|
HC TISSUE TRANSGLUTAMINASE IGA
|
Facility
|
OP
|
$36.41
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30200010
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.18 |
| Max. Negotiated Rate |
$32.77 |
| Rate for Payer: Aetna American Axle |
$23.67
|
| Rate for Payer: Aetna Commercial |
$30.95
|
| Rate for Payer: Aetna Medicare |
$11.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.41
|
| Rate for Payer: BCBS Complete |
$6.49
|
| Rate for Payer: BCBS MAPPO |
$11.53
|
| Rate for Payer: BCN Medicare Advantage |
$11.53
|
| Rate for Payer: Cash Price |
$29.13
|
| Rate for Payer: Cash Price |
$29.13
|
| Rate for Payer: Cofinity Commercial |
$31.31
|
| Rate for Payer: Cofinity Commercial |
$25.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$25.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.53
|
| Rate for Payer: Healthscope Commercial |
$32.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.31
|
| Rate for Payer: Mclaren Medicaid |
$6.18
|
| Rate for Payer: Mclaren Medicare |
$11.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.11
|
| Rate for Payer: Meridian Medicaid |
$6.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.95
|
| Rate for Payer: PACE Medicare |
$10.95
|
| Rate for Payer: PACE SWMI |
$11.53
|
| Rate for Payer: PHP Commercial |
$30.95
|
| Rate for Payer: PHP Medicare Advantage |
$11.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.67
|
| Rate for Payer: Priority Health Medicare |
$11.53
|
| Rate for Payer: Priority Health SBD |
$22.94
|
| Rate for Payer: Railroad Medicare Medicare |
$11.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.53
|
| Rate for Payer: UHC Exchange |
$22.03
|
| Rate for Payer: UHC Medicare Advantage |
$11.53
|
| Rate for Payer: UHCCP Medicaid |
$6.18
|
| Rate for Payer: UMR Bronson Commercial |
$13.47
|
| Rate for Payer: VA VA |
$11.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.31
|
|
|
HC TISSUE TRANSGLUTAMINASE IGA
|
Facility
|
IP
|
$36.41
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30200010
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.02 |
| Max. Negotiated Rate |
$32.77 |
| Rate for Payer: Aetna American Axle |
$23.67
|
| Rate for Payer: Aetna Commercial |
$30.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.67
|
| Rate for Payer: Cash Price |
$29.13
|
| Rate for Payer: Cofinity Commercial |
$25.49
|
| Rate for Payer: Cofinity Commercial |
$31.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$25.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.13
|
| Rate for Payer: Healthscope Commercial |
$32.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.95
|
| Rate for Payer: PHP Commercial |
$30.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.67
|
| Rate for Payer: Priority Health SBD |
$22.94
|
| Rate for Payer: UMR Bronson Commercial |
$16.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.31
|
|
|
HC TISSUE TRANSGLUTAMINASE IGG
|
Facility
|
IP
|
$36.41
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30200008
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.02 |
| Max. Negotiated Rate |
$32.77 |
| Rate for Payer: Aetna American Axle |
$23.67
|
| Rate for Payer: Aetna Commercial |
$30.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.67
|
| Rate for Payer: Cash Price |
$29.13
|
| Rate for Payer: Cofinity Commercial |
$25.49
|
| Rate for Payer: Cofinity Commercial |
$31.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$25.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.13
|
| Rate for Payer: Healthscope Commercial |
$32.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.95
|
| Rate for Payer: PHP Commercial |
$30.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.67
|
| Rate for Payer: Priority Health SBD |
$22.94
|
| Rate for Payer: UMR Bronson Commercial |
$16.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.31
|
|
|
HC TISSUE TRANSGLUTAMINASE IGG
|
Facility
|
OP
|
$36.41
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30200008
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.18 |
| Max. Negotiated Rate |
$32.77 |
| Rate for Payer: Aetna American Axle |
$23.67
|
| Rate for Payer: Aetna Commercial |
$30.95
|
| Rate for Payer: Aetna Medicare |
$11.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.41
|
| Rate for Payer: BCBS Complete |
$6.49
|
| Rate for Payer: BCBS MAPPO |
$11.53
|
