|
HC VANCOMYCIN LEVEL
|
Facility
|
OP
|
$138.41
|
|
|
Service Code
|
CPT 80202
|
| Hospital Charge Code |
30100051
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.26 |
| Max. Negotiated Rate |
$124.57 |
| Rate for Payer: Aetna Commercial |
$117.65
|
| Rate for Payer: Aetna Medicare |
$14.08
|
| Rate for Payer: Aetna American Axle |
$89.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.92
|
| Rate for Payer: BCBS Complete |
$7.62
|
| Rate for Payer: BCBS MAPPO |
$13.54
|
| Rate for Payer: BCBS Trust/PPO |
$13.05
|
| Rate for Payer: BCN Commercial |
$13.05
|
| Rate for Payer: BCN Medicare Advantage |
$13.54
|
| Rate for Payer: Cash Price |
$110.73
|
| Rate for Payer: Cash Price |
$110.73
|
| Rate for Payer: Cofinity Commercial |
$96.89
|
| Rate for Payer: Cofinity Commercial |
$119.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$96.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.54
|
| Rate for Payer: Healthscope Commercial |
$124.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$96.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.81
|
| Rate for Payer: Mclaren Medicaid |
$7.26
|
| Rate for Payer: Mclaren Medicare |
$13.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.22
|
| Rate for Payer: Meridian Medicaid |
$7.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.65
|
| Rate for Payer: Nomi Health Commercial |
$20.31
|
| Rate for Payer: PACE Medicare |
$12.86
|
| Rate for Payer: PACE SWMI |
$13.54
|
| Rate for Payer: PHP Commercial |
$117.65
|
| Rate for Payer: PHP Medicare Advantage |
$13.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.94
|
| Rate for Payer: Priority Health Medicare |
$13.54
|
| Rate for Payer: Priority Health Narrow Network |
$11.15
|
| Rate for Payer: Priority Health SBD |
$87.20
|
| Rate for Payer: Railroad Medicare Medicare |
$13.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.54
|
| Rate for Payer: UHC Exchange |
$13.54
|
| Rate for Payer: UHC Medicare Advantage |
$13.54
|
| Rate for Payer: UHCCP Medicaid |
$7.26
|
| Rate for Payer: UMR Bronson Commercial |
$51.21
|
| Rate for Payer: VA VA |
$13.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.81
|
|
|
HC VANCOMYCIN LEVEL
|
Facility
|
IP
|
$138.41
|
|
|
Service Code
|
CPT 80202
|
| Hospital Charge Code |
30100051
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$60.90 |
| Max. Negotiated Rate |
$124.57 |
| Rate for Payer: Aetna American Axle |
$89.97
|
| Rate for Payer: Aetna Commercial |
$117.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.97
|
| Rate for Payer: Cash Price |
$110.73
|
| Rate for Payer: Cofinity Commercial |
$119.03
|
| Rate for Payer: Cofinity Commercial |
$96.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$96.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.73
|
| Rate for Payer: Healthscope Commercial |
$124.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$96.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.65
|
| Rate for Payer: PHP Commercial |
$117.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.97
|
| Rate for Payer: Priority Health SBD |
$87.20
|
| Rate for Payer: UMR Bronson Commercial |
$60.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.81
|
|
|
HC VAP CHOLESTEROL
|
Facility
|
IP
|
$83.23
|
|
|
Service Code
|
CPT 83701
|
| Hospital Charge Code |
30100281
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$36.62 |
| Max. Negotiated Rate |
$74.91 |
| Rate for Payer: Aetna American Axle |
$54.10
|
| Rate for Payer: Aetna Commercial |
$70.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.10
|
| Rate for Payer: Cash Price |
$66.58
|
| Rate for Payer: Cofinity Commercial |
$58.26
|
| Rate for Payer: Cofinity Commercial |
$71.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$58.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.58
|
| Rate for Payer: Healthscope Commercial |
$74.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$58.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.75
|
| Rate for Payer: PHP Commercial |
$70.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.10
|
| Rate for Payer: Priority Health SBD |
$52.43
|
| Rate for Payer: UMR Bronson Commercial |
$36.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.42
|
|
|
HC VAP CHOLESTEROL
|
Facility
|
OP
|
$83.23
|
|
|
Service Code
|
CPT 83701
|
| Hospital Charge Code |
30100281
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.15 |
| Max. Negotiated Rate |
$74.91 |
| Rate for Payer: Aetna American Axle |
$54.10
|
| Rate for Payer: Aetna Commercial |
$70.75
|
