|
HC URINE PRESUMPTIVE ID
|
Facility
|
OP
|
$65.08
|
|
|
Service Code
|
CPT 87088
|
| Hospital Charge Code |
30600081
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.34 |
| Max. Negotiated Rate |
$58.57 |
| Rate for Payer: Aetna American Axle |
$42.30
|
| Rate for Payer: Aetna Commercial |
$55.32
|
| Rate for Payer: Aetna Medicare |
$8.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.11
|
| Rate for Payer: BCBS Complete |
$4.55
|
| Rate for Payer: BCBS MAPPO |
$8.09
|
| Rate for Payer: BCN Medicare Advantage |
$8.09
|
| Rate for Payer: Cash Price |
$52.06
|
| Rate for Payer: Cash Price |
$52.06
|
| Rate for Payer: Cofinity Commercial |
$55.97
|
| Rate for Payer: Cofinity Commercial |
$45.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$45.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.09
|
| Rate for Payer: Healthscope Commercial |
$58.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.81
|
| Rate for Payer: Mclaren Medicaid |
$4.34
|
| Rate for Payer: Mclaren Medicare |
$8.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.49
|
| Rate for Payer: Meridian Medicaid |
$4.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.32
|
| Rate for Payer: PACE Medicare |
$7.69
|
| Rate for Payer: PACE SWMI |
$8.09
|
| Rate for Payer: PHP Commercial |
$55.32
|
| Rate for Payer: PHP Medicare Advantage |
$8.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.30
|
| Rate for Payer: Priority Health Medicare |
$8.09
|
| Rate for Payer: Priority Health SBD |
$41.00
|
| Rate for Payer: Railroad Medicare Medicare |
$8.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.09
|
| Rate for Payer: UHC Exchange |
$15.46
|
| Rate for Payer: UHC Medicare Advantage |
$8.09
|
| Rate for Payer: UHCCP Medicaid |
$4.34
|
| Rate for Payer: UMR Bronson Commercial |
$24.08
|
| Rate for Payer: VA VA |
$8.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.81
|
|
|
HC URINE REDUCING SUBSTANCES
|
Facility
|
OP
|
$38.66
|
|
|
Service Code
|
CPT 81005
|
| Hospital Charge Code |
30700003
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$1.16 |
| Max. Negotiated Rate |
$34.79 |
| Rate for Payer: Aetna American Axle |
$25.13
|
| Rate for Payer: Aetna Commercial |
$32.86
|
| Rate for Payer: Aetna Medicare |
$2.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.71
|
| Rate for Payer: BCBS Complete |
$1.22
|
| Rate for Payer: BCBS MAPPO |
$2.17
|
| Rate for Payer: BCN Medicare Advantage |
$2.17
|
| Rate for Payer: Cash Price |
$30.93
|
| Rate for Payer: Cash Price |
$30.93
|
| Rate for Payer: Cofinity Commercial |
$33.25
|
| Rate for Payer: Cofinity Commercial |
$27.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.17
|
| Rate for Payer: Healthscope Commercial |
$34.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.00
|
| Rate for Payer: Mclaren Medicaid |
$1.16
|
| Rate for Payer: Mclaren Medicare |
$2.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.28
|
| Rate for Payer: Meridian Medicaid |
$1.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.86
|
| Rate for Payer: PACE Medicare |
$2.06
|
| Rate for Payer: PACE SWMI |
$2.17
|
| Rate for Payer: PHP Commercial |
$32.86
|
| Rate for Payer: PHP Medicare Advantage |
$2.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.13
|
| Rate for Payer: Priority Health Medicare |
$2.17
|
| Rate for Payer: Priority Health SBD |
$24.36
|
| Rate for Payer: Railroad Medicare Medicare |
$2.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.17
|
| Rate for Payer: UHC Exchange |
$4.15
|
| Rate for Payer: UHC Medicare Advantage |
$2.17
|
| Rate for Payer: UHCCP Medicaid |
$1.16
|
| Rate for Payer: UMR Bronson Commercial |
$14.30
|
| Rate for Payer: VA VA |
$2.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.00
|
|
|
HC URINE REDUCING SUBSTANCES
|
Facility
|
IP
|
$38.66
|
|
|
Service Code
|
CPT 81005
|
| Hospital Charge Code |
30700003
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$17.01 |
| Max. Negotiated Rate |
$34.79 |
| Rate for Payer: Aetna American Axle |
$25.13
|
| Rate for Payer: Aetna Commercial |
$32.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.13
|
| Rate for Payer: Cash Price |
$30.93
|
| Rate for Payer: Cofinity Commercial |
$27.06
|
| Rate for Payer: Cofinity Commercial |
$33.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.93
|
| Rate for Payer: Healthscope Commercial |
$34.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.86
|
| Rate for Payer: PHP Commercial |
$32.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.13
|
| Rate for Payer: Priority Health SBD |
$24.36
|
| Rate for Payer: UMR Bronson Commercial |
$17.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.00
|
|
|
HC URIN MDMA
|
Facility
|
IP
|
$94.53
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000133
