|
HC COLPOSCOPY VAGINA W/BIOPSY
|
Facility
|
OP
|
$853.74
|
|
|
Service Code
|
CPT 57421
|
| Hospital Charge Code |
76100223
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$119.52 |
| Max. Negotiated Rate |
$2,249.54 |
| Rate for Payer: Aetna American Axle |
$554.93
|
| Rate for Payer: Aetna Commercial |
$725.68
|
| Rate for Payer: Aetna Medicare |
$743.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$554.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$893.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$893.22
|
| Rate for Payer: BCBS Complete |
$410.45
|
| Rate for Payer: BCBS MAPPO |
$714.58
|
| Rate for Payer: BCBS Trust/PPO |
$752.29
|
| Rate for Payer: BCN Medicare Advantage |
$714.58
|
| Rate for Payer: Cash Price |
$682.99
|
| Rate for Payer: Cash Price |
$682.99
|
| Rate for Payer: Cofinity Commercial |
$597.62
|
| Rate for Payer: Cofinity Commercial |
$734.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$682.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$714.58
|
| Rate for Payer: Healthscope Commercial |
$768.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$597.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$640.30
|
| Rate for Payer: Mclaren Medicaid |
$390.88
|
| Rate for Payer: Mclaren Medicare |
$714.58
|
| Rate for Payer: Meridian Medicaid |
$410.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$750.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$821.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$725.68
|
| Rate for Payer: PACE Medicare |
$678.85
|
| Rate for Payer: PACE SWMI |
$714.58
|
| Rate for Payer: PHP Commercial |
$725.68
|
| Rate for Payer: PHP Medicare Advantage |
$714.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$390.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$597.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,249.54
|
| Rate for Payer: Priority Health Medicare |
$714.58
|
| Rate for Payer: Priority Health Narrow Network |
$1,799.63
|
| Rate for Payer: Priority Health SBD |
$537.86
|
| Rate for Payer: Railroad Medicare Medicare |
$714.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$131.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$714.58
|
| Rate for Payer: UHC Exchange |
$119.52
|
| Rate for Payer: UHC Medicare Advantage |
$736.02
|
| Rate for Payer: UMR Bronson Commercial |
$315.88
|
| Rate for Payer: VA VA |
$714.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$640.30
|
|
|
HC COLPOSCOPY VAGINA W/O BIOPSY
|
Facility
|
IP
|
$414.20
|
|
|
Service Code
|
CPT 57420
|
| Hospital Charge Code |
76100254
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$182.25 |
| Max. Negotiated Rate |
$372.78 |
| Rate for Payer: Aetna American Axle |
$269.23
|
| Rate for Payer: Aetna Commercial |
$352.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$269.23
|
| Rate for Payer: Cash Price |
$331.36
|
| Rate for Payer: Cofinity Commercial |
$289.94
|
| Rate for Payer: Cofinity Commercial |
$356.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$331.36
|
| Rate for Payer: Healthscope Commercial |
$372.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$289.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$310.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$352.07
|
| Rate for Payer: PHP Commercial |
$352.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$289.94
|
| Rate for Payer: Priority Health SBD |
$260.95
|
| Rate for Payer: UMR Bronson Commercial |
$182.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$310.65
|
|
|
HC COLPOSCOPY VAGINA W/O BIOPSY
|
Facility
|
OP
|
$414.20
|
|
|
Service Code
|
CPT 57420
|
| Hospital Charge Code |
76100254
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$68.36 |
| Max. Negotiated Rate |
$897.69 |
| Rate for Payer: Aetna American Axle |
$269.23
|
| Rate for Payer: Aetna Commercial |
$352.07
|
| Rate for Payer: Aetna Medicare |
$296.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$269.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$356.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$356.45
|
| Rate for Payer: BCBS Complete |
$163.80
|
| Rate for Payer: BCBS MAPPO |
$285.16
|
| Rate for Payer: BCBS Trust/PPO |
$68.36
|
| Rate for Payer: BCN Medicare Advantage |
$285.16
|
| Rate for Payer: Cash Price |
$331.36
|
| Rate for Payer: Cash Price |
$331.36
|
| Rate for Payer: Cofinity Commercial |
$356.21
|
| Rate for Payer: Cofinity Commercial |
$289.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$331.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$285.16