| Rate for Payer: Aetna Medicare |
$35.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$42.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$42.32
|
| Rate for Payer: BCBS Complete |
$19.06
|
| Rate for Payer: BCBS MAPPO |
$33.86
|
| Rate for Payer: BCN Medicare Advantage |
$33.86
|
| Rate for Payer: Cash Price |
$66.58
|
| Rate for Payer: Cash Price |
$66.58
|
| Rate for Payer: Cofinity Commercial |
$71.58
|
| Rate for Payer: Cofinity Commercial |
$58.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$58.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.86
|
| Rate for Payer: Healthscope Commercial |
$74.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$58.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.42
|
| Rate for Payer: Mclaren Medicaid |
$18.15
|
| Rate for Payer: Mclaren Medicare |
$33.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$35.55
|
| Rate for Payer: Meridian Medicaid |
$19.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.75
|
| Rate for Payer: Nomi Health Commercial |
$50.79
|
| Rate for Payer: PACE Medicare |
$32.17
|
| Rate for Payer: PACE SWMI |
$33.86
|
| Rate for Payer: PHP Commercial |
$70.75
|
| Rate for Payer: PHP Medicare Advantage |
$33.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33.86
|
| Rate for Payer: Priority Health Medicare |
$33.86
|
| Rate for Payer: Priority Health Narrow Network |
$27.09
|
| Rate for Payer: Priority Health SBD |
$52.43
|
| Rate for Payer: Railroad Medicare Medicare |
$33.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$33.86
|
| Rate for Payer: UHC Exchange |
$33.86
|
| Rate for Payer: UHC Medicare Advantage |
$33.86
|
| Rate for Payer: UHCCP Medicaid |
$18.15
|
| Rate for Payer: UMR Bronson Commercial |
$30.80
|
| Rate for Payer: VA VA |
$33.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.42
|
|
|
HC VAP CHOLESTEROL CMPT
|
Facility
|
OP
|
$20.81
|
|
|
Service Code
|
CPT 84478
|
| Hospital Charge Code |
30100445
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$18.73 |
| Rate for Payer: Aetna American Axle |
$13.53
|
| Rate for Payer: Aetna Commercial |
$17.69
|
| Rate for Payer: Aetna Medicare |
$5.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.18
|
| Rate for Payer: BCBS Complete |
$3.23
|
| Rate for Payer: BCBS MAPPO |
$5.74
|
| Rate for Payer: BCN Medicare Advantage |
$5.74
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$17.90
|
| Rate for Payer: Cofinity Commercial |
$14.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.74
|
| Rate for Payer: Healthscope Commercial |
$18.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.61
|
| Rate for Payer: Mclaren Medicaid |
$3.08
|
| Rate for Payer: Mclaren Medicare |
$5.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.03
|
| Rate for Payer: Meridian Medicaid |
$3.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: Nomi Health Commercial |
$17.22
|
| Rate for Payer: PACE Medicare |
$5.45
|
| Rate for Payer: PACE SWMI |
$5.74
|
| Rate for Payer: PHP Commercial |
$17.69
|
| Rate for Payer: PHP Medicare Advantage |
$5.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.91
|
| Rate for Payer: Priority Health Medicare |
$5.74
|
| Rate for Payer: Priority Health Narrow Network |
$4.73
|
| Rate for Payer: Priority Health SBD |
$13.11
|
| Rate for Payer: Railroad Medicare Medicare |
$5.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.74
|
| Rate for Payer: UHC Exchange |
$5.74
|
| Rate for Payer: UHC Medicare Advantage |
$5.74
|
| Rate for Payer: UHCCP Medicaid |
$3.08
|
| Rate for Payer: UMR Bronson Commercial |
$7.70
|
| Rate for Payer: VA VA |
$5.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.61
|
|
|
HC VAP CHOLESTEROL CMPT
|
Facility
|
IP
|
$20.81
|
|
|
Service Code
|
CPT 84478
|
| Hospital Charge Code |
30100445
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.16 |
| Max. Negotiated Rate |
$18.73 |
| Rate for Payer: Aetna American Axle |
$13.53
|
| Rate for Payer: Aetna Commercial |
$17.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.53
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$14.57
|
| Rate for Payer: Cofinity Commercial |
$17.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Healthscope Commercial |
$18.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: PHP Commercial |
$17.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: Priority Health SBD |
$13.11
|
| Rate for Payer: UMR Bronson Commercial |
$9.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.61
|
|
|
HC VARICELLA VIRUS VACCINE (VAR), LIVE SUBQ
|
Facility
|
IP
|
$220.56
|
|
|
