
|
| Rate for Payer: PHP Commercial |
$106.12
|
| Rate for Payer: PHP Medicare Advantage |
$24.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24.91
|
| Rate for Payer: Priority Health Medicare |
$24.91
|
| Rate for Payer: Priority Health Narrow Network |
$19.93
|
| Rate for Payer: Priority Health SBD |
$78.66
|
| Rate for Payer: Railroad Medicare Medicare |
$24.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.91
|
| Rate for Payer: UHC Exchange |
$24.91
|
| Rate for Payer: UHC Medicare Advantage |
$24.91
|
| Rate for Payer: UHCCP Medicaid |
$13.35
|
| Rate for Payer: UMR Bronson Commercial |
$46.19
|
| Rate for Payer: VA VA |
$24.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.64
|
|
|
HC TEG PLATELET AGGREGATION IN VITRO EACH
|
Facility
|
IP
|
$124.85
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
30500102
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$54.93 |
| Max. Negotiated Rate |
$112.36 |
| Rate for Payer: Aetna American Axle |
$81.15
|
| Rate for Payer: Aetna Commercial |
$106.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.15
|
| Rate for Payer: Cash Price |
$99.88
|
| Rate for Payer: Cofinity Commercial |
$107.37
|
| Rate for Payer: Cofinity Commercial |
$87.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$87.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.88
|
| Rate for Payer: Healthscope Commercial |
$112.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$87.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.12
|
| Rate for Payer: PHP Commercial |
$106.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.15
|
| Rate for Payer: Priority Health SBD |
$78.66
|
| Rate for Payer: UMR Bronson Commercial |
$54.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.64
|
|
|
HC TEGRETOL CARBAMAZEPINE LVL
|
Facility
|
OP
|
$107.51
|
|
|
Service Code
|
CPT 80156
|
| Hospital Charge Code |
30100585
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.81 |
| Max. Negotiated Rate |
$96.76 |
| Rate for Payer: Aetna American Axle |
$69.88
|
| Rate for Payer: Aetna Commercial |
$91.38
|
| Rate for Payer: Aetna Medicare |
$15.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.21
|
| Rate for Payer: BCBS Complete |
$8.20
|
| Rate for Payer: BCBS MAPPO |
$14.57
|
| Rate for Payer: BCBS Trust/PPO |
$14.04
|
| Rate for Payer: BCN Commercial |
$14.04
|
| Rate for Payer: BCN Medicare Advantage |
$14.57
|
| Rate for Payer: Cash Price |
$86.01
|
| Rate for Payer: Cash Price |
$86.01
|
| Rate for Payer: Cofinity Commercial |
$92.46
|
| Rate for Payer: Cofinity Commercial |
$75.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$75.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.57
|
| Rate for Payer: Healthscope Commercial |
$96.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$75.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.63
|
| Rate for Payer: Mclaren Medicaid |
$7.81
|
| Rate for Payer: Mclaren Medicare |
$14.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.30
|
| Rate for Payer: Meridian Medicaid |
$8.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.38
|
| Rate for Payer: Nomi Health Commercial |
$21.86
|
| Rate for Payer: PACE Medicare |
$13.84
|
| Rate for Payer: PACE SWMI |
$14.57
|
| Rate for Payer: PHP Commercial |
$91.38
|
| Rate for Payer: PHP Medicare Advantage |
$14.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.99
|
| Rate for Payer: Priority Health Medicare |
$14.57
|
| Rate for Payer: Priority Health Narrow Network |
$11.99
|
| Rate for Payer: Priority Health SBD |
$67.73
|
| Rate for Payer: Railroad Medicare Medicare |
$14.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.57
|
| Rate for Payer: UHC Exchange |
$14.57
|
| Rate for Payer: UHC Medicare Advantage |
$14.57
|
| Rate for Payer: UHCCP Medicaid |
$7.81
|
| Rate for Payer: UMR Bronson Commercial |
$39.78
|
| Rate for Payer: VA VA |
$14.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.63
|
|
|
HC TEGRETOL CARBAMAZEPINE LVL
|
Facility
|
IP
|
$107.51
|
|
|
Service Code
|
CPT 80156
|
| Hospital Charge Code |
30100585
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.30 |
| Max. Negotiated Rate |
$96.76 |
| Rate for Payer: Aetna American Axle |
$69.88
|