|
| Rate for Payer: Healthscope Commercial |
$372.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$289.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$310.65
|
| Rate for Payer: Mclaren Medicaid |
$155.98
|
| Rate for Payer: Mclaren Medicare |
$285.16
|
| Rate for Payer: Meridian Medicaid |
$163.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$299.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$327.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$352.07
|
| Rate for Payer: PACE Medicare |
$270.90
|
| Rate for Payer: PACE SWMI |
$285.16
|
| Rate for Payer: PHP Commercial |
$352.07
|
| Rate for Payer: PHP Medicare Advantage |
$285.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$155.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$289.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$897.69
|
| Rate for Payer: Priority Health Medicare |
$285.16
|
| Rate for Payer: Priority Health Narrow Network |
$718.15
|
| Rate for Payer: Priority Health SBD |
$260.95
|
| Rate for Payer: Railroad Medicare Medicare |
$285.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$96.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$285.16
|
| Rate for Payer: UHC Exchange |
$88.08
|
| Rate for Payer: UHC Medicare Advantage |
$293.71
|
| Rate for Payer: UMR Bronson Commercial |
$153.25
|
| Rate for Payer: VA VA |
$285.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$310.65
|
|
|
HC COLPOSCOPY, VULVA
|
Facility
|
IP
|
$322.32
|
|
|
Service Code
|
CPT 56820
|
| Hospital Charge Code |
76100258
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$141.82 |
| Max. Negotiated Rate |
$290.09 |
| Rate for Payer: Aetna American Axle |
$209.51
|
| Rate for Payer: Aetna Commercial |
$273.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$209.51
|
| Rate for Payer: Cash Price |
$257.86
|
| Rate for Payer: Cofinity Commercial |
$225.62
|
| Rate for Payer: Cofinity Commercial |
$277.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$257.86
|
| Rate for Payer: Healthscope Commercial |
$290.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$225.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$241.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$273.97
|
| Rate for Payer: PHP Commercial |
$273.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$225.62
|
| Rate for Payer: Priority Health SBD |
$203.06
|
| Rate for Payer: UMR Bronson Commercial |
$141.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$241.74
|
|
|
HC COLPOSCOPY, VULVA
|
Facility
|
OP
|
$322.32
|
|
|
Service Code
|
CPT 56820
|
| Hospital Charge Code |
76100258
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$82.52 |
| Max. Negotiated Rate |
$557.61 |
| Rate for Payer: Aetna American Axle |
$209.51
|
| Rate for Payer: Aetna Commercial |
$273.97
|
| Rate for Payer: Aetna Medicare |
$184.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$209.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$221.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$221.40
|
| Rate for Payer: BCBS Complete |
$101.74
|
| Rate for Payer: BCBS MAPPO |
$177.12
|
| Rate for Payer: BCBS Trust/PPO |
$121.34
|
| Rate for Payer: BCN Medicare Advantage |
$177.12
|
| Rate for Payer: Cash Price |
$257.86
|
| Rate for Payer: Cash Price |
$257.86
|
| Rate for Payer: Cofinity Commercial |
$225.62
|
| Rate for Payer: Cofinity Commercial |
$277.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$257.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.12
|
| Rate for Payer: Healthscope Commercial |
$290.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$225.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$241.74
|
| Rate for Payer: Mclaren Medicaid |
$96.88
|
| Rate for Payer: Mclaren Medicare |
$177.12
|
| Rate for Payer: Meridian Medicaid |
$101.74
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$185.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$203.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$273.97
|
| Rate for Payer: PACE Medicare |
$168.26
|
| Rate for Payer: PACE SWMI |
$177.12
|
| Rate for Payer: PHP Commercial |
$273.97
|
| Rate for Payer: PHP Medicare Advantage |
$177.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$96.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$225.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$557.61
|
| Rate for Payer: Priority Health Medicare |
$177.12
|
| Rate for Payer: Priority Health Narrow Network |
$446.09
|
| Rate for Payer: Priority Health SBD |
$203.06
|