| Rate for Payer: BCN Medicare Advantage |
$11.53
|
| Rate for Payer: Cash Price |
$29.13
|
| Rate for Payer: Cash Price |
$29.13
|
| Rate for Payer: Cofinity Commercial |
$31.31
|
| Rate for Payer: Cofinity Commercial |
$25.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$25.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.53
|
| Rate for Payer: Healthscope Commercial |
$32.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.31
|
| Rate for Payer: Mclaren Medicaid |
$6.18
|
| Rate for Payer: Mclaren Medicare |
$11.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.11
|
| Rate for Payer: Meridian Medicaid |
$6.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.95
|
| Rate for Payer: PACE Medicare |
$10.95
|
| Rate for Payer: PACE SWMI |
$11.53
|
| Rate for Payer: PHP Commercial |
$30.95
|
| Rate for Payer: PHP Medicare Advantage |
$11.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.67
|
| Rate for Payer: Priority Health Medicare |
$11.53
|
| Rate for Payer: Priority Health SBD |
$22.94
|
| Rate for Payer: Railroad Medicare Medicare |
$11.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.53
|
| Rate for Payer: UHC Exchange |
$22.03
|
| Rate for Payer: UHC Medicare Advantage |
$11.53
|
| Rate for Payer: UHCCP Medicaid |
$6.18
|
| Rate for Payer: UMR Bronson Commercial |
$13.47
|
| Rate for Payer: VA VA |
$11.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.31
|
|
|
HC TIXAGEVIMAB/CILGAVIMAB 150 MG
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS Q0220
|
| Hospital Charge Code |
63600197
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna American Axle |
$0.01
|
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: Aetna Medicare |
$0.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.01
|
| Rate for Payer: BCBS Complete |
$0.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$0.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.01
|
| Rate for Payer: Healthscope Commercial |
$0.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: PHP Commercial |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.01
|
| Rate for Payer: Priority Health SBD |
$0.01
|
| Rate for Payer: UMR Bronson Commercial |
$0.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.01
|
|
|
HC TIXAGEVIMAB/CILGAVIMAB 150 MG
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS Q0220
|
| Hospital Charge Code |
63600197
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna American Axle |
$0.01
|
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$0.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.01
|
| Rate for Payer: Healthscope Commercial |
$0.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: PHP Commercial |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.01
|
| Rate for Payer: Priority Health SBD |
$0.01
|
| Rate for Payer: UMR Bronson Commercial |
$0.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.01
|
|
|
HC TIXAGEVIMAB/CILGAVIMAB 300 MG
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS Q0221
|
| Hospital Charge Code |
63600203
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna American Axle |
$0.01
|
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$0.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.01
|
| Rate for Payer: Healthscope Commercial |
$0.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: PHP Commercial |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.01
|
| Rate for Payer: Priority Health SBD |
$0.01
|
| Rate for Payer: UMR Bronson Commercial |
$0.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.01
|
|
|
HC TIXAGEVIMAB/CILGAVIMAB 300 MG
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS Q0221
|
| Hospital Charge Code |
63600203
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna American Axle |
$0.01
|
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: Aetna Medicare |
$0.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.01
|
| Rate for Payer: BCBS Complete |
$0.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$0.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.01
|
| Rate for Payer: Healthscope Commercial |
$0.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: PHP Commercial |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.01
|
| Rate for Payer: Priority Health SBD |
$0.01
|
| Rate for Payer: UMR Bronson Commercial |
$0.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.01
