|
HC THEOPHYLLINE LEVEL
|
Facility
|
OP
|
$92.21
|
|
|
Service Code
|
CPT 80198
|
| Hospital Charge Code |
30100048
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.58 |
| Max. Negotiated Rate |
$82.99 |
| Rate for Payer: Mclaren Medicare |
$14.14
|
| Rate for Payer: Aetna American Axle |
$59.94
|
| Rate for Payer: Aetna Commercial |
$78.38
|
| Rate for Payer: Aetna Medicare |
$14.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.68
|
| Rate for Payer: BCBS Complete |
$7.96
|
| Rate for Payer: BCBS MAPPO |
$14.14
|
| Rate for Payer: BCBS Trust/PPO |
$13.63
|
| Rate for Payer: BCN Commercial |
$13.63
|
| Rate for Payer: BCN Medicare Advantage |
$14.14
|
| Rate for Payer: Cash Price |
$73.77
|
| Rate for Payer: Cash Price |
$73.77
|
| Rate for Payer: Cofinity Commercial |
$79.30
|
| Rate for Payer: Cofinity Commercial |
$64.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$64.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.14
|
| Rate for Payer: Healthscope Commercial |
$82.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$64.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.16
|
| Rate for Payer: Mclaren Medicaid |
$7.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.85
|
| Rate for Payer: Meridian Medicaid |
$7.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.38
|
| Rate for Payer: Nomi Health Commercial |
$21.21
|
| Rate for Payer: PACE Medicare |
$13.43
|
| Rate for Payer: PACE SWMI |
$14.14
|
| Rate for Payer: PHP Commercial |
$78.38
|
| Rate for Payer: PHP Medicare Advantage |
$14.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.14
|
| Rate for Payer: Priority Health Medicare |
$14.14
|
| Rate for Payer: Priority Health Narrow Network |
$11.31
|
| Rate for Payer: Priority Health SBD |
$58.09
|
| Rate for Payer: Railroad Medicare Medicare |
$14.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.14
|
| Rate for Payer: UHC Exchange |
$14.14
|
| Rate for Payer: UHC Medicare Advantage |
$14.14
|
| Rate for Payer: UHCCP Medicaid |
$7.58
|
| Rate for Payer: UMR Bronson Commercial |
$34.12
|
| Rate for Payer: VA VA |
$14.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.16
|
|
|
HC THERAPEUTIC ACTIVITIES EA 15 MIN
|
Facility
|
OP
|
$98.84
|
|
|
Service Code
|
CPT 97530
|
| Hospital Charge Code |
42000028
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$23.20 |
| Max. Negotiated Rate |
$294.00 |
| Rate for Payer: Aetna American Axle |
$64.25
|
| Rate for Payer: Aetna Commercial |
$84.01
|
| Rate for Payer: Aetna Medicare |
$49.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.25
|
| Rate for Payer: BCBS Complete |
$39.54
|
| Rate for Payer: BCBS Trust/PPO |
$29.74
|
| Rate for Payer: BCN Commercial |
$29.74
|
| Rate for Payer: Cash Price |
$79.07
|
| Rate for Payer: Cash Price |
$79.07
|
| Rate for Payer: Cash Price |
$79.07
|
| Rate for Payer: Cofinity Commercial |
$69.19
|
| Rate for Payer: Cofinity Commercial |
$85.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$69.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.07
|
| Rate for Payer: Healthscope Commercial |
$88.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$69.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.01
|
| Rate for Payer: Nomi Health Commercial |
$135.00
|
| Rate for Payer: PHP Commercial |
$84.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$29.00
|
| Rate for Payer: Priority Health Narrow Network |
$23.20
|
| Rate for Payer: Priority Health SBD |
$62.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.60
|
| Rate for Payer: UHC Core |
$294.00
|
| Rate for Payer: UHC Exchange |
$34.18
|
| Rate for Payer: UMR Bronson Commercial |
$36.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.13
|
|
|
HC THERAPEUTIC ACTIVITIES EA 15 MIN
|
Facility
|
IP
|
$98.84
|
|
|
Service Code
|
CPT 97530
|
| Hospital Charge Code |
42000028
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$43.49 |
| Max. Negotiated Rate |
$88.96 |
| Rate for Payer: Aetna American Axle |
$64.25
|
| Rate for Payer: Aetna Commercial |
$84.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.25
|
| Rate for Payer: Cash Price |
$79.07
|
| Rate for Payer: Cofinity Commercial |
$69.19
|
| Rate for Payer: Cofinity Commercial |
$85.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$69.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.07
|
| Rate for Payer: Healthscope Commercial |
$88.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$69.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.01
|
| Rate for Payer: PHP Commercial |
$84.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.25
|
| Rate for Payer: Priority Health SBD |