| Rate for Payer: Railroad Medicare Medicare |
$177.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$90.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$177.12
|
| Rate for Payer: UHC Exchange |
$82.52
|
| Rate for Payer: UHC Medicare Advantage |
$182.43
|
| Rate for Payer: UMR Bronson Commercial |
$119.26
|
| Rate for Payer: VA VA |
$177.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$241.74
|
|
|
HC COLPOSCOPY VULVA W/BIOPSY
|
Facility
|
OP
|
$837.42
|
|
|
Service Code
|
CPT 56821
|
| Hospital Charge Code |
76100332
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$84.20 |
| Max. Negotiated Rate |
$897.69 |
| Rate for Payer: Aetna American Axle |
$544.32
|
| Rate for Payer: Aetna Commercial |
$711.81
|
| Rate for Payer: Aetna Medicare |
$296.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$544.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$356.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$356.45
|
| Rate for Payer: BCBS Complete |
$163.80
|
| Rate for Payer: BCBS MAPPO |
$285.16
|
| Rate for Payer: BCBS Trust/PPO |
$84.20
|
| Rate for Payer: BCN Medicare Advantage |
$285.16
|
| Rate for Payer: Cash Price |
$669.94
|
| Rate for Payer: Cash Price |
$669.94
|
| Rate for Payer: Cofinity Commercial |
$720.18
|
| Rate for Payer: Cofinity Commercial |
$586.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$669.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$285.16
|
| Rate for Payer: Healthscope Commercial |
$753.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$586.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$628.06
|
| Rate for Payer: Mclaren Medicaid |
$155.98
|
| Rate for Payer: Mclaren Medicare |
$285.16
|
| Rate for Payer: Meridian Medicaid |
$163.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$299.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$327.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$711.81
|
| Rate for Payer: PACE Medicare |
$270.90
|
| Rate for Payer: PACE SWMI |
$285.16
|
| Rate for Payer: PHP Commercial |
$711.81
|
| Rate for Payer: PHP Medicare Advantage |
$285.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$155.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$586.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$897.69
|
| Rate for Payer: Priority Health Medicare |
$285.16
|
| Rate for Payer: Priority Health Narrow Network |
$718.15
|
| Rate for Payer: Priority Health SBD |
$527.57
|
| Rate for Payer: Railroad Medicare Medicare |
$285.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$122.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$285.16
|
| Rate for Payer: UHC Exchange |
$111.33
|
| Rate for Payer: UHC Medicare Advantage |
$293.71
|
| Rate for Payer: UMR Bronson Commercial |
$309.85
|
| Rate for Payer: VA VA |
$285.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$628.06
|
|
|
HC COLPOSCOPY VULVA W/BIOPSY
|
Facility
|
IP
|
$837.42
|
|
|
Service Code
|
CPT 56821
|
| Hospital Charge Code |
76100332
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$368.46 |
| Max. Negotiated Rate |
$753.68 |
| Rate for Payer: Aetna American Axle |
$544.32
|
| Rate for Payer: Aetna Commercial |
$711.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$544.32
|
| Rate for Payer: Cash Price |
$669.94
|
| Rate for Payer: Cofinity Commercial |
$586.19
|
| Rate for Payer: Cofinity Commercial |
$720.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$669.94
|
| Rate for Payer: Healthscope Commercial |
$753.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$586.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$628.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$711.81
|
| Rate for Payer: PHP Commercial |
$711.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$586.19
|
| Rate for Payer: Priority Health SBD |
$527.57
|
| Rate for Payer: UMR Bronson Commercial |
$368.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$628.06
|
|
|
HC COMBI CATH SUPPLY
|
Facility
|
IP
|
$121.04
|
|
| Hospital Charge Code |
27200116
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$53.26 |
| Max. Negotiated Rate |
$108.94 |
| Rate for Payer: Aetna American Axle |
$78.68
|
| Rate for Payer: Aetna Commercial |
$102.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.68
|
| Rate for Payer: Cash Price |
$96.83
|
| Rate for Payer: Cofinity Commercial |
$104.09
|
| Rate for Payer: Cofinity Commercial |
$84.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.83
|
| Rate for Payer: Healthscope Commercial |