|
|
|
HC TL 201 PER MCI
|
Facility
|
IP
|
$193.26
|
|
|
Service Code
|
HCPCS A9505
|
| Hospital Charge Code |
34300022
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$85.03 |
| Max. Negotiated Rate |
$173.93 |
| Rate for Payer: Aetna American Axle |
$125.62
|
| Rate for Payer: Aetna Commercial |
$164.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.62
|
| Rate for Payer: Cash Price |
$154.61
|
| Rate for Payer: Cofinity Commercial |
$135.28
|
| Rate for Payer: Cofinity Commercial |
$166.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$135.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.61
|
| Rate for Payer: Healthscope Commercial |
$173.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$135.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$144.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$164.27
|
| Rate for Payer: PHP Commercial |
$164.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$125.62
|
| Rate for Payer: Priority Health SBD |
$121.75
|
| Rate for Payer: UMR Bronson Commercial |
$85.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$144.94
|
|
|
HC TL 201 PER MCI
|
Facility
|
OP
|
$193.26
|
|
|
Service Code
|
HCPCS A9505
|
| Hospital Charge Code |
34300022
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$71.51 |
| Max. Negotiated Rate |
$173.93 |
| Rate for Payer: Aetna American Axle |
$125.62
|
| Rate for Payer: Aetna Commercial |
$164.27
|
| Rate for Payer: Aetna Medicare |
$96.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.62
|
| Rate for Payer: BCBS Complete |
$77.30
|
| Rate for Payer: Cash Price |
$154.61
|
| Rate for Payer: Cofinity Commercial |
$135.28
|
| Rate for Payer: Cofinity Commercial |
$166.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$135.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.61
|
| Rate for Payer: Healthscope Commercial |
$173.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$135.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$144.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$164.27
|
| Rate for Payer: PHP Commercial |
$164.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$125.62
|
| Rate for Payer: Priority Health SBD |
$121.75
|
| Rate for Payer: UMR Bronson Commercial |
$71.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$144.94
|
|
|
HC TOBRAMYCIN LEVEL
|
Facility
|
IP
|
$107.51
|
|
|
Service Code
|
CPT 80200
|
| Hospital Charge Code |
30100049
|
|
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 TOBRAMYCIN LEVEL
|
Facility
|
OP
|
$107.51
|
|
|
Service Code
|
CPT 80200
|
| Hospital Charge Code |
30100049
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.65 |
| 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 |
$16.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.16
|
| Rate for Payer: BCBS Complete |
$9.08
|
| Rate for Payer: BCBS MAPPO |
$16.13
|
| Rate for Payer: BCN Medicare Advantage |
$16.13
|
| 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 |
$16.13
|
| 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 |
$8.65
|
| Rate for Payer: Mclaren Medicare |
$16.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.94
|
| Rate for Payer: Meridian Medicaid |
$9.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.38
|
| Rate for Payer: PACE Medicare |
$15.32
|
| Rate for Payer: PACE SWMI |
$16.13
|
| Rate for Payer: PHP Commercial |
$91.38
|
| Rate for Payer: PHP Medicare Advantage |
$16.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.88
|
| Rate for Payer: Priority Health Medicare |
$16.13
|
| Rate for Payer: Priority Health SBD |
$67.73
|
| Rate for Payer: Railroad Medicare Medicare |
$16.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.13
|
| Rate for Payer: UHC Exchange |
$30.83
|
| Rate for Payer: UHC Medicare Advantage |
$16.13
|
| Rate for Payer: UHCCP Medicaid |
$8.65
|
| Rate for Payer: UMR Bronson Commercial |
$39.78
|
| Rate for Payer: VA VA |
$16.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.63
|
|
|
HC TOMATO IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200105
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna American Axle |
$16.50
|
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.04
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$16.00
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$9.98
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.80