$62.27
|
| Rate for Payer: UMR Bronson Commercial |
$43.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.13
|
|
|
HC THERAPEUTIC APHERESIS PLASMA PHERESIS
|
Facility
|
OP
|
$2,555.49
|
|
|
Service Code
|
CPT 36514
|
| Hospital Charge Code |
36100520
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$88.59 |
| Max. Negotiated Rate |
$5,048.06 |
| Rate for Payer: Aetna American Axle |
$1,661.07
|
| Rate for Payer: Aetna Commercial |
$2,172.17
|
| Rate for Payer: Aetna Medicare |
$1,670.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,661.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,007.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,007.66
|
| Rate for Payer: BCBS Complete |
$903.93
|
| Rate for Payer: BCBS MAPPO |
$1,606.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,955.64
|
| Rate for Payer: BCN Commercial |
$1,955.64
|
| Rate for Payer: BCN Medicare Advantage |
$1,606.13
|
| Rate for Payer: Cash Price |
$2,044.39
|
| Rate for Payer: Cash Price |
$2,044.39
|
| Rate for Payer: Cash Price |
$2,044.39
|
| Rate for Payer: Cofinity Commercial |
$1,788.84
|
| Rate for Payer: Cofinity Commercial |
$2,197.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,788.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,044.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,606.13
|
| Rate for Payer: Healthscope Commercial |
$2,299.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,788.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,916.62
|
| Rate for Payer: Mclaren Medicaid |
$860.89
|
| Rate for Payer: Mclaren Medicare |
$1,606.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,686.44
|
| Rate for Payer: Meridian Medicaid |
$903.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,847.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,172.17
|
| Rate for Payer: Nomi Health Commercial |
$4,818.39
|
| Rate for Payer: PACE Medicare |
$1,525.82
|
| Rate for Payer: PACE SWMI |
$1,606.13
|
| Rate for Payer: PHP Commercial |
$2,172.17
|
| Rate for Payer: PHP Medicare Advantage |
$1,606.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$860.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,661.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,048.06
|
| Rate for Payer: Priority Health Medicare |
$1,606.13
|
| Rate for Payer: Priority Health Narrow Network |
$4,038.45
|
| Rate for Payer: Priority Health SBD |
$1,609.96
|
| Rate for Payer: Railroad Medicare Medicare |
$1,606.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$97.45
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,606.13
|
| Rate for Payer: UHC Exchange |
$88.59
|
| Rate for Payer: UHC Medicare Advantage |
$1,606.13
|
| Rate for Payer: UHCCP Medicaid |
$860.89
|
| Rate for Payer: UMR Bronson Commercial |
$945.53
|
| Rate for Payer: VA VA |
$1,606.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,916.62
|
|
|
HC THERAPEUTIC APHERESIS PLASMA PHERESIS
|
Facility
|
IP
|
$2,555.49
|
|
|
Service Code
|
CPT 36514
|
| Hospital Charge Code |
36100520
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,124.42 |
| Max. Negotiated Rate |
$2,299.94 |
| Rate for Payer: Aetna American Axle |
$1,661.07
|
| Rate for Payer: Aetna Commercial |
$2,172.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,661.07
|
| Rate for Payer: Cash Price |
$2,044.39
|
| Rate for Payer: Cofinity Commercial |
$1,788.84
|
| Rate for Payer: Cofinity Commercial |
$2,197.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,788.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,044.39
|
| Rate for Payer: Healthscope Commercial |
$2,299.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,788.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,916.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,172.17
|
| Rate for Payer: PHP Commercial |
$2,172.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,661.07
|
| Rate for Payer: Priority Health SBD |
$1,609.96
|
| Rate for Payer: UMR Bronson Commercial |
$1,124.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,916.62
|
|
|
HC THERAPEUTIC APHERESIS RED BLOOD CELLS
|
Facility
|
IP
|
$2,481.05
|
|
|
Service Code
|
CPT 36512
|
| Hospital Charge Code |
76100326
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,091.66 |
| Max. Negotiated Rate |
$2,232.94 |
| Rate for Payer: Aetna American Axle |
$1,612.68
|
| Rate for Payer: Aetna Commercial |
$2,108.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,612.68
|
| Rate for Payer: Cash Price |
$1,984.84
|
| Rate for Payer: Cofinity Commercial |
$1,736.74
|
| Rate for Payer: Cofinity Commercial |