$108.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$84.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$102.88
|
| Rate for Payer: PHP Commercial |
$102.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.73
|
| Rate for Payer: Priority Health SBD |
$76.26
|
| Rate for Payer: UMR Bronson Commercial |
$53.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.78
|
|
|
HC COMBI CATH SUPPLY
|
Facility
|
OP
|
$121.04
|
|
| Hospital Charge Code |
27200116
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$44.78 |
| Max. Negotiated Rate |
$108.94 |
| Rate for Payer: Aetna American Axle |
$78.68
|
| Rate for Payer: Aetna Commercial |
$102.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.68
|
| Rate for Payer: BCBS Complete |
$48.42
|
| Rate for Payer: Cash Price |
$96.83
|
| Rate for Payer: Cofinity Commercial |
$104.09
|
| Rate for Payer: Cofinity Commercial |
$84.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.83
|
| Rate for Payer: Healthscope Commercial |
$108.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$84.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$102.88
|
| Rate for Payer: PHP Commercial |
$102.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.73
|
| Rate for Payer: Priority Health SBD |
$76.26
|
| Rate for Payer: UMR Bronson Commercial |
$44.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.78
|
|
|
HC COMBINED VACCINE, MMR+VARICELLA, SUBQ
|
Facility
|
IP
|
$209.10
|
|
|
Service Code
|
CPT 90710
|
| Hospital Charge Code |
63600206
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$92.00 |
| Max. Negotiated Rate |
$188.19 |
| Rate for Payer: Aetna American Axle |
$135.92
|
| Rate for Payer: Aetna Commercial |
$177.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.92
|
| Rate for Payer: Cash Price |
$167.28
|
| Rate for Payer: Cofinity Commercial |
$146.37
|
| Rate for Payer: Cofinity Commercial |
$179.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.28
|
| Rate for Payer: Healthscope Commercial |
$188.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$146.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$177.74
|
| Rate for Payer: PHP Commercial |
$177.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.37
|
| Rate for Payer: Priority Health SBD |
$131.73
|
| Rate for Payer: UMR Bronson Commercial |
$92.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.82
|
|
|
HC COMBINED VACCINE, MMR+VARICELLA, SUBQ
|
Facility
|
OP
|
$209.10
|
|
|
Service Code
|
CPT 90710
|
| Hospital Charge Code |
63600206
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$67.71 |
| Max. Negotiated Rate |
$824.64 |
| Rate for Payer: Aetna American Axle |
$135.92
|
| Rate for Payer: Aetna Commercial |
$177.74
|
| Rate for Payer: Aetna Medicare |
$128.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$154.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$154.74
|
| Rate for Payer: BCBS Complete |
$71.10
|
| Rate for Payer: BCBS MAPPO |
$123.79
|
| Rate for Payer: BCBS Trust/PPO |
$824.64
|
| Rate for Payer: BCN Medicare Advantage |
$123.79
|
| Rate for Payer: Cash Price |
$167.28
|
| Rate for Payer: Cash Price |
$167.28
|
| Rate for Payer: Cofinity Commercial |
$179.83
|
| Rate for Payer: Cofinity Commercial |
$146.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$123.79
|
| Rate for Payer: Healthscope Commercial |
$188.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$146.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.82
|
| Rate for Payer: Mclaren Medicaid |
$67.71
|
| Rate for Payer: Mclaren Medicare |
$123.79
|
| Rate for Payer: Meridian Medicaid |
$71.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$129.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$177.74
|
| Rate for Payer: PACE Medicare |
$117.60
|
| Rate for Payer: PACE SWMI |
$123.79
|
| Rate for Payer: PHP Commercial |
$177.74
|
| Rate for Payer: PHP Medicare Advantage |
$123.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$469.89
|
| Rate for Payer: Priority Health Medicare |
$123.79
|
| Rate for Payer: Priority Health Narrow Network |
$375.91
|
| Rate for Payer: Priority Health SBD |
$131.73
|
| Rate for Payer: Railroad Medicare Medicare |
$123.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$123.79
|
| Rate for Payer: UHC Medicare Advantage |
$127.50
|
| Rate for Payer: UMR Bronson Commercial |
$77.37
|
| Rate for Payer: VA VA |
$123.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.82
|
|
|
HC COMMON REED IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200080