Service Code
|
CPT 90716
|
| Hospital Charge Code |
63600084
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$97.05 |
| Max. Negotiated Rate |
$198.50 |
| Rate for Payer: Aetna American Axle |
$143.36
|
| Rate for Payer: Aetna Commercial |
$187.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.36
|
| Rate for Payer: Cash Price |
$176.45
|
| Rate for Payer: Cofinity Commercial |
$154.39
|
| Rate for Payer: Cofinity Commercial |
$189.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$154.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.45
|
| Rate for Payer: Healthscope Commercial |
$198.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$154.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$165.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$187.48
|
| Rate for Payer: PHP Commercial |
$187.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.36
|
| Rate for Payer: Priority Health SBD |
$138.95
|
| Rate for Payer: UMR Bronson Commercial |
$97.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$165.42
|
|
|
HC VARICELLA VIRUS VACCINE (VAR), LIVE SUBQ
|
Facility
|
OP
|
$220.56
|
|
|
Service Code
|
CPT 90716
|
| Hospital Charge Code |
63600084
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$81.61 |
| Max. Negotiated Rate |
$476.19 |
| Rate for Payer: Aetna American Axle |
$143.36
|
| Rate for Payer: Aetna Commercial |
$187.48
|
| Rate for Payer: Aetna Medicare |
$110.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.36
|
| Rate for Payer: BCBS Complete |
$88.22
|
| Rate for Payer: BCBS Trust/PPO |
$476.19
|
| Rate for Payer: BCN Commercial |
$476.19
|
| Rate for Payer: Cash Price |
$176.45
|
| Rate for Payer: Cash Price |
$176.45
|
| Rate for Payer: Cofinity Commercial |
$154.39
|
| Rate for Payer: Cofinity Commercial |
$189.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$154.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.45
|
| Rate for Payer: Healthscope Commercial |
$198.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$154.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$165.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$187.48
|
| Rate for Payer: PHP Commercial |
$187.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$208.48
|
| Rate for Payer: Priority Health Narrow Network |
$166.78
|
| Rate for Payer: Priority Health SBD |
$138.95
|
| Rate for Payer: UMR Bronson Commercial |
$81.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$165.42
|
|
|
HC VARICELLA ZOSTER IGG
|
Facility
|
OP
|
$44.74
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
30200327
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$40.27 |
| Rate for Payer: Aetna American Axle |
$29.08
|
| Rate for Payer: Aetna Commercial |
$38.03
|
| Rate for Payer: Aetna Medicare |
$13.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.10
|
| Rate for Payer: BCBS Complete |
$7.25
|
| Rate for Payer: BCBS MAPPO |
$12.88
|
| Rate for Payer: BCBS Trust/PPO |
$12.41
|
| Rate for Payer: BCN Commercial |
$12.41
|
| Rate for Payer: BCN Medicare Advantage |
$12.88
|
| Rate for Payer: Cash Price |
$35.79
|
| Rate for Payer: Cash Price |
$35.79
|
| Rate for Payer: Cofinity Commercial |
$38.48
|
| Rate for Payer: Cofinity Commercial |
$31.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.88
|
| Rate for Payer: Healthscope Commercial |
$40.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.56
|
| Rate for Payer: Mclaren Medicaid |
$6.90
|
| Rate for Payer: Mclaren Medicare |
$12.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.52
|
| Rate for Payer: Meridian Medicaid |
$7.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.03
|
| Rate for Payer: Nomi Health Commercial |
$19.32
|
| Rate for Payer: PACE Medicare |
$12.24
|
| Rate for Payer: PACE SWMI |
$12.88
|
| Rate for Payer: PHP Commercial |
$38.03
|
| Rate for Payer: PHP Medicare Advantage |
$12.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.25
|
| Rate for Payer: Priority Health Medicare |
$12.88
|
| Rate for Payer: Priority Health Narrow Network |
$10.60
|
| Rate for Payer: Priority Health SBD |
$28.19
|
| Rate for Payer: Railroad Medicare Medicare |
$12.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.88
|
| Rate for Payer: UHC Exchange |
$12.88
|
| Rate for Payer: UHC Medicare Advantage |
$12.88
|
| Rate for Payer: UHCCP Medicaid |
$6.90
|
| Rate for Payer: UMR Bronson Commercial |
$16.55
|
| Rate for Payer: VA VA |
$12.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.56
|
|
|
HC VARICELLA ZOSTER IGG
|
Facility
|
IP
|
$44.74