$2,133.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,736.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,984.84
|
| Rate for Payer: Healthscope Commercial |
$2,232.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,736.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,860.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,108.89
|
| Rate for Payer: PHP Commercial |
$2,108.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,612.68
|
| Rate for Payer: Priority Health SBD |
$1,563.06
|
| Rate for Payer: UMR Bronson Commercial |
$1,091.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,860.79
|
|
|
HC THERAPEUTIC APHERESIS RED BLOOD CELLS
|
Facility
|
OP
|
$2,481.05
|
|
|
Service Code
|
CPT 36512
|
| Hospital Charge Code |
76100326
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$99.93 |
| Max. Negotiated Rate |
$5,048.06 |
| Rate for Payer: Aetna American Axle |
$1,612.68
|
| Rate for Payer: Aetna Commercial |
$2,108.89
|
| Rate for Payer: Aetna Medicare |
$1,670.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,612.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,007.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,007.66
|
| Rate for Payer: BCBS Complete |
$903.93
|
| Rate for Payer: BCBS MAPPO |
$1,606.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,138.90
|
| Rate for Payer: BCN Commercial |
$1,138.90
|
| Rate for Payer: BCN Medicare Advantage |
$1,606.13
|
| Rate for Payer: Cash Price |
$1,984.84
|
| Rate for Payer: Cash Price |
$1,984.84
|
| Rate for Payer: Cash Price |
$1,984.84
|
| Rate for Payer: Cofinity Commercial |
$1,736.74
|
| Rate for Payer: Cofinity Commercial |
$2,133.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,736.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,984.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,606.13
|
| Rate for Payer: Healthscope Commercial |
$2,232.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,736.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,860.79
|
| Rate for Payer: Mclaren Medicaid |
$860.89
|
| Rate for Payer: Mclaren Medicare |
$1,606.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,686.44
|
| Rate for Payer: Meridian Medicaid |
$903.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,847.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,108.89
|
| Rate for Payer: Nomi Health Commercial |
$4,818.39
|
| Rate for Payer: PACE Medicare |
$1,525.82
|
| Rate for Payer: PACE SWMI |
$1,606.13
|
| Rate for Payer: PHP Commercial |
$2,108.89
|
| Rate for Payer: PHP Medicare Advantage |
$1,606.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$860.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,612.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,048.06
|
| Rate for Payer: Priority Health Medicare |
$1,606.13
|
| Rate for Payer: Priority Health Narrow Network |
$4,038.45
|
| Rate for Payer: Priority Health SBD |
$1,563.06
|
| Rate for Payer: Railroad Medicare Medicare |
$1,606.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$109.92
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,606.13
|
| Rate for Payer: UHC Exchange |
$99.93
|
| Rate for Payer: UHC Medicare Advantage |
$1,606.13
|
| Rate for Payer: UHCCP Medicaid |
$860.89
|
| Rate for Payer: UMR Bronson Commercial |
$917.99
|
| Rate for Payer: VA VA |
$1,606.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,860.79
|
|
|
HC THERAPEUTIC APHERESIS WHITE BLOOD CELL
|
Facility
|
IP
|
$2,481.05
|
|
|
Service Code
|
CPT 36511
|
| Hospital Charge Code |
76100327
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,091.66 |
| Max. Negotiated Rate |
$2,232.94 |
| Rate for Payer: Aetna American Axle |
$1,612.68
|
| Rate for Payer: Aetna Commercial |
$2,108.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,612.68
|
| Rate for Payer: Cash Price |
$1,984.84
|
| Rate for Payer: Cofinity Commercial |
$1,736.74
|
| Rate for Payer: Cofinity Commercial |
$2,133.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,736.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,984.84
|
| Rate for Payer: Healthscope Commercial |
$2,232.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,736.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,860.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,108.89
|
| Rate for Payer: PHP Commercial |
$2,108.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,612.68
|
| Rate for Payer: Priority Health SBD |
$1,563.06
|
| Rate for Payer: UMR Bronson Commercial |
$1,091.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,860.79
|
|
|
HC THERAPEUTIC APHERESIS WHITE BLOOD CELL
|
Facility
|
OP
|
$2,481.05
|
|
|
Service Code
|