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.95 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna American Axle |
$16.18
|
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.18
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$17.42
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health SBD |
$15.68
|
| Rate for Payer: UMR Bronson Commercial |
$10.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.67
|
|
|
HC COMMON REED IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200080
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna American Axle |
$16.18
|
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: BCBS Complete |
$3.00
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$4.70
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Cofinity Commercial |
$17.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.67
|
| Rate for Payer: Mclaren Medicaid |
$2.86
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Medicaid |
$3.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7.16
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$5.73
|
| Rate for Payer: Priority Health SBD |
$15.68
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.26
|
| Rate for Payer: UHC Core |
$8.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$5.22
|
| Rate for Payer: UHC Medicare Advantage |
$5.38
|
| Rate for Payer: UMR Bronson Commercial |
$9.21
|
| Rate for Payer: VA VA |
$5.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.67
|
|
|
HC COMM WORK REINTEGRATION EA 15 MIN
|
Facility
|
OP
|
$95.00
|
|
|
Service Code
|
CPT 97537
|
| Hospital Charge Code |
42000031
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$21.60 |
| Max. Negotiated Rate |
$294.00 |
| Rate for Payer: Aetna American Axle |
$61.75
|
| Rate for Payer: Aetna Commercial |
$80.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.75
|
| Rate for Payer: BCBS Complete |
$38.00
|
| Rate for Payer: BCBS Trust/PPO |
$22.28
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Cofinity Commercial |
$81.70
|
| Rate for Payer: Cofinity Commercial |
$66.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.00
|
| Rate for Payer: Healthscope Commercial |
$85.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$80.75
|
| Rate for Payer: PHP Commercial |
$80.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27.00
|
| Rate for Payer: Priority Health Narrow Network |
$21.60
|
| Rate for Payer: Priority Health SBD |
$59.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.22
|
| Rate for Payer: UHC Core |
$294.00
|
| Rate for Payer: UHC Exchange |
$31.11
|
| Rate for Payer: UMR Bronson Commercial |
$35.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.25
|
|
|
HC COMM WORK REINTEGRATION EA 15 MIN
|
Facility
|
IP
|
$95.00
|
|
|
Service Code
|
CPT 97537
|
| Hospital Charge Code |
42000031
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$41.80 |
| Max. Negotiated Rate |
$85.50 |
| Rate for Payer: Aetna American Axle |
$61.75
|
| Rate for Payer: Aetna Commercial |
$80.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.75
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Cofinity Commercial |
$66.50
|
| Rate for Payer: Cofinity Commercial |
$81.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.00
|
| Rate for Payer: Healthscope Commercial |
$85.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$80.75
|
| Rate for Payer: PHP Commercial |
$80.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.50
|
| Rate for Payer: Priority Health SBD |
$59.85
|
| Rate for Payer: UMR Bronson Commercial |
$41.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.25
|
|
|
HC COMPARTMENT PRESSURE CHECK
|
Facility
|
OP
|
$645.71
|
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$238.91 |
| Max. Negotiated Rate |
$581.14 |
| Rate for Payer: Aetna American Axle |
$419.71
|
| Rate for Payer: Aetna Commercial |
$548.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$419.71
|
| Rate for Payer: BCBS Complete |
$258.28
|
| Rate for Payer: Cash Price |
$516.57
|
| Rate for Payer: Cofinity Commercial |
$555.31
|
| Rate for Payer: Cofinity Commercial |
$452.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$516.57
|
| Rate for Payer: Healthscope Commercial |
$581.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$452.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$484.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$548.85
|
| Rate for Payer: PHP Commercial |
$548.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$452.00
|
| Rate for Payer: Priority Health SBD |
$406.80
|