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$41.59 |
| Max. Negotiated Rate |
$85.08 |
| Rate for Payer: Aetna American Axle |
$61.44
|
| Rate for Payer: Aetna Commercial |
$80.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.44
|
| Rate for Payer: Cash Price |
$75.62
|
| Rate for Payer: Cofinity Commercial |
$66.17
|
| Rate for Payer: Cofinity Commercial |
$81.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$66.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.62
|
| Rate for Payer: Healthscope Commercial |
$85.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.35
|
| Rate for Payer: PHP Commercial |
$80.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.44
|
| Rate for Payer: Priority Health SBD |
$59.55
|
| Rate for Payer: UMR Bronson Commercial |
$41.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.90
|
|
|
HC URIN MDMA
|
Facility
|
OP
|
$94.53
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000133
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.31 |
| Max. Negotiated Rate |
$174.92 |
| Rate for Payer: Aetna American Axle |
$61.44
|
| Rate for Payer: Aetna Commercial |
$80.35
|
| Rate for Payer: Aetna Medicare |
$64.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.67
|
| Rate for Payer: BCBS Complete |
$34.97
|
| Rate for Payer: BCBS MAPPO |
$62.14
|
| Rate for Payer: BCN Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$75.62
|
| Rate for Payer: Cash Price |
$75.62
|
| Rate for Payer: Cofinity Commercial |
$81.30
|
| Rate for Payer: Cofinity Commercial |
$66.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$66.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Healthscope Commercial |
$85.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.90
|
| Rate for Payer: Mclaren Medicaid |
$33.31
|
| Rate for Payer: Mclaren Medicare |
$62.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.25
|
| Rate for Payer: Meridian Medicaid |
$34.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.35
|
| Rate for Payer: PACE Medicare |
$59.03
|
| Rate for Payer: PACE SWMI |
$62.14
|
| Rate for Payer: PHP Commercial |
$80.35
|
| Rate for Payer: PHP Medicare Advantage |
$62.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.44
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: Priority Health SBD |
$59.55
|
| Rate for Payer: Railroad Medicare Medicare |
$62.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$174.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.14
|
| Rate for Payer: UHC Exchange |
$118.76
|
| Rate for Payer: UHC Medicare Advantage |
$62.14
|
| Rate for Payer: UHCCP Medicaid |
$33.31
|
| Rate for Payer: UMR Bronson Commercial |
$34.98
|
| Rate for Payer: VA VA |
$62.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.90
|
|
|
HC URN COTININE.
|
Facility
|
OP
|
$101.95
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100647
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.31 |
| Max. Negotiated Rate |
$174.92 |
| Rate for Payer: Aetna American Axle |
$66.27
|
| Rate for Payer: Aetna Commercial |
$86.66
|
| Rate for Payer: Aetna Medicare |
$64.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.67
|
| Rate for Payer: BCBS Complete |
$34.97
|
| Rate for Payer: BCBS MAPPO |
$62.14
|
| Rate for Payer: BCN Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$81.56
|
| Rate for Payer: Cash Price |
$81.56
|
| Rate for Payer: Cofinity Commercial |
$87.68
|
| Rate for Payer: Cofinity Commercial |
$71.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$71.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Healthscope Commercial |
$91.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$71.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.46
|
| Rate for Payer: Mclaren Medicaid |
$33.31
|
| Rate for Payer: Mclaren Medicare |
$62.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.25
|
| Rate for Payer: Meridian Medicaid |
$34.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.66
|
| Rate for Payer: PACE Medicare |
$59.03
|
| Rate for Payer: PACE SWMI |
$62.14
|
| Rate for Payer: PHP Commercial |
$86.66
|
| Rate for Payer: PHP Medicare Advantage |
$62.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.27
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: Priority Health SBD |
$64.23
|
| Rate for Payer: Railroad Medicare Medicare |
$62.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$174.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.14
|
| Rate for Payer: UHC Exchange |
$118.76
|
| Rate for Payer: UHC Medicare Advantage |
$62.14
|
| Rate for Payer: UHCCP Medicaid |
$33.31
|
| Rate for Payer: UMR Bronson Commercial |
$37.72
|
| Rate for Payer: VA VA |
$62.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.46
|
|
|
HC URN COTININE.