CPT 36511
|
| Hospital Charge Code |
76100327
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.79 |
| Max. Negotiated Rate |
$5,048.06 |
| Rate for Payer: Aetna American Axle |
$1,612.68
|
| Rate for Payer: Aetna Commercial |
$2,108.89
|
| Rate for Payer: Aetna Medicare |
$1,670.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,612.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,007.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,007.66
|
| Rate for Payer: BCBS Complete |
$903.93
|
| Rate for Payer: BCBS MAPPO |
$1,606.13
|
| Rate for Payer: BCBS Trust/PPO |
$924.71
|
| Rate for Payer: BCN Commercial |
$924.71
|
| Rate for Payer: BCN Medicare Advantage |
$1,606.13
|
| Rate for Payer: Cash Price |
$1,984.84
|
| Rate for Payer: Cash Price |
$1,984.84
|
| Rate for Payer: Cash Price |
$1,984.84
|
| Rate for Payer: Cofinity Commercial |
$1,736.74
|
| Rate for Payer: Cofinity Commercial |
$2,133.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,736.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,984.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,606.13
|
| Rate for Payer: Healthscope Commercial |
$2,232.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,736.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,860.79
|
| Rate for Payer: Mclaren Medicaid |
$860.89
|
| Rate for Payer: Mclaren Medicare |
$1,606.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,686.44
|
| Rate for Payer: Meridian Medicaid |
$903.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,847.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,108.89
|
| Rate for Payer: Nomi Health Commercial |
$4,818.39
|
| Rate for Payer: PACE Medicare |
$1,525.82
|
| Rate for Payer: PACE SWMI |
$1,606.13
|
| Rate for Payer: PHP Commercial |
$2,108.89
|
| Rate for Payer: PHP Medicare Advantage |
$1,606.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$860.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,612.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,048.06
|
| Rate for Payer: Priority Health Medicare |
$1,606.13
|
| Rate for Payer: Priority Health Narrow Network |
$4,038.45
|
| Rate for Payer: Priority Health SBD |
$1,563.06
|
| Rate for Payer: Railroad Medicare Medicare |
$1,606.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$115.27
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,606.13
|
| Rate for Payer: UHC Exchange |
$104.79
|
| Rate for Payer: UHC Medicare Advantage |
$1,606.13
|
| Rate for Payer: UHCCP Medicaid |
$860.89
|
| Rate for Payer: UMR Bronson Commercial |
$917.99
|
| Rate for Payer: VA VA |
$1,606.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,860.79
|
|
|
HC THERAPEUTIC EX EACH 15 MIN
|
Facility
|
IP
|
$114.44
|
|
|
Service Code
|
CPT 97110
|
| Hospital Charge Code |
42000020
|
|
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 THERAPEUTIC EX EACH 15 MIN
|
Facility
|
OP
|
$114.44
|
|
|
Service Code
|
CPT 97110
|
| Hospital Charge Code |
42000020
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$22.40 |
| 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 |
$23.80
|
| Rate for Payer: BCN Commercial |
$23.80
|
| 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 |
$28.00
|
| Rate for Payer: Priority Health Narrow Network |
$22.40
|
| Rate for Payer: Priority Health SBD |
$72.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.42
|
| Rate for Payer: UHC Core |
$294.00
|
| Rate for Payer: UHC Exchange |
$27.65
|
| Rate for Payer: UMR Bronson Commercial |
$42.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.83
|
|
|
HC THERAPEUTIC PHLEBOTOMY
|
Facility
|
OP
|
$863.24
|
|
|
Service Code
|
CPT 99195
|
| Hospital Charge Code |
76100010
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$67.69 |
| Max. Negotiated Rate |
$776.92 |
| Rate for Payer: Aetna American Axle |
$561.11
|
| Rate for Payer: Aetna Commercial |
$733.75
|
| Rate for Payer: Aetna Medicare |
$131.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$561.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.86
|
| Rate for Payer: BCBS Complete |
$71.08
|
| Rate for Payer: BCBS MAPPO |
$126.29
|
| Rate for Payer: BCBS Trust/PPO |
$396.06
|
| Rate for Payer: BCN Commercial |
$396.06
|
| Rate for Payer: BCN Medicare Advantage |
$126.29
|
| Rate for Payer: Cash Price |
$690.59
|
| Rate for Payer: Cash Price |
$690.59
|
| Rate for Payer: Cofinity Commercial |
$742.39
|
| Rate for Payer: Cofinity Commercial |
$604.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$604.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$690.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$126.29
|