| Rate for Payer: UMR Bronson Commercial |
$238.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$484.28
|
|
|
HC COMPARTMENT PRESSURE CHECK
|
Facility
|
IP
|
$645.71
|
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$284.11 |
| Max. Negotiated Rate |
$581.14 |
| Rate for Payer: Aetna American Axle |
$419.71
|
| Rate for Payer: Aetna Commercial |
$548.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$419.71
|
| Rate for Payer: Cash Price |
$516.57
|
| Rate for Payer: Cofinity Commercial |
$452.00
|
| Rate for Payer: Cofinity Commercial |
$555.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$516.57
|
| Rate for Payer: Healthscope Commercial |
$581.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$452.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$484.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$548.85
|
| Rate for Payer: PHP Commercial |
$548.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$452.00
|
| Rate for Payer: Priority Health SBD |
$406.80
|
| Rate for Payer: UMR Bronson Commercial |
$284.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$484.28
|
|
|
HC COMP BURN GARM 2 LEGS-WAIST
|
Facility
|
OP
|
$234.00
|
|
|
Service Code
|
HCPCS A6511
|
| Hospital Charge Code |
98300142
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$86.58 |
| Max. Negotiated Rate |
$342.54 |
| Rate for Payer: Aetna American Axle |
$152.10
|
| Rate for Payer: Aetna Commercial |
$198.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.10
|
| Rate for Payer: BCBS Complete |
$93.60
|
| Rate for Payer: BCBS Trust/PPO |
$342.54
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cofinity Commercial |
$163.80
|
| Rate for Payer: Cofinity Commercial |
$201.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.20
|
| Rate for Payer: Healthscope Commercial |
$210.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$163.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$175.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$198.90
|
| Rate for Payer: PHP Commercial |
$198.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.80
|
| Rate for Payer: Priority Health SBD |
$147.42
|
| Rate for Payer: UMR Bronson Commercial |
$86.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$175.50
|
|
|
HC COMP BURN GARM 2 LEGS-WAIST
|
Facility
|
IP
|
$234.00
|
|
|
Service Code
|
HCPCS A6511
|
| Hospital Charge Code |
98300142
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$102.96 |
| Max. Negotiated Rate |
$210.60 |
| Rate for Payer: Aetna American Axle |
$152.10
|
| Rate for Payer: Aetna Commercial |
$198.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.10
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cofinity Commercial |
$163.80
|
| Rate for Payer: Cofinity Commercial |
$201.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.20
|
| Rate for Payer: Healthscope Commercial |
$210.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$163.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$175.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$198.90
|
| Rate for Payer: PHP Commercial |
$198.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.80
|
| Rate for Payer: Priority Health SBD |
$147.42
|
| Rate for Payer: UMR Bronson Commercial |
$102.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$175.50
|
|
|
HC COMP BURN GARM 2 OR MORE FAB/C
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300143
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.28 |
| Max. Negotiated Rate |
$10.80 |
| Rate for Payer: Aetna American Axle |
$7.80
|
| Rate for Payer: Aetna Commercial |
$10.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.80
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cofinity Commercial |
$10.32
|
| Rate for Payer: Cofinity Commercial |
$8.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.60
|
| Rate for Payer: Healthscope Commercial |
$10.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10.20
|
| Rate for Payer: PHP Commercial |
$10.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.40
|
| Rate for Payer: Priority Health SBD |
$7.56
|
| Rate for Payer: UMR Bronson Commercial |
$5.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.00
|
|
|
HC COMP BURN GARM 2 OR MORE FAB/C
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300143
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.44 |
| Max. Negotiated Rate |
$496.69 |
| Rate for Payer: Aetna American Axle |
$7.80
|
| Rate for Payer: Aetna Commercial |
$10.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.80
|