|
Facility
|
IP
|
$101.95
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100647
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$44.86 |
| Max. Negotiated Rate |
$91.75 |
| Rate for Payer: Aetna American Axle |
$66.27
|
| Rate for Payer: Aetna Commercial |
$86.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.27
|
| Rate for Payer: Cash Price |
$81.56
|
| Rate for Payer: Cofinity Commercial |
$71.36
|
| Rate for Payer: Cofinity Commercial |
$87.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$71.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.56
|
| Rate for Payer: Healthscope Commercial |
$91.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$71.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.66
|
| Rate for Payer: PHP Commercial |
$86.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.27
|
| Rate for Payer: Priority Health SBD |
$64.23
|
| Rate for Payer: UMR Bronson Commercial |
$44.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.46
|
|
|
HC URN MDMA
|
Facility
|
OP
|
$41.62
|
|
|
Service Code
|
CPT 80305
|
| Hospital Charge Code |
30000132
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.75 |
| 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 |
$13.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.75
|
| Rate for Payer: BCBS Complete |
$7.09
|
| Rate for Payer: BCBS MAPPO |
$12.60
|
| Rate for Payer: BCN Medicare Advantage |
$12.60
|
| 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 |
$12.60
|
| 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 |
$31.21
|
| Rate for Payer: Mclaren Medicaid |
$6.75
|
| Rate for Payer: Mclaren Medicare |
$12.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.23
|
| Rate for Payer: Meridian Medicaid |
$7.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.38
|
| Rate for Payer: PACE Medicare |
$11.97
|
| Rate for Payer: PACE SWMI |
$12.60
|
| Rate for Payer: PHP Commercial |
$35.38
|
| Rate for Payer: PHP Medicare Advantage |
$12.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.05
|
| Rate for Payer: Priority Health Medicare |
$12.60
|
| Rate for Payer: Priority Health SBD |
$26.22
|
| Rate for Payer: Railroad Medicare Medicare |
$12.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.60
|
| Rate for Payer: UHC Exchange |
$24.08
|
| Rate for Payer: UHC Medicare Advantage |
$12.60
|
| Rate for Payer: UHCCP Medicaid |
$6.75
|
| Rate for Payer: UMR Bronson Commercial |
$15.40
|
| Rate for Payer: VA VA |
$12.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.21
|
|
|
HC URN MDMA
|
Facility
|
IP
|
$41.62
|
|
|
Service Code
|
CPT 80305
|
| Hospital Charge Code |
30000132
|
|
Hospital Revenue Code
|
300
|
| 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 |
$31.21
|
| 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 |
$31.21
|
|
|
HC URN TRICYCLIC
|
Facility
|
IP
|
$47.76
|
|
|
Service Code
|
CPT 80305
|
| Hospital Charge Code |
30000131
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.01 |
| Max. Negotiated Rate |
$42.98 |
| Rate for Payer: Aetna American Axle |
$31.04
|
| Rate for Payer: Aetna Commercial |
$40.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.04
|
| Rate for Payer: Cash Price |
$38.21
|
| Rate for Payer: Cofinity Commercial |
$33.43
|
| Rate for Payer: Cofinity Commercial |
$41.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$33.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.21
|
| Rate for Payer: Healthscope Commercial |
$42.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.60
|
| Rate for Payer: PHP Commercial |
$40.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.04
|
| Rate for Payer: Priority Health SBD |
$30.09
|
| Rate for Payer: UMR Bronson Commercial |
$21.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.82
|
|
|
HC URN TRICYCLIC
|
Facility
|
OP
|
$47.76
|
|
|
Service Code
|
CPT 80305
|
| Hospital Charge Code |
30000131
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.75 |
| Max. Negotiated Rate |
$42.98 |
| Rate for Payer: Aetna American Axle |
$31.04
|
| Rate for Payer: Aetna Commercial |
$40.60
|
| Rate for Payer: Aetna Medicare |
$13.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.75
|
| Rate for Payer: BCBS Complete |
$7.09
|
| Rate for Payer: BCBS MAPPO |
$12.60
|
| Rate for Payer: BCN Medicare Advantage |
$12.60
|
| Rate for Payer: Cash Price |
$38.21
|
| Rate for Payer: Cash Price |
$38.21
|
| Rate for Payer: Cofinity Commercial |
$41.07
|
| Rate for Payer: Cofinity Commercial |