| Rate for Payer: Healthscope Commercial |
$776.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$604.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$647.43
|
| Rate for Payer: Mclaren Medicaid |
$67.69
|
| Rate for Payer: Mclaren Medicare |
$126.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.60
|
| Rate for Payer: Meridian Medicaid |
$71.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$145.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$733.75
|
| Rate for Payer: Nomi Health Commercial |
$378.87
|
| Rate for Payer: PACE Medicare |
$119.98
|
| Rate for Payer: PACE SWMI |
$126.29
|
| Rate for Payer: PHP Commercial |
$733.75
|
| Rate for Payer: PHP Medicare Advantage |
$126.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$561.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$396.95
|
| Rate for Payer: Priority Health Medicare |
$126.29
|
| Rate for Payer: Priority Health Narrow Network |
$317.56
|
| Rate for Payer: Priority Health SBD |
$543.84
|
| Rate for Payer: Railroad Medicare Medicare |
$126.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$126.29
|
| Rate for Payer: UHC Exchange |
$86.13
|
| Rate for Payer: UHC Medicare Advantage |
$126.29
|
| Rate for Payer: UHCCP Medicaid |
$67.69
|
| Rate for Payer: UMR Bronson Commercial |
$319.40
|
| Rate for Payer: VA VA |
$126.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$647.43
|
|
|
HC THERAPEUTIC PHLEBOTOMY
|
Facility
|
IP
|
$863.24
|
|
|
Service Code
|
CPT 99195
|
| Hospital Charge Code |
76100010
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$379.83 |
| Max. Negotiated Rate |
$776.92 |
| Rate for Payer: Aetna American Axle |
$561.11
|
| Rate for Payer: Aetna Commercial |
$733.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$561.11
|
| Rate for Payer: Cash Price |
$690.59
|
| Rate for Payer: Cofinity Commercial |
$604.27
|
| Rate for Payer: Cofinity Commercial |
$742.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$604.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$690.59
|
| Rate for Payer: Healthscope Commercial |
$776.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$604.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$647.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$733.75
|
| Rate for Payer: PHP Commercial |
$733.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$561.11
|
| Rate for Payer: Priority Health SBD |
$543.84
|
| Rate for Payer: UMR Bronson Commercial |
$379.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$647.43
|
|
|
HC THERASKIN PER SQ CM (116 SQ CM)
|
Facility
|
IP
|
$59.43
|
|
|
Service Code
|
HCPCS Q4121
|
| Hospital Charge Code |
63600219
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.15 |
| Max. Negotiated Rate |
$53.49 |
| Rate for Payer: Aetna American Axle |
$38.63
|
| Rate for Payer: Aetna Commercial |
$50.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.63
|
| Rate for Payer: Cash Price |
$47.54
|
| Rate for Payer: Cofinity Commercial |
$41.60
|
| Rate for Payer: Cofinity Commercial |
$51.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$41.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.54
|
| Rate for Payer: Healthscope Commercial |
$53.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$41.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.52
|
| Rate for Payer: PHP Commercial |
$50.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.63
|
| Rate for Payer: Priority Health SBD |
$37.44
|
| Rate for Payer: UMR Bronson Commercial |
$26.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.57
|
|
|
HC THERASKIN PER SQ CM (116 SQ CM)
|
Facility
|
OP
|
$59.43
|
|
|
Service Code
|
HCPCS Q4121
|
| Hospital Charge Code |
63600219
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.99 |
| Max. Negotiated Rate |
$53.49 |
| Rate for Payer: Aetna American Axle |
$38.63
|
| Rate for Payer: Aetna Commercial |
$50.52
|
| Rate for Payer: Aetna Medicare |
$29.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.63
|
| Rate for Payer: BCBS Complete |
$23.77
|
| Rate for Payer: BCBS Trust/PPO |
$38.93
|
| Rate for Payer: BCN Commercial |
$38.93
|
| Rate for Payer: Cash Price |
$47.54
|
| Rate for Payer: Cash Price |
$47.54
|
| Rate for Payer: Cofinity Commercial |
$41.60
|
| Rate for Payer: Cofinity Commercial |
$51.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$41.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.54
|
| Rate for Payer: Healthscope Commercial |
$53.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$41.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.52
|
| Rate for Payer: PHP Commercial |
$50.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.63