|
| Rate for Payer: UMR Bronson Commercial |
$9.39
|
| Rate for Payer: VA VA |
$5.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.04
|
|
|
HC TOMATO IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200105
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.17 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna American Axle |
$16.50
|
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health SBD |
$16.00
|
| Rate for Payer: UMR Bronson Commercial |
$11.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.04
|
|
|
HC TOMO GUIDED BREAST BIOPSY
|
Facility
|
OP
|
$4,731.78
|
|
|
Service Code
|
CPT 19499
|
| Hospital Charge Code |
36100566
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,750.76 |
| Max. Negotiated Rate |
$10,512.58 |
| Rate for Payer: Aetna American Axle |
$3,075.66
|
| Rate for Payer: Aetna Commercial |
$4,022.01
|
| Rate for Payer: Aetna Medicare |
$3,884.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,075.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,668.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,668.27
|
| Rate for Payer: BCBS Complete |
$2,101.84
|
| Rate for Payer: BCBS MAPPO |
$3,734.62
|
| Rate for Payer: BCN Medicare Advantage |
$3,734.62
|
| Rate for Payer: Cash Price |
$3,785.42
|
| Rate for Payer: Cash Price |
$3,785.42
|
| Rate for Payer: Cofinity Commercial |
$4,069.33
|
| Rate for Payer: Cofinity Commercial |
$3,312.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,312.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,785.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,734.62
|
| Rate for Payer: Healthscope Commercial |
$4,258.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,312.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,548.84
|
| Rate for Payer: Mclaren Medicaid |
$2,001.76
|
| Rate for Payer: Mclaren Medicare |
$3,734.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,921.35
|
| Rate for Payer: Meridian Medicaid |
$2,101.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,294.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,022.01
|
| Rate for Payer: PACE Medicare |
$3,547.89
|
| Rate for Payer: PACE SWMI |
$3,734.62
|
| Rate for Payer: PHP Commercial |
$4,022.01
|
| Rate for Payer: PHP Medicare Advantage |
$3,734.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,001.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,075.66
|
| Rate for Payer: Priority Health Medicare |
$3,734.62
|
| Rate for Payer: Priority Health SBD |
$2,981.02
|
| Rate for Payer: Railroad Medicare Medicare |
$3,734.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,512.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,734.62
|
| Rate for Payer: UHC Exchange |
$7,137.23
|
| Rate for Payer: UHC Medicare Advantage |
$3,734.62
|
| Rate for Payer: UHCCP Medicaid |
$2,001.76
|
| Rate for Payer: UMR Bronson Commercial |
$1,750.76
|
| Rate for Payer: VA VA |
$3,734.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,548.84
|
|
|
HC TOMO GUIDED BREAST BIOPSY
|
Facility
|
IP
|
$4,731.78
|
|
|
Service Code
|
CPT 19499
|
| Hospital Charge Code |
36100566
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,081.98 |
| Max. Negotiated Rate |
$4,258.60 |
| Rate for Payer: Aetna American Axle |
$3,075.66
|
| Rate for Payer: Aetna Commercial |
$4,022.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,075.66
|
| Rate for Payer: Cash Price |
$3,785.42
|
| Rate for Payer: Cofinity Commercial |
$3,312.25
|
| Rate for Payer: Cofinity Commercial |
$4,069.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,312.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,785.42
|
| Rate for Payer: Healthscope Commercial |
$4,258.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,312.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,548.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,022.01
|
| Rate for Payer: PHP Commercial |
$4,022.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,075.66
|
| Rate for Payer: Priority Health SBD |
$2,981.02
|
| Rate for Payer: UMR Bronson Commercial |
$2,081.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,548.84
|
|
|
HC TOMO GUIDED BREAST LOCALIZATION
|
Facility
|
IP
|
$3,155.08
|
|
|
Service Code
|
CPT 19499
|
| Hospital Charge Code |
36100567
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,388.24 |
| Max. Negotiated Rate |