$33.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$33.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.60
|
| Rate for Payer: Healthscope Commercial |
$42.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.82
|
| Rate for Payer: Mclaren Medicaid |
$6.75
|
| Rate for Payer: Mclaren Medicare |
$12.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.23
|
| Rate for Payer: Meridian Medicaid |
$7.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.60
|
| Rate for Payer: PACE Medicare |
$11.97
|
| Rate for Payer: PACE SWMI |
$12.60
|
| Rate for Payer: PHP Commercial |
$40.60
|
| Rate for Payer: PHP Medicare Advantage |
$12.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.04
|
| Rate for Payer: Priority Health Medicare |
$12.60
|
| Rate for Payer: Priority Health SBD |
$30.09
|
| Rate for Payer: Railroad Medicare Medicare |
$12.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.60
|
| Rate for Payer: UHC Exchange |
$24.08
|
| Rate for Payer: UHC Medicare Advantage |
$12.60
|
| Rate for Payer: UHCCP Medicaid |
$6.75
|
| Rate for Payer: UMR Bronson Commercial |
$17.67
|
| Rate for Payer: VA VA |
$12.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.82
|
|
|
HC UROLIFT PER DEVICE
|
Facility
|
OP
|
$1,963.76
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
27800129
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$726.59 |
| Max. Negotiated Rate |
$1,767.38 |
| Rate for Payer: Aetna American Axle |
$1,276.44
|
| Rate for Payer: Aetna Commercial |
$1,669.20
|
| Rate for Payer: Aetna Medicare |
$981.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,276.44
|
| Rate for Payer: BCBS Complete |
$785.50
|
| Rate for Payer: Cash Price |
$1,571.01
|
| Rate for Payer: Cofinity Commercial |
$1,374.63
|
| Rate for Payer: Cofinity Commercial |
$1,688.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,374.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,571.01
|
| Rate for Payer: Healthscope Commercial |
$1,767.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,374.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,472.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,669.20
|
| Rate for Payer: PHP Commercial |
$1,669.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,276.44
|
| Rate for Payer: Priority Health SBD |
$1,237.17
|
| Rate for Payer: UMR Bronson Commercial |
$726.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,472.82
|
|
|
HC UROLIFT PER DEVICE
|
Facility
|
IP
|
$1,963.76
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
27800129
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$864.05 |
| Max. Negotiated Rate |
$1,767.38 |
| Rate for Payer: Aetna American Axle |
$1,276.44
|
| Rate for Payer: Aetna Commercial |
$1,669.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,276.44
|
| Rate for Payer: Cash Price |
$1,571.01
|
| Rate for Payer: Cofinity Commercial |
$1,374.63
|
| Rate for Payer: Cofinity Commercial |
$1,688.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,374.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,571.01
|
| Rate for Payer: Healthscope Commercial |
$1,767.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,374.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,472.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,669.20
|
| Rate for Payer: PHP Commercial |
$1,669.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,276.44
|
| Rate for Payer: Priority Health SBD |
$1,237.17
|
| Rate for Payer: UMR Bronson Commercial |
$864.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,472.82
|
|
|
HC UROSTOMY ADAPTOR TUBE
|
Facility
|
OP
|
$16.37
|
|
| Hospital Charge Code |
27000168
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.06 |
| Max. Negotiated Rate |
$14.73 |
| Rate for Payer: Aetna American Axle |
$10.64
|
| Rate for Payer: Aetna Commercial |
$13.91
|
| Rate for Payer: Aetna Medicare |
$8.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.64
|
| Rate for Payer: BCBS Complete |
$6.55
|
| Rate for Payer: Cash Price |
$13.10
|
| Rate for Payer: Cofinity Commercial |
$11.46
|
| Rate for Payer: Cofinity Commercial |
$14.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.10
|
| Rate for Payer: Healthscope Commercial |
$14.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.91
|
| Rate for Payer: PHP Commercial |
$13.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.64
|
| Rate for Payer: Priority Health SBD |
$10.31
|
| Rate for Payer: UMR Bronson Commercial |
$6.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.28