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
30200327
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.69 |
| Max. Negotiated Rate |
$40.27 |
| Rate for Payer: Aetna American Axle |
$29.08
|
| Rate for Payer: Aetna Commercial |
$38.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.08
|
| Rate for Payer: Cash Price |
$35.79
|
| Rate for Payer: Cofinity Commercial |
$31.32
|
| Rate for Payer: Cofinity Commercial |
$38.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.79
|
| Rate for Payer: Healthscope Commercial |
$40.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.03
|
| Rate for Payer: PHP Commercial |
$38.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.08
|
| Rate for Payer: Priority Health SBD |
$28.19
|
| Rate for Payer: UMR Bronson Commercial |
$19.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.56
|
|
|
HC VARICELLA ZOSTER IGM
|
Facility
|
OP
|
$80.58
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
30200326
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$72.52 |
| Rate for Payer: Aetna American Axle |
$52.38
|
| Rate for Payer: Aetna Commercial |
$68.49
|
| Rate for Payer: Aetna Medicare |
$13.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.10
|
| Rate for Payer: BCBS Complete |
$7.25
|
| Rate for Payer: BCBS MAPPO |
$12.88
|
| Rate for Payer: BCBS Trust/PPO |
$12.41
|
| Rate for Payer: BCN Commercial |
$12.41
|
| Rate for Payer: BCN Medicare Advantage |
$12.88
|
| Rate for Payer: Cash Price |
$64.46
|
| Rate for Payer: Cash Price |
$64.46
|
| Rate for Payer: Cofinity Commercial |
$69.30
|
| Rate for Payer: Cofinity Commercial |
$56.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$56.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.88
|
| Rate for Payer: Healthscope Commercial |
$72.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.44
|
| Rate for Payer: Mclaren Medicaid |
$6.90
|
| Rate for Payer: Mclaren Medicare |
$12.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.52
|
| Rate for Payer: Meridian Medicaid |
$7.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.49
|
| Rate for Payer: Nomi Health Commercial |
$19.32
|
| Rate for Payer: PACE Medicare |
$12.24
|
| Rate for Payer: PACE SWMI |
$12.88
|
| Rate for Payer: PHP Commercial |
$68.49
|
| Rate for Payer: PHP Medicare Advantage |
$12.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.25
|
| Rate for Payer: Priority Health Medicare |
$12.88
|
| Rate for Payer: Priority Health Narrow Network |
$10.60
|
| Rate for Payer: Priority Health SBD |
$50.77
|
| Rate for Payer: Railroad Medicare Medicare |
$12.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.88
|
| Rate for Payer: UHC Exchange |
$12.88
|
| Rate for Payer: UHC Medicare Advantage |
$12.88
|
| Rate for Payer: UHCCP Medicaid |
$6.90
|
| Rate for Payer: UMR Bronson Commercial |
$29.81
|
| Rate for Payer: VA VA |
$12.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.44
|
|
|
HC VARICELLA ZOSTER IGM
|
Facility
|
IP
|
$80.58
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
30200326
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$35.46 |
| Max. Negotiated Rate |
$72.52 |
| Rate for Payer: Aetna American Axle |
$52.38
|
| Rate for Payer: Aetna Commercial |
$68.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.38
|
| Rate for Payer: Cash Price |
$64.46
|
| Rate for Payer: Cofinity Commercial |
$56.41
|
| Rate for Payer: Cofinity Commercial |
$69.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$56.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.46
|
| Rate for Payer: Healthscope Commercial |
$72.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.49
|
| Rate for Payer: PHP Commercial |
$68.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.38
|
| Rate for Payer: Priority Health SBD |
$50.77
|
| Rate for Payer: UMR Bronson Commercial |
$35.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.44
|
|
|
HC VARICELLA ZOSTER PCR CSF
|
Facility
|
IP
|
$109.24
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600167
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$48.07 |
| Max. Negotiated Rate |
$98.32 |
| Rate for Payer: Aetna American Axle |
$71.01
|
| Rate for Payer: Aetna Commercial |
$92.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.01
|
| Rate for Payer: Cash Price |
$87.39
|
| Rate for Payer: Cofinity Commercial |
$76.47
|
| Rate for Payer: Cofinity Commercial |
$93.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$76.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.39
|
| Rate for Payer: Healthscope Commercial |