$2,839.57 |
| Rate for Payer: Aetna American Axle |
$2,050.80
|
| Rate for Payer: Aetna Commercial |
$2,681.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,050.80
|
| Rate for Payer: Cash Price |
$2,524.06
|
| Rate for Payer: Cofinity Commercial |
$2,208.56
|
| Rate for Payer: Cofinity Commercial |
$2,713.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,208.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,524.06
|
| Rate for Payer: Healthscope Commercial |
$2,839.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,208.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,366.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,681.82
|
| Rate for Payer: PHP Commercial |
$2,681.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,050.80
|
| Rate for Payer: Priority Health SBD |
$1,987.70
|
| Rate for Payer: UMR Bronson Commercial |
$1,388.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,366.31
|
|
|
HC TOMO GUIDED BREAST LOCALIZATION
|
Facility
|
OP
|
$3,155.08
|
|
|
Service Code
|
CPT 19499
|
| Hospital Charge Code |
36100567
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,167.38 |
| Max. Negotiated Rate |
$10,512.58 |
| Rate for Payer: Aetna American Axle |
$2,050.80
|
| Rate for Payer: Aetna Commercial |
$2,681.82
|
| Rate for Payer: Aetna Medicare |
$3,884.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,050.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,668.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,668.27
|
| Rate for Payer: BCBS Complete |
$2,101.84
|
| Rate for Payer: BCBS MAPPO |
$3,734.62
|
| Rate for Payer: BCN Medicare Advantage |
$3,734.62
|
| Rate for Payer: Cash Price |
$2,524.06
|
| Rate for Payer: Cash Price |
$2,524.06
|
| Rate for Payer: Cofinity Commercial |
$2,713.37
|
| Rate for Payer: Cofinity Commercial |
$2,208.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,208.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,524.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,734.62
|
| Rate for Payer: Healthscope Commercial |
$2,839.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,208.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,366.31
|
| Rate for Payer: Mclaren Medicaid |
$2,001.76
|
| Rate for Payer: Mclaren Medicare |
$3,734.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,921.35
|
| Rate for Payer: Meridian Medicaid |
$2,101.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,294.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,681.82
|
| Rate for Payer: PACE Medicare |
$3,547.89
|
| Rate for Payer: PACE SWMI |
$3,734.62
|
| Rate for Payer: PHP Commercial |
$2,681.82
|
| Rate for Payer: PHP Medicare Advantage |
$3,734.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,001.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,050.80
|
| Rate for Payer: Priority Health Medicare |
$3,734.62
|
| Rate for Payer: Priority Health SBD |
$1,987.70
|
| Rate for Payer: Railroad Medicare Medicare |
$3,734.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,512.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,734.62
|
| Rate for Payer: UHC Exchange |
$7,137.23
|
| Rate for Payer: UHC Medicare Advantage |
$3,734.62
|
| Rate for Payer: UHCCP Medicaid |
$2,001.76
|
| Rate for Payer: UMR Bronson Commercial |
$1,167.38
|
| Rate for Payer: VA VA |
$3,734.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,366.31
|
|
|
HC TONE DECAY HEARING TEST
|
Facility
|
IP
|
$57.12
|
|
|
Service Code
|
CPT 92563
|
| Hospital Charge Code |
76100501
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$25.13 |
| Max. Negotiated Rate |
$51.41 |
| Rate for Payer: Aetna American Axle |
$37.13
|
| Rate for Payer: Aetna Commercial |
$48.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.13
|
| Rate for Payer: Cash Price |
$45.70
|
| Rate for Payer: Cofinity Commercial |
$39.98
|
| Rate for Payer: Cofinity Commercial |
$49.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$39.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.70
|
| Rate for Payer: Healthscope Commercial |
$51.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.55
|
| Rate for Payer: PHP Commercial |
$48.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.13
|
| Rate for Payer: Priority Health SBD |
$35.99
|
| Rate for Payer: UMR Bronson Commercial |
$25.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.84