|
|
|
HC UROSTOMY ADAPTOR TUBE
|
Facility
|
IP
|
$16.37
|
|
| Hospital Charge Code |
27000168
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$14.73 |
| Rate for Payer: Aetna American Axle |
$10.64
|
| Rate for Payer: Aetna Commercial |
$13.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.64
|
| Rate for Payer: Cash Price |
$13.10
|
| Rate for Payer: Cofinity Commercial |
$11.46
|
| Rate for Payer: Cofinity Commercial |
$14.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.10
|
| Rate for Payer: Healthscope Commercial |
$14.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.91
|
| Rate for Payer: PHP Commercial |
$13.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.64
|
| Rate for Payer: Priority Health SBD |
$10.31
|
| Rate for Payer: UMR Bronson Commercial |
$7.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.28
|
|
|
HC US AAA SCREENING
|
Facility
|
IP
|
$367.02
|
|
|
Service Code
|
CPT 76706
|
| Hospital Charge Code |
40200073
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$161.49 |
| Max. Negotiated Rate |
$330.32 |
| Rate for Payer: Aetna American Axle |
$238.56
|
| Rate for Payer: Aetna Commercial |
$311.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$238.56
|
| Rate for Payer: Cash Price |
$293.62
|
| Rate for Payer: Cofinity Commercial |
$256.91
|
| Rate for Payer: Cofinity Commercial |
$315.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$256.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$293.62
|
| Rate for Payer: Healthscope Commercial |
$330.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$256.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$275.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.97
|
| Rate for Payer: PHP Commercial |
$311.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.56
|
| Rate for Payer: Priority Health SBD |
$231.22
|
| Rate for Payer: UMR Bronson Commercial |
$161.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$275.26
|
|
|
HC US AAA SCREENING
|
Facility
|
OP
|
$367.02
|
|
|
Service Code
|
CPT 76706
|
| Hospital Charge Code |
40200073
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$55.59 |
| Max. Negotiated Rate |
$367.00 |
| Rate for Payer: Aetna American Axle |
$238.56
|
| Rate for Payer: Aetna Commercial |
$311.97
|
| Rate for Payer: Aetna Medicare |
$107.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$238.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$129.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$129.64
|
| Rate for Payer: BCBS Complete |
$58.37
|
| Rate for Payer: BCBS MAPPO |
$103.71
|
| Rate for Payer: BCN Medicare Advantage |
$103.71
|
| Rate for Payer: Cash Price |
$293.62
|
| Rate for Payer: Cash Price |
$293.62
|
| Rate for Payer: Cofinity Commercial |
$315.64
|
| Rate for Payer: Cofinity Commercial |
$256.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$256.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$293.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.71
|
| Rate for Payer: Healthscope Commercial |
$330.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$256.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$275.26
|
| Rate for Payer: Mclaren Medicaid |
$55.59
|
| Rate for Payer: Mclaren Medicare |
$103.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$108.90
|
| Rate for Payer: Meridian Medicaid |
$58.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.97
|
| Rate for Payer: PACE Medicare |
$98.52
|
| Rate for Payer: PACE SWMI |
$103.71
|
| Rate for Payer: PHP Commercial |
$311.97
|
| Rate for Payer: PHP Medicare Advantage |
$103.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.56
|
| Rate for Payer: Priority Health Medicare |
$103.71
|
| Rate for Payer: Priority Health SBD |
$231.22
|
| Rate for Payer: Railroad Medicare Medicare |
$103.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$291.93
|
| Rate for Payer: UHC Core |
$367.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.71
|
| Rate for Payer: UHC Exchange |
$198.20
|
| Rate for Payer: UHC Medicare Advantage |
$103.71
|
| Rate for Payer: UHCCP Medicaid |
$55.59
|
| Rate for Payer: UMR Bronson Commercial |
$135.80
|
| Rate for Payer: VA VA |
$103.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$275.26
|
|
|
HC US ABDOMEN COMPLETE
|
Facility
|
IP
|
$950.92
|
|
|
Service Code
|
CPT 76700
|
| Hospital Charge Code |
40200009
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$418.40 |
| Max. Negotiated Rate |
$855.83 |