$98.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$76.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.85
|
| Rate for Payer: PHP Commercial |
$92.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.01
|
| Rate for Payer: Priority Health SBD |
$68.82
|
| Rate for Payer: UMR Bronson Commercial |
$48.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.93
|
|
|
HC VARICELLA ZOSTER PCR CSF
|
Facility
|
OP
|
$109.24
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600167
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.81 |
| Max. Negotiated Rate |
$98.32 |
| Rate for Payer: Aetna American Axle |
$71.01
|
| Rate for Payer: Aetna Commercial |
$92.85
|
| Rate for Payer: Aetna Medicare |
$36.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: BCBS Complete |
$19.75
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$33.81
|
| Rate for Payer: BCN Commercial |
$33.81
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$87.39
|
| Rate for Payer: Cash Price |
$87.39
|
| Rate for Payer: Cofinity Commercial |
$93.95
|
| Rate for Payer: Cofinity Commercial |
$76.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$76.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$98.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$76.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.93
|
| Rate for Payer: Mclaren Medicaid |
$18.81
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: Meridian Medicaid |
$19.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.85
|
| Rate for Payer: Nomi Health Commercial |
$52.64
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$92.85
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.01
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health SBD |
$68.82
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.09
|
| Rate for Payer: UHC Exchange |
$35.09
|
| Rate for Payer: UHC Medicare Advantage |
$35.09
|
| Rate for Payer: UHCCP Medicaid |
$18.81
|
| Rate for Payer: UMR Bronson Commercial |
$40.42
|
| Rate for Payer: VA VA |
$35.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.93
|
|
|
HC VARICELLA ZOSTER VIRUS (VZV)
|
Facility
|
IP
|
$57.40
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600278
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$25.26 |
| Max. Negotiated Rate |
$51.66 |
| Rate for Payer: Aetna American Axle |
$37.31
|
| Rate for Payer: Aetna Commercial |
$48.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.31
|
| Rate for Payer: Cash Price |
$45.92
|
| Rate for Payer: Cofinity Commercial |
$40.18
|
| Rate for Payer: Cofinity Commercial |
$49.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$40.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.92
|
| Rate for Payer: Healthscope Commercial |
$51.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$40.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.79
|
| Rate for Payer: PHP Commercial |
$48.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.31
|
| Rate for Payer: Priority Health SBD |
$36.16
|
| Rate for Payer: UMR Bronson Commercial |
$25.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.05
|
|
|
HC VARICELLA ZOSTER VIRUS (VZV)
|
Facility
|
OP
|
$57.40
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600278
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.81 |
| Max. Negotiated Rate |
$52.64 |
| Rate for Payer: Aetna American Axle |
$37.31
|
| Rate for Payer: Aetna Commercial |
$48.79
|
| Rate for Payer: Aetna Medicare |
$36.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: BCBS Complete |
$19.75
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$33.81
|
| Rate for Payer: BCN Commercial |
$33.81
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$45.92
|
| Rate for Payer: Cash Price |
$45.92
|
| Rate for Payer: Cofinity Commercial |
$49.36
|
| Rate for Payer: Cofinity Commercial |
$40.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$40.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$51.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$40.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.05
|
| Rate for Payer: Mclaren Medicaid |
$18.81
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: Meridian Medicaid |
$19.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.79
|
| Rate for Payer: Nomi Health Commercial |
$52.64
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$48.79
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.31
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health SBD |
$36.16
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.09