|
|
|
HC TONE DECAY HEARING TEST
|
Facility
|
OP
|
$57.12
|
|
|
Service Code
|
CPT 92563
|
| Hospital Charge Code |
76100501
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$20.52 |
| Max. Negotiated Rate |
$294.00 |
| Rate for Payer: Aetna American Axle |
$37.13
|
| Rate for Payer: Aetna Commercial |
$48.55
|
| Rate for Payer: Aetna Medicare |
$39.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47.85
|
| Rate for Payer: BCBS Complete |
$21.54
|
| Rate for Payer: BCBS MAPPO |
$38.28
|
| Rate for Payer: BCN Medicare Advantage |
$38.28
|
| Rate for Payer: Cash Price |
$45.70
|
| Rate for Payer: Cash Price |
$45.70
|
| Rate for Payer: Cash Price |
$45.70
|
| Rate for Payer: Cofinity Commercial |
$39.98
|
| Rate for Payer: Cofinity Commercial |
$49.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$39.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.28
|
| Rate for Payer: Healthscope Commercial |
$51.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.84
|
| Rate for Payer: Mclaren Medicaid |
$20.52
|
| Rate for Payer: Mclaren Medicare |
$38.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.19
|
| Rate for Payer: Meridian Medicaid |
$21.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.55
|
| Rate for Payer: PACE Medicare |
$36.37
|
| Rate for Payer: PACE SWMI |
$38.28
|
| Rate for Payer: PHP Commercial |
$48.55
|
| Rate for Payer: PHP Medicare Advantage |
$38.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.13
|
| Rate for Payer: Priority Health Medicare |
$38.28
|
| Rate for Payer: Priority Health SBD |
$35.99
|
| Rate for Payer: Railroad Medicare Medicare |
$38.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$107.75
|
| Rate for Payer: UHC Core |
$294.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.28
|
| Rate for Payer: UHC Exchange |
$73.16
|
| Rate for Payer: UHC Medicare Advantage |
$38.28
|
| Rate for Payer: UHCCP Medicaid |
$20.52
|
| Rate for Payer: UMR Bronson Commercial |
$21.13
|
| Rate for Payer: VA VA |
$38.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.84
|
|
|
HC TOPIRAMATE LEVEL
|
Facility
|
OP
|
$58.62
|
|
|
Service Code
|
CPT 80201
|
| Hospital Charge Code |
30100050
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.39 |
| Max. Negotiated Rate |
$52.76 |
| Rate for Payer: Aetna American Axle |
$38.10
|
| Rate for Payer: Aetna Commercial |
$49.83
|
| Rate for Payer: Aetna Medicare |
$12.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.90
|
| Rate for Payer: BCBS Complete |
$6.71
|
| Rate for Payer: BCBS MAPPO |
$11.92
|
| Rate for Payer: BCN Medicare Advantage |
$11.92
|
| Rate for Payer: Cash Price |
$46.90
|
| Rate for Payer: Cash Price |
$46.90
|
| Rate for Payer: Cofinity Commercial |
$50.41
|
| Rate for Payer: Cofinity Commercial |
$41.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$41.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.92
|
| Rate for Payer: Healthscope Commercial |
$52.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$41.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.97
|
| Rate for Payer: Mclaren Medicaid |
$6.39
|
| Rate for Payer: Mclaren Medicare |
$11.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.52
|
| Rate for Payer: Meridian Medicaid |
$6.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.83
|
| Rate for Payer: PACE Medicare |
$11.32
|
| Rate for Payer: PACE SWMI |
$11.92
|
| Rate for Payer: PHP Commercial |
$49.83
|
| Rate for Payer: PHP Medicare Advantage |
$11.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.10
|
| Rate for Payer: Priority Health Medicare |
$11.92
|
| Rate for Payer: Priority Health SBD |
$36.93
|
| Rate for Payer: Railroad Medicare Medicare |
$11.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.92
|
| Rate for Payer: UHC Exchange |
$22.78
|
| Rate for Payer: UHC Medicare Advantage |
$11.92
|
| Rate for Payer: UHCCP Medicaid |
$6.39
|
| Rate for Payer: UMR Bronson Commercial |
$21.69
|
| Rate for Payer: VA VA |
$11.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.97
|
|
|
HC TOPIRAMATE LEVEL
|
Facility
|
IP
|
$58.62
|
|
|
Service Code
|
CPT 80201
|
| Hospital Charge Code |
30100050
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.79 |
| Max. Negotiated Rate |
$52.76 |
| Rate for Payer: Aetna American Axle |
$38.10
|
| Rate for Payer: Aetna Commercial |
$49.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.10