| Rate for Payer: Aetna Commercial |
$91.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.88
|
| Rate for Payer: Cash Price |
$86.01
|
| Rate for Payer: Cofinity Commercial |
$75.26
|
| Rate for Payer: Cofinity Commercial |
$92.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$75.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.01
|
| Rate for Payer: Healthscope Commercial |
$96.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$75.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.38
|
| Rate for Payer: PHP Commercial |
$91.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.88
|
| Rate for Payer: Priority Health SBD |
$67.73
|
| Rate for Payer: UMR Bronson Commercial |
$47.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.63
|
|
|
HC TEGRETOL FREE AND TOTAL CMPT
|
Facility
|
OP
|
$46.82
|
|
|
Service Code
|
CPT 80156
|
| Hospital Charge Code |
30100023
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.81 |
| Max. Negotiated Rate |
$42.14 |
| Rate for Payer: UHC Medicare Advantage |
$14.57
|
| Rate for Payer: UHCCP Medicaid |
$7.81
|
| Rate for Payer: UMR Bronson Commercial |
$17.32
|
| Rate for Payer: VA VA |
$14.57
|
| Rate for Payer: Aetna American Axle |
$30.43
|
| Rate for Payer: Aetna Commercial |
$39.80
|
| Rate for Payer: Aetna Medicare |
$15.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.21
|
| Rate for Payer: BCBS Complete |
$8.20
|
| Rate for Payer: BCBS MAPPO |
$14.57
|
| Rate for Payer: BCBS Trust/PPO |
$14.04
|
| Rate for Payer: BCN Commercial |
$14.04
|
| Rate for Payer: BCN Medicare Advantage |
$14.57
|
| Rate for Payer: Cash Price |
$37.46
|
| Rate for Payer: Cash Price |
$37.46
|
| Rate for Payer: Cofinity Commercial |
$40.27
|
| Rate for Payer: Cofinity Commercial |
$32.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$32.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.57
|
| Rate for Payer: Healthscope Commercial |
$42.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.12
|
| Rate for Payer: Mclaren Medicaid |
$7.81
|
| Rate for Payer: Mclaren Medicare |
$14.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.30
|
| Rate for Payer: Meridian Medicaid |
$8.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.80
|
| Rate for Payer: Nomi Health Commercial |
$21.86
|
| Rate for Payer: PACE Medicare |
$13.84
|
| Rate for Payer: PACE SWMI |
$14.57
|
| Rate for Payer: PHP Commercial |
$39.80
|
| Rate for Payer: PHP Medicare Advantage |
$14.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.99
|
| Rate for Payer: Priority Health Medicare |
$14.57
|
| Rate for Payer: Priority Health Narrow Network |
$11.99
|
| Rate for Payer: Priority Health SBD |
$29.50
|
| Rate for Payer: Railroad Medicare Medicare |
$14.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.57
|
| Rate for Payer: UHC Exchange |
$14.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.12
|
|
|
HC TEGRETOL FREE AND TOTAL CMPT
|
Facility
|
IP
|
$46.82
|
|
|
Service Code
|
CPT 80156
|
| Hospital Charge Code |
30100023
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.60 |
| Max. Negotiated Rate |
$42.14 |
| Rate for Payer: Aetna American Axle |
$30.43
|
| Rate for Payer: Aetna Commercial |
$39.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.43
|
| Rate for Payer: Cash Price |
$37.46
|
| Rate for Payer: Cofinity Commercial |
$32.77
|
| Rate for Payer: Cofinity Commercial |
$40.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$32.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.46
|
| Rate for Payer: Healthscope Commercial |
$42.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.80
|
| Rate for Payer: PHP Commercial |
$39.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.43
|
| Rate for Payer: Priority Health SBD |
$29.50
|
| Rate for Payer: UMR Bronson Commercial |
$20.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.12
|
|
|
HC TEGRETOL FREE AND TOTAL LEVEL
|
Facility
|
IP
|
$41.62
|
|
|
Service Code
|
CPT 80157
|
| Hospital Charge Code |
30100024
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.31 |
| Max. Negotiated Rate |
$37.46 |
| Rate for Payer: Aetna American Axle |
$27.05
|
| Rate for Payer: Aetna Commercial |
$35.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.05