|
| Rate for Payer: UHC Exchange |
$35.09
|
| Rate for Payer: UHC Medicare Advantage |
$35.09
|
| Rate for Payer: UHCCP Medicaid |
$18.81
|
| Rate for Payer: UMR Bronson Commercial |
$21.24
|
| Rate for Payer: VA VA |
$35.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.05
|
|
|
HC VASCLAR EMBO OR OCCLUS DIALYSIS CIRCUIT W IMAGING
|
Facility
|
OP
|
$204.41
|
|
|
Service Code
|
CPT 36909
|
| Hospital Charge Code |
36100533
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$75.63 |
| Max. Negotiated Rate |
$6,989.54 |
| Rate for Payer: Aetna American Axle |
$132.87
|
| Rate for Payer: Aetna Commercial |
$173.75
|
| Rate for Payer: Aetna Medicare |
$102.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.87
|
| Rate for Payer: BCBS Complete |
$81.76
|
| Rate for Payer: BCBS Trust/PPO |
$6,989.54
|
| Rate for Payer: BCN Commercial |
$6,989.54
|
| Rate for Payer: Cash Price |
$163.53
|
| Rate for Payer: Cash Price |
$163.53
|
| Rate for Payer: Cash Price |
$163.53
|
| Rate for Payer: Cofinity Commercial |
$175.79
|
| Rate for Payer: Cofinity Commercial |
$143.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$143.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.53
|
| Rate for Payer: Healthscope Commercial |
$183.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$143.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$153.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.75
|
| Rate for Payer: PHP Commercial |
$173.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.87
|
| Rate for Payer: Priority Health SBD |
$128.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$211.49
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$192.26
|
| Rate for Payer: UMR Bronson Commercial |
$75.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$153.31
|
|
|
HC VASCLAR EMBO OR OCCLUS DIALYSIS CIRCUIT W IMAGING
|
Facility
|
IP
|
$204.41
|
|
|
Service Code
|
CPT 36909
|
| Hospital Charge Code |
36100533
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$89.94 |
| Max. Negotiated Rate |
$183.97 |
| Rate for Payer: Aetna American Axle |
$132.87
|
| Rate for Payer: Aetna Commercial |
$173.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.87
|
| Rate for Payer: Cash Price |
$163.53
|
| Rate for Payer: Cofinity Commercial |
$143.09
|
| Rate for Payer: Cofinity Commercial |
$175.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$143.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.53
|
| Rate for Payer: Healthscope Commercial |
$183.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$143.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$153.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.75
|
| Rate for Payer: PHP Commercial |
$173.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.87
|
| Rate for Payer: Priority Health SBD |
$128.78
|
| Rate for Payer: UMR Bronson Commercial |
$89.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$153.31
|
|
|
HC VASCULAR EMBOL/OCCLU W PRESSURE GEN CATH
|
Facility
|
IP
|
$33,420.00
|
|
|
Service Code
|
CPT C9797
|
| Hospital Charge Code |
36100635
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$14,704.80 |
| Max. Negotiated Rate |
$30,078.00 |
| Rate for Payer: Aetna American Axle |
$21,723.00
|
| Rate for Payer: Aetna Commercial |
$28,407.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21,723.00
|
| Rate for Payer: Cash Price |
$26,736.00
|
| Rate for Payer: Cofinity Commercial |
$23,394.00
|
| Rate for Payer: Cofinity Commercial |
$28,741.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$23,394.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26,736.00
|
| Rate for Payer: Healthscope Commercial |
$30,078.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23,394.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25,065.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28,407.00
|
| Rate for Payer: PHP Commercial |
$28,407.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21,723.00
|
| Rate for Payer: Priority Health SBD |
$21,054.60
|
| Rate for Payer: UMR Bronson Commercial |
$14,704.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25,065.00
|
|
|
HC VASCULAR EMBOL/OCCLU W PRESSURE GEN CATH
|
Facility
|
OP
|
$33,420.00
|
|
|
Service Code
|
CPT C9797
|
| Hospital Charge Code |
36100635
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$9,430.19 |
| Max. Negotiated Rate |
$55,296.52 |
| Rate for Payer: Aetna American Axle |
$21,723.00
|
| Rate for Payer: Aetna Commercial |
$28,407.00
|
| Rate for Payer: Aetna Medicare |