|
| Rate for Payer: Cash Price |
$46.90
|
| Rate for Payer: Cofinity Commercial |
$41.03
|
| Rate for Payer: Cofinity Commercial |
$50.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$41.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.90
|
| Rate for Payer: Healthscope Commercial |
$52.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$41.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.83
|
| Rate for Payer: PHP Commercial |
$49.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.10
|
| Rate for Payer: Priority Health SBD |
$36.93
|
| Rate for Payer: UMR Bronson Commercial |
$25.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.97
|
|
|
HC TORCH PROFILE IGG
|
Facility
|
IP
|
$14.57
|
|
|
Service Code
|
CPT 86644
|
| Hospital Charge Code |
30200251
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.41 |
| Max. Negotiated Rate |
$13.11 |
| Rate for Payer: Aetna American Axle |
$9.47
|
| Rate for Payer: Aetna Commercial |
$12.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.47
|
| Rate for Payer: Cash Price |
$11.66
|
| Rate for Payer: Cofinity Commercial |
$10.20
|
| Rate for Payer: Cofinity Commercial |
$12.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.66
|
| Rate for Payer: Healthscope Commercial |
$13.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.38
|
| Rate for Payer: PHP Commercial |
$12.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.47
|
| Rate for Payer: Priority Health SBD |
$9.18
|
| Rate for Payer: UMR Bronson Commercial |
$6.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.93
|
|
|
HC TORCH PROFILE IGG
|
Facility
|
OP
|
$14.57
|
|
|
Service Code
|
CPT 86644
|
| Hospital Charge Code |
30200251
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.39 |
| Max. Negotiated Rate |
$40.51 |
| Rate for Payer: Aetna American Axle |
$9.47
|
| Rate for Payer: Aetna Commercial |
$12.38
|
| Rate for Payer: Aetna Medicare |
$14.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.99
|
| Rate for Payer: BCBS Complete |
$8.10
|
| Rate for Payer: BCBS MAPPO |
$14.39
|
| Rate for Payer: BCN Medicare Advantage |
$14.39
|
| Rate for Payer: Cash Price |
$11.66
|
| Rate for Payer: Cash Price |
$11.66
|
| Rate for Payer: Cofinity Commercial |
$12.53
|
| Rate for Payer: Cofinity Commercial |
$10.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.39
|
| Rate for Payer: Healthscope Commercial |
$13.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.93
|
| Rate for Payer: Mclaren Medicaid |
$7.71
|
| Rate for Payer: Mclaren Medicare |
$14.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.11
|
| Rate for Payer: Meridian Medicaid |
$8.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.38
|
| Rate for Payer: PACE Medicare |
$13.67
|
| Rate for Payer: PACE SWMI |
$14.39
|
| Rate for Payer: PHP Commercial |
$12.38
|
| Rate for Payer: PHP Medicare Advantage |
$14.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.47
|
| Rate for Payer: Priority Health Medicare |
$14.39
|
| Rate for Payer: Priority Health SBD |
$9.18
|
| Rate for Payer: Railroad Medicare Medicare |
$14.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.39
|
| Rate for Payer: UHC Exchange |
$27.50
|
| Rate for Payer: UHC Medicare Advantage |
$14.39
|
| Rate for Payer: UHCCP Medicaid |
$7.71
|
| Rate for Payer: UMR Bronson Commercial |
$5.39
|
| Rate for Payer: VA VA |
$14.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.93
|
|
|
HC TORCH PROFILE IGG CMPT 1
|
Facility
|
IP
|
$14.57
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
30200354
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.41 |
| Max. Negotiated Rate |
$13.11 |
| Rate for Payer: Aetna American Axle |
$9.47
|
| Rate for Payer: Aetna Commercial |
$12.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.47
|
| Rate for Payer: Cash Price |
$11.66
|
| Rate for Payer: Cofinity Commercial |
$10.20
|
| Rate for Payer: Cofinity Commercial |
$12.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.66
|
| Rate for Payer: Healthscope Commercial |
$13.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.38
|
| Rate for Payer: PHP Commercial |
$12.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.47
|
| Rate for Payer: Priority Health SBD |
$9.18
|
| Rate for Payer: UMR Bronson Commercial |
$6.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.93
|
|