|
| Rate for Payer: Priority Health SBD |
$37.44
|
| Rate for Payer: UMR Bronson Commercial |
$21.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.57
|
|
|
HC THERASKIN PER SQ CM (13 SQ CM)
|
Facility
|
IP
|
$184.13
|
|
|
Service Code
|
CPT Q4121
|
| Hospital Charge Code |
63600064
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$81.02 |
| Max. Negotiated Rate |
$165.72 |
| Rate for Payer: Aetna American Axle |
$119.68
|
| Rate for Payer: Aetna Commercial |
$156.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$119.68
|
| Rate for Payer: Cash Price |
$147.30
|
| Rate for Payer: Cofinity Commercial |
$128.89
|
| Rate for Payer: Cofinity Commercial |
$158.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$128.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$147.30
|
| Rate for Payer: Healthscope Commercial |
$165.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$128.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$138.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$156.51
|
| Rate for Payer: PHP Commercial |
$156.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.68
|
| Rate for Payer: Priority Health SBD |
$116.00
|
| Rate for Payer: UMR Bronson Commercial |
$81.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$138.10
|
|
|
HC THERASKIN PER SQ CM (13 SQ CM)
|
Facility
|
OP
|
$184.13
|
|
|
Service Code
|
CPT Q4121
|
| Hospital Charge Code |
63600064
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.93 |
| Max. Negotiated Rate |
$165.72 |
| Rate for Payer: Aetna American Axle |
$119.68
|
| Rate for Payer: Aetna Commercial |
$156.51
|
| Rate for Payer: Aetna Medicare |
$92.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$119.68
|
| Rate for Payer: BCBS Complete |
$73.65
|
| Rate for Payer: BCBS Trust/PPO |
$38.93
|
| Rate for Payer: BCN Commercial |
$38.93
|
| Rate for Payer: Cash Price |
$147.30
|
| Rate for Payer: Cash Price |
$147.30
|
| Rate for Payer: Cofinity Commercial |
$128.89
|
| Rate for Payer: Cofinity Commercial |
$158.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$128.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$147.30
|
| Rate for Payer: Healthscope Commercial |
$165.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$128.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$138.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$156.51
|
| Rate for Payer: PHP Commercial |
$156.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.68
|
| Rate for Payer: Priority Health SBD |
$116.00
|
| Rate for Payer: UMR Bronson Commercial |
$68.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$138.10
|
|
|
HC THERASKIN PER SQ CM (39 SQ CM)
|
Facility
|
OP
|
$84.55
|
|
|
Service Code
|
CPT Q4121
|
| Hospital Charge Code |
63600065
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.28 |
| Max. Negotiated Rate |
$76.10 |
| Rate for Payer: Aetna American Axle |
$54.96
|
| Rate for Payer: Aetna Commercial |
$71.87
|
| Rate for Payer: Aetna Medicare |
$42.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.96
|
| Rate for Payer: BCBS Complete |
$33.82
|
| Rate for Payer: BCBS Trust/PPO |
$38.93
|
| Rate for Payer: BCN Commercial |
$38.93
|
| Rate for Payer: Cash Price |
$67.64
|
| Rate for Payer: Cash Price |
$67.64
|
| Rate for Payer: Cofinity Commercial |
$59.18
|
| Rate for Payer: Cofinity Commercial |
$72.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$59.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.64
|
| Rate for Payer: Healthscope Commercial |
$76.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$59.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.87
|
| Rate for Payer: PHP Commercial |
$71.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.96
|
| Rate for Payer: Priority Health SBD |
$53.27
|
| Rate for Payer: UMR Bronson Commercial |
$31.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.41
|
|
|
HC THERASKIN PER SQ CM (39 SQ CM)
|
Facility
|
IP
|
$84.55
|
|
|
Service Code
|
CPT Q4121
|
| Hospital Charge Code |
63600065
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.20 |
| Max. Negotiated Rate |
$76.10 |
| Rate for Payer: Aetna American Axle |
$54.96
|
| Rate for Payer: Aetna Commercial |
$71.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.96
|
| Rate for Payer: Cash Price |
$67.64
|
| Rate for Payer: Cofinity Commercial |
$59.18
|
| Rate for Payer: Cofinity Commercial |
$72.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$59.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.64
|
| Rate for Payer: Healthscope Commercial |