$18,297.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21,723.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,992.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,992.05
|
| Rate for Payer: BCBS Complete |
$9,901.70
|
| Rate for Payer: BCBS MAPPO |
$17,593.64
|
| Rate for Payer: BCBS Trust/PPO |
$15,553.23
|
| Rate for Payer: BCN Commercial |
$15,553.23
|
| Rate for Payer: BCN Medicare Advantage |
$17,593.64
|
| Rate for Payer: Cash Price |
$26,736.00
|
| Rate for Payer: Cash Price |
$26,736.00
|
| Rate for Payer: Cash Price |
$26,736.00
|
| Rate for Payer: Cofinity Commercial |
$28,741.20
|
| Rate for Payer: Cofinity Commercial |
$23,394.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$23,394.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26,736.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,593.64
|
| Rate for Payer: Healthscope Commercial |
$30,078.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23,394.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25,065.00
|
| Rate for Payer: Mclaren Medicaid |
$9,430.19
|
| Rate for Payer: Mclaren Medicare |
$17,593.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18,473.32
|
| Rate for Payer: Meridian Medicaid |
$9,901.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,232.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28,407.00
|
| Rate for Payer: Nomi Health Commercial |
$36,946.64
|
| Rate for Payer: PACE Medicare |
$16,713.96
|
| Rate for Payer: PACE SWMI |
$17,593.64
|
| Rate for Payer: PHP Commercial |
$28,407.00
|
| Rate for Payer: PHP Medicare Advantage |
$17,593.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,430.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21,723.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55,296.52
|
| Rate for Payer: Priority Health Medicare |
$17,593.64
|
| Rate for Payer: Priority Health Narrow Network |
$44,237.22
|
| Rate for Payer: Priority Health SBD |
$21,054.60
|
| Rate for Payer: Railroad Medicare Medicare |
$17,593.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49,524.34
|
| Rate for Payer: UHC Core |
$13,752.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$17,593.64
|
| Rate for Payer: UHC Exchange |
$33,623.21
|
| Rate for Payer: UHC Medicare Advantage |
$17,593.64
|
| Rate for Payer: UHCCP Medicaid |
$9,430.19
|
| Rate for Payer: UMR Bronson Commercial |
$12,365.40
|
| Rate for Payer: VA VA |
$17,593.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25,065.00
|
|
|
HC VASCULAR GRAFT
|
Facility
|
OP
|
$2,314.40
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27800033
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$856.33 |
| Max. Negotiated Rate |
$2,082.96 |
| Rate for Payer: Aetna American Axle |
$1,504.36
|
| Rate for Payer: Aetna Commercial |
$1,967.24
|
| Rate for Payer: Aetna Medicare |
$1,157.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,504.36
|
| Rate for Payer: BCBS Complete |
$925.76
|
| Rate for Payer: Cash Price |
$1,851.52
|
| Rate for Payer: Cofinity Commercial |
$1,620.08
|
| Rate for Payer: Cofinity Commercial |
$1,990.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,620.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,851.52
|
| Rate for Payer: Healthscope Commercial |
$2,082.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,620.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,735.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,967.24
|
| Rate for Payer: PHP Commercial |
$1,967.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,504.36
|
| Rate for Payer: Priority Health SBD |
$1,458.07
|
| Rate for Payer: UMR Bronson Commercial |
$856.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,735.80
|
|
|
HC VASCULAR GRAFT
|
Facility
|
IP
|
$2,314.40
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27800033
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,018.34 |
| Max. Negotiated Rate |
$2,082.96 |
| Rate for Payer: Aetna American Axle |
$1,504.36
|
| Rate for Payer: Aetna Commercial |
$1,967.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,504.36
|
| Rate for Payer: Cash Price |
$1,851.52
|
| Rate for Payer: Cofinity Commercial |
$1,620.08
|
| Rate for Payer: Cofinity Commercial |
$1,990.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,620.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,851.52
|
| Rate for Payer: Healthscope Commercial |
$2,082.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,620.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,735.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,967.24