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cofinity Commercial |
$29.13
|
| Rate for Payer: Cofinity Commercial |
$35.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$29.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.30
|
| Rate for Payer: Healthscope Commercial |
$37.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.38
|
| Rate for Payer: PHP Commercial |
$35.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.05
|
| Rate for Payer: Priority Health SBD |
$26.22
|
| Rate for Payer: UMR Bronson Commercial |
$18.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.22
|
|
|
HC TEGRETOL FREE AND TOTAL LEVEL
|
Facility
|
OP
|
$41.62
|
|
|
Service Code
|
CPT 80157
|
| Hospital Charge Code |
30100024
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.10 |
| Max. Negotiated Rate |
$37.46 |
| Rate for Payer: Aetna American Axle |
$27.05
|
| Rate for Payer: Aetna Commercial |
$35.38
|
| Rate for Payer: Aetna Medicare |
$13.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.56
|
| Rate for Payer: BCBS Complete |
$7.46
|
| Rate for Payer: BCBS MAPPO |
$13.25
|
| Rate for Payer: BCBS Trust/PPO |
$12.77
|
| Rate for Payer: BCN Commercial |
$12.77
|
| Rate for Payer: BCN Medicare Advantage |
$13.25
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cofinity Commercial |
$35.79
|
| Rate for Payer: Cofinity Commercial |
$29.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$29.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.25
|
| Rate for Payer: Healthscope Commercial |
$37.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.22
|
| Rate for Payer: Mclaren Medicaid |
$7.10
|
| Rate for Payer: Mclaren Medicare |
$13.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.91
|
| Rate for Payer: Meridian Medicaid |
$7.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.38
|
| Rate for Payer: Nomi Health Commercial |
$19.88
|
| Rate for Payer: PACE Medicare |
$12.59
|
| Rate for Payer: PACE SWMI |
$13.25
|
| Rate for Payer: PHP Commercial |
$35.38
|
| Rate for Payer: PHP Medicare Advantage |
$13.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.64
|
| Rate for Payer: Priority Health Medicare |
$13.25
|
| Rate for Payer: Priority Health Narrow Network |
$10.91
|
| Rate for Payer: Priority Health SBD |
$26.22
|
| Rate for Payer: Railroad Medicare Medicare |
$13.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.25
|
| Rate for Payer: UHC Exchange |
$13.25
|
| Rate for Payer: UHC Medicare Advantage |
$13.25
|
| Rate for Payer: UHCCP Medicaid |
$7.10
|
| Rate for Payer: UMR Bronson Commercial |
$15.40
|
| Rate for Payer: VA VA |
$13.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.22
|
|
|
HC TELEHEALTH ORG SITE FACILITY
|
Facility
|
IP
|
$89.78
|
|
|
Service Code
|
HCPCS Q3014
|
| Hospital Charge Code |
78000001
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$39.50 |
| Max. Negotiated Rate |
$80.80 |
| Rate for Payer: Aetna American Axle |
$58.36
|
| Rate for Payer: Aetna Commercial |
$76.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.36
|
| Rate for Payer: Cash Price |
$71.82
|
| Rate for Payer: Cofinity Commercial |
$62.85
|
| Rate for Payer: Cofinity Commercial |
$77.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$62.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.82
|
| Rate for Payer: Healthscope Commercial |
$80.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$62.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.31
|
| Rate for Payer: PHP Commercial |
$76.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.36
|
| Rate for Payer: Priority Health SBD |
$56.56
|
| Rate for Payer: UMR Bronson Commercial |
$39.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.34
|
|
|
HC TELEHEALTH ORG SITE FACILITY
|
Facility
|
OP
|
$89.78
|
|
|
Service Code
|
HCPCS Q3014
|
| Hospital Charge Code |
78000001
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$33.22 |
| Max. Negotiated Rate |
$80.80 |
| Rate for Payer: Aetna American Axle |
$58.36
|
| Rate for Payer: Aetna Commercial |
$76.31
|
| Rate for Payer: Aetna Medicare |
$44.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.36
|
| Rate for Payer: BCBS Complete |
$35.91
|