| Rate for Payer: Aetna American Axle |
$618.10
|
| Rate for Payer: Aetna Commercial |
$808.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$618.10
|
| Rate for Payer: Cash Price |
$760.74
|
| Rate for Payer: Cofinity Commercial |
$665.64
|
| Rate for Payer: Cofinity Commercial |
$817.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$665.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$760.74
|
| Rate for Payer: Healthscope Commercial |
$855.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$665.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$713.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$808.28
|
| Rate for Payer: PHP Commercial |
$808.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$618.10
|
| Rate for Payer: Priority Health SBD |
$599.08
|
| Rate for Payer: UMR Bronson Commercial |
$418.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$713.19
|
|
|
HC US ABDOMEN COMPLETE
|
Facility
|
OP
|
$950.92
|
|
|
Service Code
|
CPT 76700
|
| Hospital Charge Code |
40200009
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$55.59 |
| Max. Negotiated Rate |
$855.83 |
| Rate for Payer: Aetna American Axle |
$618.10
|
| Rate for Payer: Aetna Commercial |
$808.28
|
| Rate for Payer: Aetna Medicare |
$107.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$618.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$129.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$129.64
|
| Rate for Payer: BCBS Complete |
$58.37
|
| Rate for Payer: BCBS MAPPO |
$103.71
|
| Rate for Payer: BCN Medicare Advantage |
$103.71
|
| Rate for Payer: Cash Price |
$760.74
|
| Rate for Payer: Cash Price |
$760.74
|
| Rate for Payer: Cofinity Commercial |
$817.79
|
| Rate for Payer: Cofinity Commercial |
$665.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$665.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$760.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.71
|
| Rate for Payer: Healthscope Commercial |
$855.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$665.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$713.19
|
| Rate for Payer: Mclaren Medicaid |
$55.59
|
| Rate for Payer: Mclaren Medicare |
$103.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$108.90
|
| Rate for Payer: Meridian Medicaid |
$58.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$808.28
|
| Rate for Payer: PACE Medicare |
$98.52
|
| Rate for Payer: PACE SWMI |
$103.71
|
| Rate for Payer: PHP Commercial |
$808.28
|
| Rate for Payer: PHP Medicare Advantage |
$103.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$618.10
|
| Rate for Payer: Priority Health Medicare |
$103.71
|
| Rate for Payer: Priority Health SBD |
$599.08
|
| Rate for Payer: Railroad Medicare Medicare |
$103.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$291.93
|
| Rate for Payer: UHC Core |
$367.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.71
|
| Rate for Payer: UHC Exchange |
$198.20
|
| Rate for Payer: UHC Medicare Advantage |
$103.71
|
| Rate for Payer: UHCCP Medicaid |
$55.59
|
| Rate for Payer: UMR Bronson Commercial |
$351.84
|
| Rate for Payer: VA VA |
$103.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$713.19
|
|
|
HC US ABDOMEN LIMITED
|
Facility
|
OP
|
$816.66
|
|
|
Service Code
|
CPT 76705
|
| Hospital Charge Code |
40200010
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$55.59 |
| Max. Negotiated Rate |
$734.99 |
| Rate for Payer: Aetna American Axle |
$530.83
|
| Rate for Payer: Aetna Commercial |
$694.16
|
| Rate for Payer: Aetna Medicare |
$107.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$530.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$129.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$129.64
|
| Rate for Payer: BCBS Complete |
$58.37
|
| Rate for Payer: BCBS MAPPO |
$103.71
|
| Rate for Payer: BCN Medicare Advantage |
$103.71
|
| Rate for Payer: Cash Price |
$653.33
|
| Rate for Payer: Cash Price |
$653.33
|
| Rate for Payer: Cofinity Commercial |
$702.33
|
| Rate for Payer: Cofinity Commercial |
$571.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$571.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$653.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.71
|
| Rate for Payer: Healthscope Commercial |
$734.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$571.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$612.50
|
| Rate for Payer: Mclaren Medicaid |
$55.59
|
| Rate for Payer: Mclaren Medicare |
$103.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$108.90