|
| Rate for Payer: PHP Commercial |
$1,967.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,504.36
|
| Rate for Payer: Priority Health SBD |
$1,458.07
|
| Rate for Payer: UMR Bronson Commercial |
$1,018.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,735.80
|
|
|
HC VASOACTIVE INTESTINAL PEPTIDE/VIP
|
Facility
|
IP
|
$84.27
|
|
|
Service Code
|
CPT 84586
|
| Hospital Charge Code |
30100456
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.08 |
| Max. Negotiated Rate |
$75.84 |
| Rate for Payer: Aetna American Axle |
$54.78
|
| Rate for Payer: Aetna Commercial |
$71.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.78
|
| Rate for Payer: Cash Price |
$67.42
|
| Rate for Payer: Cofinity Commercial |
$58.99
|
| Rate for Payer: Cofinity Commercial |
$72.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$58.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.42
|
| Rate for Payer: Healthscope Commercial |
$75.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$58.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.63
|
| Rate for Payer: PHP Commercial |
$71.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.78
|
| Rate for Payer: Priority Health SBD |
$53.09
|
| Rate for Payer: UMR Bronson Commercial |
$37.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.20
|
|
|
HC VASOACTIVE INTESTINAL PEPTIDE/VIP
|
Facility
|
OP
|
$84.27
|
|
|
Service Code
|
CPT 84586
|
| Hospital Charge Code |
30100456
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.94 |
| Max. Negotiated Rate |
$75.84 |
| Rate for Payer: BCN Commercial |
$34.04
|
| Rate for Payer: BCN Medicare Advantage |
$35.33
|
| Rate for Payer: Cash Price |
$67.42
|
| Rate for Payer: Cash Price |
$67.42
|
| Rate for Payer: Cofinity Commercial |
$72.47
|
| Rate for Payer: Cofinity Commercial |
$58.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$58.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.33
|
| Rate for Payer: Healthscope Commercial |
$75.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$58.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.20
|
| Rate for Payer: Mclaren Medicaid |
$18.94
|
| Rate for Payer: Mclaren Medicare |
$35.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37.10
|
| Rate for Payer: Meridian Medicaid |
$19.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.63
|
| Rate for Payer: Nomi Health Commercial |
$53.00
|
| Rate for Payer: PACE Medicare |
$33.56
|
| Rate for Payer: PACE SWMI |
$35.33
|
| Rate for Payer: PHP Commercial |
$71.63
|
| Rate for Payer: PHP Medicare Advantage |
$35.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36.35
|
| Rate for Payer: Priority Health Medicare |
$35.33
|
| Rate for Payer: Priority Health Narrow Network |
$29.08
|
| Rate for Payer: Priority Health SBD |
$53.09
|
| Rate for Payer: Railroad Medicare Medicare |
$35.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.33
|
| Rate for Payer: UHC Exchange |
$35.33
|
| Rate for Payer: UHC Medicare Advantage |
$35.33
|
| Rate for Payer: UHCCP Medicaid |
$18.94
|
| Rate for Payer: UMR Bronson Commercial |
$31.18
|
| Rate for Payer: VA VA |
$35.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.20
|
| Rate for Payer: Aetna American Axle |
$54.78
|
| Rate for Payer: Aetna Commercial |
$71.63
|
| Rate for Payer: Aetna Medicare |
$36.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$44.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$44.16
|
| Rate for Payer: BCBS Complete |
$19.88
|
| Rate for Payer: BCBS MAPPO |
$35.33
|
| Rate for Payer: BCBS Trust/PPO |
$34.04
|
|
|
HC VASOPNEUMATIC TREATMENT
|
Facility
|
IP
|
$74.91
|
|
|
Service Code
|
CPT 97016
|
| Hospital Charge Code |
43000017
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$32.96 |
| Max. Negotiated Rate |
$67.42 |
| Rate for Payer: Aetna American Axle |
$48.69
|
| Rate for Payer: Aetna Commercial |
$63.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.69
|
| Rate for Payer: Cash Price |
$59.93
|
| Rate for Payer: Cofinity Commercial |
$52.44
|
| Rate for Payer: Cofinity Commercial |
$64.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$52.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.93
|
| Rate for Payer: Healthscope Commercial |
$67.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.67
|
| Rate for Payer: PHP Commercial |
$63.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.69
|
| Rate for Payer: Priority Health SBD |
$47.19
|
| Rate for Payer: UMR Bronson Commercial |
$32.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.18
|
|