| Rate for Payer: BCBS Trust/PPO |
$55.34
|
| Rate for Payer: BCN Commercial |
$55.34
|
| Rate for Payer: Cash Price |
$71.82
|
| Rate for Payer: Cash Price |
$71.82
|
| Rate for Payer: Cofinity Commercial |
$62.85
|
| Rate for Payer: Cofinity Commercial |
$77.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$62.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.82
|
| Rate for Payer: Healthscope Commercial |
$80.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$62.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.31
|
| Rate for Payer: PHP Commercial |
$76.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.36
|
| Rate for Payer: Priority Health SBD |
$56.56
|
| Rate for Payer: UMR Bronson Commercial |
$33.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.34
|
|
|
HC TE MANUAL TX EACH 15 MIN
|
Facility
|
OP
|
$114.44
|
|
|
Service Code
|
CPT 97140
|
| Hospital Charge Code |
42000026
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$20.80 |
| Max. Negotiated Rate |
$294.00 |
| Rate for Payer: Aetna American Axle |
$74.39
|
| Rate for Payer: Aetna Commercial |
$97.27
|
| Rate for Payer: Aetna Medicare |
$57.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.39
|
| Rate for Payer: BCBS Complete |
$45.78
|
| Rate for Payer: BCBS Trust/PPO |
$21.90
|
| Rate for Payer: BCN Commercial |
$21.90
|
| Rate for Payer: Cash Price |
$91.55
|
| Rate for Payer: Cash Price |
$91.55
|
| Rate for Payer: Cash Price |
$91.55
|
| Rate for Payer: Cofinity Commercial |
$80.11
|
| Rate for Payer: Cofinity Commercial |
$98.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$80.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.55
|
| Rate for Payer: Healthscope Commercial |
$103.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$80.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.27
|
| Rate for Payer: Nomi Health Commercial |
$135.00
|
| Rate for Payer: PHP Commercial |
$97.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26.00
|
| Rate for Payer: Priority Health Narrow Network |
$20.80
|
| Rate for Payer: Priority Health SBD |
$72.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.05
|
| Rate for Payer: UHC Core |
$294.00
|
| Rate for Payer: UHC Exchange |
$25.50
|
| Rate for Payer: UMR Bronson Commercial |
$42.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.83
|
|
|
HC TE MANUAL TX EACH 15 MIN
|
Facility
|
IP
|
$114.44
|
|
|
Service Code
|
CPT 97140
|
| Hospital Charge Code |
42000026
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$50.35 |
| Max. Negotiated Rate |
$103.00 |
| Rate for Payer: Aetna American Axle |
$74.39
|
| Rate for Payer: Aetna Commercial |
$97.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.39
|
| Rate for Payer: Cash Price |
$91.55
|
| Rate for Payer: Cofinity Commercial |
$80.11
|
| Rate for Payer: Cofinity Commercial |
$98.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$80.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.55
|
| Rate for Payer: Healthscope Commercial |
$103.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$80.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.27
|
| Rate for Payer: PHP Commercial |
$97.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.39
|
| Rate for Payer: Priority Health SBD |
$72.10
|
| Rate for Payer: UMR Bronson Commercial |
$50.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.83
|
|
|
HC TEMPORARY PACEMAKER
|
Facility
|
IP
|
$2,803.88
|
|
|
Service Code
|
CPT 33210
|
| Hospital Charge Code |
36100060
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,233.71 |
| Max. Negotiated Rate |
$2,523.49 |
| Rate for Payer: Aetna American Axle |
$1,822.52
|
| Rate for Payer: Aetna Commercial |
$2,383.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,822.52
|
| Rate for Payer: Cash Price |
$2,243.10
|
| Rate for Payer: Cofinity Commercial |
$1,962.72
|
| Rate for Payer: Cofinity Commercial |
$2,411.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,962.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,243.10
|
| Rate for Payer: Healthscope Commercial |
$2,523.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,962.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,102.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,383.30