|
| Rate for Payer: Meridian Medicaid |
$58.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$694.16
|
| Rate for Payer: PACE Medicare |
$98.52
|
| Rate for Payer: PACE SWMI |
$103.71
|
| Rate for Payer: PHP Commercial |
$694.16
|
| Rate for Payer: PHP Medicare Advantage |
$103.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$530.83
|
| Rate for Payer: Priority Health Medicare |
$103.71
|
| Rate for Payer: Priority Health SBD |
$514.50
|
| Rate for Payer: Railroad Medicare Medicare |
$103.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$291.93
|
| Rate for Payer: UHC Core |
$367.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.71
|
| Rate for Payer: UHC Exchange |
$198.20
|
| Rate for Payer: UHC Medicare Advantage |
$103.71
|
| Rate for Payer: UHCCP Medicaid |
$55.59
|
| Rate for Payer: UMR Bronson Commercial |
$302.16
|
| Rate for Payer: VA VA |
$103.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$612.50
|
|
|
HC US ABDOMEN LIMITED
|
Facility
|
IP
|
$816.66
|
|
|
Service Code
|
CPT 76705
|
| Hospital Charge Code |
40200010
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$359.33 |
| Max. Negotiated Rate |
$734.99 |
| Rate for Payer: Aetna American Axle |
$530.83
|
| Rate for Payer: Aetna Commercial |
$694.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$530.83
|
| Rate for Payer: Cash Price |
$653.33
|
| Rate for Payer: Cofinity Commercial |
$571.66
|
| Rate for Payer: Cofinity Commercial |
$702.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$571.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$653.33
|
| Rate for Payer: Healthscope Commercial |
$734.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$571.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$612.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$694.16
|
| Rate for Payer: PHP Commercial |
$694.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$530.83
|
| Rate for Payer: Priority Health SBD |
$514.50
|
| Rate for Payer: UMR Bronson Commercial |
$359.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$612.50
|
|
|
HC US BREAST BIL COMPLETE
|
Facility
|
OP
|
$602.20
|
|
|
Service Code
|
CPT 76641
|
| Hospital Charge Code |
40200072
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$55.59 |
| Max. Negotiated Rate |
$541.98 |
| Rate for Payer: Aetna American Axle |
$391.43
|
| Rate for Payer: Aetna Commercial |
$511.87
|
| Rate for Payer: Aetna Medicare |
$107.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$391.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$129.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$129.64
|
| Rate for Payer: BCBS Complete |
$58.37
|
| Rate for Payer: BCBS MAPPO |
$103.71
|
| Rate for Payer: BCN Medicare Advantage |
$103.71
|
| Rate for Payer: Cash Price |
$481.76
|
| Rate for Payer: Cash Price |
$481.76
|
| Rate for Payer: Cofinity Commercial |
$517.89
|
| Rate for Payer: Cofinity Commercial |
$421.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$421.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$481.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.71
|
| Rate for Payer: Healthscope Commercial |
$541.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$421.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$451.65
|
| Rate for Payer: Mclaren Medicaid |
$55.59
|
| Rate for Payer: Mclaren Medicare |
$103.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$108.90
|
| Rate for Payer: Meridian Medicaid |
$58.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$511.87
|
| Rate for Payer: PACE Medicare |
$98.52
|
| Rate for Payer: PACE SWMI |
$103.71
|
| Rate for Payer: PHP Commercial |
$511.87
|
| Rate for Payer: PHP Medicare Advantage |
$103.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$391.43
|
| Rate for Payer: Priority Health Medicare |
$103.71
|
| Rate for Payer: Priority Health SBD |
$379.39
|
| Rate for Payer: Railroad Medicare Medicare |
$103.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$291.93
|
| Rate for Payer: UHC Core |
$367.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.71
|
| Rate for Payer: UHC Exchange |
$198.20
|
| Rate for Payer: UHC Medicare Advantage |
$103.71
|
| Rate for Payer: UHCCP Medicaid |
$55.59
|
| Rate for Payer: UMR Bronson Commercial |
$222.81
|
| Rate for Payer: VA VA |
$103.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$451.65
|
|
|
HC US BREAST BIL COMPLETE
|
Facility
|
IP
|
$602.20
|
|
|
Service Code
|
CPT 76641
|