$76.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$59.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.87
|
| Rate for Payer: PHP Commercial |
$71.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.96
|
| Rate for Payer: Priority Health SBD |
$53.27
|
| Rate for Payer: UMR Bronson Commercial |
$37.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.41
|
|
|
HC THERASKIN PER SQ CM (6 SQ CM)
|
Facility
|
OP
|
$421.04
|
|
|
Service Code
|
HCPCS Q4121
|
| Hospital Charge Code |
63600127
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.93 |
| Max. Negotiated Rate |
$378.94 |
| Rate for Payer: Aetna American Axle |
$273.68
|
| Rate for Payer: Aetna Commercial |
$357.88
|
| Rate for Payer: Aetna Medicare |
$210.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$273.68
|
| Rate for Payer: BCBS Complete |
$168.42
|
| Rate for Payer: BCBS Trust/PPO |
$38.93
|
| Rate for Payer: BCN Commercial |
$38.93
|
| Rate for Payer: Cash Price |
$336.83
|
| Rate for Payer: Cash Price |
$336.83
|
| Rate for Payer: Cofinity Commercial |
$294.73
|
| Rate for Payer: Cofinity Commercial |
$362.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$294.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$336.83
|
| Rate for Payer: Healthscope Commercial |
$378.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$294.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$315.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$357.88
|
| Rate for Payer: PHP Commercial |
$357.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$273.68
|
| Rate for Payer: Priority Health SBD |
$265.26
|
| Rate for Payer: UMR Bronson Commercial |
$155.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$315.78
|
|
|
HC THERASKIN PER SQ CM (6 SQ CM)
|
Facility
|
IP
|
$421.04
|
|
|
Service Code
|
HCPCS Q4121
|
| Hospital Charge Code |
63600127
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$185.26 |
| Max. Negotiated Rate |
$378.94 |
| Rate for Payer: Aetna American Axle |
$273.68
|
| Rate for Payer: Aetna Commercial |
$357.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$273.68
|
| Rate for Payer: Cash Price |
$336.83
|
| Rate for Payer: Cofinity Commercial |
$294.73
|
| Rate for Payer: Cofinity Commercial |
$362.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$294.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$336.83
|
| Rate for Payer: Healthscope Commercial |
$378.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$294.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$315.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$357.88
|
| Rate for Payer: PHP Commercial |
$357.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$273.68
|
| Rate for Payer: Priority Health SBD |
$265.26
|
| Rate for Payer: UMR Bronson Commercial |
$185.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$315.78
|
|
|
HC THER PROC STRGTH/END RESP 15M
|
Facility
|
OP
|
$87.68
|
|
|
Service Code
|
HCPCS G0237
|
| Hospital Charge Code |
41000047
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$10.23 |
| Max. Negotiated Rate |
$294.00 |
| Rate for Payer: Aetna American Axle |
$56.99
|
| Rate for Payer: Aetna Commercial |
$74.53
|
| Rate for Payer: Aetna Medicare |
$24.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.99
|
| Rate for Payer: BCBS Complete |
$13.50
|
| Rate for Payer: BCBS MAPPO |
$23.99
|
| Rate for Payer: BCBS Trust/PPO |
$13.72
|
| Rate for Payer: BCN Commercial |
$13.72
|
| Rate for Payer: BCN Medicare Advantage |
$23.99
|
| Rate for Payer: Cash Price |
$70.14
|
| Rate for Payer: Cash Price |
$70.14
|
| Rate for Payer: Cash Price |
$70.14
|
| Rate for Payer: Cofinity Commercial |
$61.38
|
| Rate for Payer: Cofinity Commercial |
$75.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$61.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.99
|
| Rate for Payer: Healthscope Commercial |
$78.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$61.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.76
|
| Rate for Payer: Mclaren Medicaid |
$12.86
|
| Rate for Payer: Mclaren Medicare |
$23.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.19
|
| Rate for Payer: Meridian Medicaid |
$13.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.53
|
| Rate for Payer: Nomi Health Commercial |
$71.97
|
| Rate for Payer: PACE Medicare |
$22.79
|
| Rate for Payer: PACE SWMI |
$23.99
|
| Rate for Payer: PHP Commercial |
$74.53
|
| Rate for Payer: PHP Medicare Advantage |
$23.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75.43
|
| Rate for Payer: Priority Health Medicare |
$23.99
|
| Rate for Payer: Priority Health Narrow Network |
$60.34
|
| Rate for Payer: Priority Health SBD |