|
| Rate for Payer: PHP Commercial |
$2,383.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,822.52
|
| Rate for Payer: Priority Health SBD |
$1,766.44
|
| Rate for Payer: UMR Bronson Commercial |
$1,233.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,102.91
|
|
|
HC TEMPORARY PACEMAKER
|
Facility
|
OP
|
$2,803.88
|
|
|
Service Code
|
CPT 33210
|
| Hospital Charge Code |
36100060
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$155.09 |
| Max. Negotiated Rate |
$25,485.33 |
| Rate for Payer: Aetna American Axle |
$1,822.52
|
| Rate for Payer: Aetna Commercial |
$2,383.30
|
| Rate for Payer: Aetna Medicare |
$8,432.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,822.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,135.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,135.80
|
| Rate for Payer: BCBS Complete |
$4,563.54
|
| Rate for Payer: BCBS MAPPO |
$8,108.64
|
| Rate for Payer: BCBS Trust/PPO |
$7,506.92
|
| Rate for Payer: BCN Commercial |
$7,506.92
|
| Rate for Payer: BCN Medicare Advantage |
$8,108.64
|
| Rate for Payer: Cash Price |
$2,243.10
|
| Rate for Payer: Cash Price |
$2,243.10
|
| Rate for Payer: Cash Price |
$2,243.10
|
| Rate for Payer: Cofinity Commercial |
$2,411.34
|
| Rate for Payer: Cofinity Commercial |
$1,962.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,962.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,243.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,108.64
|
| Rate for Payer: Healthscope Commercial |
$2,523.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,962.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,102.91
|
| Rate for Payer: Mclaren Medicaid |
$4,346.23
|
| Rate for Payer: Mclaren Medicare |
$8,108.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,514.07
|
| Rate for Payer: Meridian Medicaid |
$4,563.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,324.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,383.30
|
| Rate for Payer: Nomi Health Commercial |
$17,028.14
|
| Rate for Payer: PACE Medicare |
$7,703.21
|
| Rate for Payer: PACE SWMI |
$8,108.64
|
| Rate for Payer: PHP Commercial |
$2,383.30
|
| Rate for Payer: PHP Medicare Advantage |
$8,108.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,346.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,822.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25,485.33
|
| Rate for Payer: Priority Health Medicare |
$8,108.64
|
| Rate for Payer: Priority Health Narrow Network |
$20,388.26
|
| Rate for Payer: Priority Health SBD |
$1,766.44
|
| Rate for Payer: Railroad Medicare Medicare |
$8,108.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$170.60
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$8,108.64
|
| Rate for Payer: UHC Exchange |
$155.09
|
| Rate for Payer: UHC Medicare Advantage |
$8,108.64
|
| Rate for Payer: UHCCP Medicaid |
$4,346.23
|
| Rate for Payer: UMR Bronson Commercial |
$1,037.44
|
| Rate for Payer: VA VA |
$8,108.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,102.91
|
|
|
HC TEMPORARY PACING WIRE
|
Facility
|
IP
|
$688.29
|
|
|
Service Code
|
HCPCS C1756
|
| Hospital Charge Code |
27200074
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$302.85 |
| Max. Negotiated Rate |
$619.46 |
| Rate for Payer: Aetna American Axle |
$447.39
|
| Rate for Payer: Aetna Commercial |
$585.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$447.39
|
| Rate for Payer: Cash Price |
$550.63
|
| Rate for Payer: Cofinity Commercial |
$481.80
|
| Rate for Payer: Cofinity Commercial |
$591.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$481.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$550.63
|
| Rate for Payer: Healthscope Commercial |
$619.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$481.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$516.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$585.05
|
| Rate for Payer: PHP Commercial |
$585.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$447.39
|
| Rate for Payer: Priority Health SBD |
$433.62
|
| Rate for Payer: UMR Bronson Commercial |
$302.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$516.22
|
|