| Hospital Charge Code |
40200072
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$264.97 |
| Max. Negotiated Rate |
$541.98 |
| Rate for Payer: Aetna American Axle |
$391.43
|
| Rate for Payer: Aetna Commercial |
$511.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$391.43
|
| Rate for Payer: Cash Price |
$481.76
|
| Rate for Payer: Cofinity Commercial |
$421.54
|
| Rate for Payer: Cofinity Commercial |
$517.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$421.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$481.76
|
| Rate for Payer: Healthscope Commercial |
$541.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$421.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$451.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$511.87
|
| Rate for Payer: PHP Commercial |
$511.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$391.43
|
| Rate for Payer: Priority Health SBD |
$379.39
|
| Rate for Payer: UMR Bronson Commercial |
$264.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$451.65
|
|
|
HC US BREAST BIL LIMITED
|
Facility
|
IP
|
$562.45
|
|
|
Service Code
|
CPT 76642
|
| Hospital Charge Code |
40200071
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$247.48 |
| Max. Negotiated Rate |
$506.20 |
| Rate for Payer: Aetna American Axle |
$365.59
|
| Rate for Payer: Aetna Commercial |
$478.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$365.59
|
| Rate for Payer: Cash Price |
$449.96
|
| Rate for Payer: Cofinity Commercial |
$393.71
|
| Rate for Payer: Cofinity Commercial |
$483.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$393.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$449.96
|
| Rate for Payer: Healthscope Commercial |
$506.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$393.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$421.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$478.08
|
| Rate for Payer: PHP Commercial |
$478.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$365.59
|
| Rate for Payer: Priority Health SBD |
$354.34
|
| Rate for Payer: UMR Bronson Commercial |
$247.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$421.84
|
|
|
HC US BREAST BIL LIMITED
|
Facility
|
OP
|
$562.45
|
|
|
Service Code
|
CPT 76642
|
| Hospital Charge Code |
40200071
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$46.03 |
| Max. Negotiated Rate |
$506.20 |
| Rate for Payer: Aetna American Axle |
$365.59
|
| Rate for Payer: Aetna Commercial |
$478.08
|
| Rate for Payer: Aetna Medicare |
$89.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$365.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$107.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$107.34
|
| Rate for Payer: BCBS Complete |
$48.33
|
| Rate for Payer: BCBS MAPPO |
$85.87
|
| Rate for Payer: BCN Medicare Advantage |
$85.87
|
| Rate for Payer: Cash Price |
$449.96
|
| Rate for Payer: Cash Price |
$449.96
|
| Rate for Payer: Cofinity Commercial |
$483.71
|
| Rate for Payer: Cofinity Commercial |
$393.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$393.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$449.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.87
|
| Rate for Payer: Healthscope Commercial |
$506.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$393.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$421.84
|
| Rate for Payer: Mclaren Medicaid |
$46.03
|
| Rate for Payer: Mclaren Medicare |
$85.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.16
|
| Rate for Payer: Meridian Medicaid |
$48.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$98.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$478.08
|
| Rate for Payer: PACE Medicare |
$81.58
|
| Rate for Payer: PACE SWMI |
$85.87
|
| Rate for Payer: PHP Commercial |
$478.08
|
| Rate for Payer: PHP Medicare Advantage |
$85.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$365.59
|
| Rate for Payer: Priority Health Medicare |
$85.87
|
| Rate for Payer: Priority Health SBD |
$354.34
|
| Rate for Payer: Railroad Medicare Medicare |
$85.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$241.72
|
| Rate for Payer: UHC Core |
$367.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$85.87
|
| Rate for Payer: UHC Exchange |
$164.11
|
| Rate for Payer: UHC Medicare Advantage |
$85.87
|
| Rate for Payer: UHCCP Medicaid |
$46.03
|
| Rate for Payer: UMR Bronson Commercial |
$208.11
|
| Rate for Payer: VA VA |
$85.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$421.84
|
|