$55.24
|
| Rate for Payer: Railroad Medicare Medicare |
$23.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.25
|
| Rate for Payer: UHC Core |
$294.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.99
|
| Rate for Payer: UHC Exchange |
$10.23
|
| Rate for Payer: UHC Medicare Advantage |
$23.99
|
| Rate for Payer: UHCCP Medicaid |
$12.86
|
| Rate for Payer: UMR Bronson Commercial |
$32.44
|
| Rate for Payer: VA VA |
$23.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.76
|
|
|
HC THER PROC STRGTH/END RESP 15M
|
Facility
|
IP
|
$87.68
|
|
|
Service Code
|
HCPCS G0237
|
| Hospital Charge Code |
41000047
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$38.58 |
| Max. Negotiated Rate |
$78.91 |
| Rate for Payer: Aetna American Axle |
$56.99
|
| Rate for Payer: Aetna Commercial |
$74.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.99
|
| Rate for Payer: Cash Price |
$70.14
|
| Rate for Payer: Cofinity Commercial |
$61.38
|
| Rate for Payer: Cofinity Commercial |
$75.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$61.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.14
|
| Rate for Payer: Healthscope Commercial |
$78.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$61.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.53
|
| Rate for Payer: PHP Commercial |
$74.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.99
|
| Rate for Payer: Priority Health SBD |
$55.24
|
| Rate for Payer: UMR Bronson Commercial |
$38.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.76
|
|
|
HC THIAMINE LEVEL VITAMIN B1
|
Facility
|
OP
|
$61.38
|
|
|
Service Code
|
CPT 84425
|
| Hospital Charge Code |
30100432
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.38 |
| Max. Negotiated Rate |
$55.24 |
| Rate for Payer: Aetna American Axle |
$39.90
|
| Rate for Payer: Aetna Commercial |
$52.17
|
| Rate for Payer: Aetna Medicare |
$22.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.54
|
| Rate for Payer: BCBS Complete |
$11.95
|
| Rate for Payer: BCBS MAPPO |
$21.23
|
| Rate for Payer: BCBS Trust/PPO |
$20.45
|
| Rate for Payer: BCN Commercial |
$20.45
|
| Rate for Payer: BCN Medicare Advantage |
$21.23
|
| Rate for Payer: Cash Price |
$49.10
|
| Rate for Payer: Cash Price |
$49.10
|
| Rate for Payer: Cofinity Commercial |
$52.79
|
| Rate for Payer: Cofinity Commercial |
$42.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$42.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.23
|
| Rate for Payer: Healthscope Commercial |
$55.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.04
|
| Rate for Payer: Mclaren Medicaid |
$11.38
|
| Rate for Payer: Mclaren Medicare |
$21.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.29
|
| Rate for Payer: Meridian Medicaid |
$11.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.17
|
| Rate for Payer: Nomi Health Commercial |
$31.84
|
| Rate for Payer: PACE Medicare |
$20.17
|
| Rate for Payer: PACE SWMI |
$21.23
|
| Rate for Payer: PHP Commercial |
$52.17
|
| Rate for Payer: PHP Medicare Advantage |
$21.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.84
|
| Rate for Payer: Priority Health Medicare |
$21.23
|
| Rate for Payer: Priority Health Narrow Network |
$17.47
|
| Rate for Payer: Priority Health SBD |
$38.67
|
| Rate for Payer: Railroad Medicare Medicare |
$21.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.23
|
| Rate for Payer: UHC Exchange |
$21.23
|
| Rate for Payer: UHC Medicare Advantage |
$21.23
|
| Rate for Payer: UHCCP Medicaid |
$11.38
|
| Rate for Payer: UMR Bronson Commercial |
$22.71
|
| Rate for Payer: VA VA |
$21.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.04
|
|
|
HC THIAMINE LEVEL VITAMIN B1
|
Facility
|
IP
|
$61.38
|
|
|
Service Code
|
CPT 84425
|
| Hospital Charge Code |
30100432
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.01 |
| Max. Negotiated Rate |
$55.24 |
| Rate for Payer: Aetna American Axle |
$39.90
|
| Rate for Payer: Aetna Commercial |
$52.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.90
|
| Rate for Payer: Cash Price |
$49.10
|
| Rate for Payer: Cofinity Commercial |
$42.97
|
| Rate for Payer: Cofinity Commercial |
$52.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$42.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.10
|
| Rate for Payer: Healthscope Commercial |
$55.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.17
|
| Rate for Payer: PHP Commercial |
$52.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.90
|
| Rate for Payer: Priority Health SBD |
$38.67
|
| Rate for Payer: UMR Bronson Commercial |
$27.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.04
|
|