| Rate for Payer: BCBS Complete |
$4.80
|
| Rate for Payer: BCBS Trust/PPO |
$496.69
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cofinity Commercial |
$10.32
|
| Rate for Payer: Cofinity Commercial |
$8.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.60
|
| Rate for Payer: Healthscope Commercial |
$10.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10.20
|
| Rate for Payer: PHP Commercial |
$10.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.40
|
| Rate for Payer: Priority Health SBD |
$7.56
|
| Rate for Payer: UMR Bronson Commercial |
$4.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.00
|
|
|
HC COMP BURN GARM ABD REINFOR DBL
|
Facility
|
OP
|
$16.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300144
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.92 |
| Max. Negotiated Rate |
$496.69 |
| Rate for Payer: Aetna American Axle |
$10.40
|
| Rate for Payer: Aetna Commercial |
$13.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.40
|
| Rate for Payer: BCBS Complete |
$6.40
|
| Rate for Payer: BCBS Trust/PPO |
$496.69
|
| Rate for Payer: Cash Price |
$12.80
|
| Rate for Payer: Cash Price |
$12.80
|
| Rate for Payer: Cofinity Commercial |
$11.20
|
| Rate for Payer: Cofinity Commercial |
$13.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.80
|
| Rate for Payer: Healthscope Commercial |
$14.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.60
|
| Rate for Payer: PHP Commercial |
$13.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.20
|
| Rate for Payer: Priority Health SBD |
$10.08
|
| Rate for Payer: UMR Bronson Commercial |
$5.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.00
|
|
|
HC COMP BURN GARM ABD REINFOR DBL
|
Facility
|
IP
|
$16.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300144
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.04 |
| Max. Negotiated Rate |
$14.40 |
| Rate for Payer: Aetna American Axle |
$10.40
|
| Rate for Payer: Aetna Commercial |
$13.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.40
|
| Rate for Payer: Cash Price |
$12.80
|
| Rate for Payer: Cofinity Commercial |
$11.20
|
| Rate for Payer: Cofinity Commercial |
$13.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.80
|
| Rate for Payer: Healthscope Commercial |
$14.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.60
|
| Rate for Payer: PHP Commercial |
$13.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.20
|
| Rate for Payer: Priority Health SBD |
$10.08
|
| Rate for Payer: UMR Bronson Commercial |
$7.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.00
|
|
|
HC COMP BURN GARM ANKLET
|
Facility
|
IP
|
$62.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300145
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$27.28 |
| Max. Negotiated Rate |
$55.80 |
| Rate for Payer: Aetna American Axle |
$40.30
|
| Rate for Payer: Aetna Commercial |
$52.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.30
|
| Rate for Payer: Cash Price |
$49.60
|
| Rate for Payer: Cofinity Commercial |
$43.40
|
| Rate for Payer: Cofinity Commercial |
$53.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.60
|
| Rate for Payer: Healthscope Commercial |
$55.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.70
|
| Rate for Payer: PHP Commercial |
$52.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.40
|
| Rate for Payer: Priority Health SBD |
$39.06
|
| Rate for Payer: UMR Bronson Commercial |
$27.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.50
|
|
|
HC COMP BURN GARM ANKLET
|
Facility
|
OP
|
$62.00
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300145
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$22.94 |
| Max. Negotiated Rate |
$496.69 |
| Rate for Payer: Aetna American Axle |
$40.30
|
| Rate for Payer: Aetna Commercial |
$52.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.30
|
| Rate for Payer: BCBS Complete |
$24.80
|
| Rate for Payer: BCBS Trust/PPO |
$496.69
|
| Rate for Payer: Cash Price |
$49.60
|
| Rate for Payer: Cash Price |
$49.60
|
| Rate for Payer: Cofinity Commercial |
$43.40
|
| Rate for Payer: Cofinity Commercial |
$53.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.60
|
| Rate for Payer: Healthscope Commercial |
$55.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.70
|
| Rate for Payer: PHP Commercial |
$52.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.40
|
| Rate for Payer: Priority Health SBD |
$39.06
|
| Rate for Payer: UMR Bronson Commercial |
$22.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.50
|
|
