|
HC DESTRUCT MALIGNANT LESION TRUNK, ARMS, LEGS 0.5 CM OR LESS
|
Facility
|
OP
|
$158.65
|
|
|
Service Code
|
CPT 17260
|
| Hospital Charge Code |
76100125
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$58.70 |
| Max. Negotiated Rate |
$560.20 |
| Rate for Payer: Aetna American Axle |
$103.12
|
| Rate for Payer: Aetna Commercial |
$134.85
|
| Rate for Payer: Aetna Medicare |
$185.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$103.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$222.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$222.44
|
| Rate for Payer: BCBS Complete |
$102.21
|
| Rate for Payer: BCBS MAPPO |
$177.95
|
| Rate for Payer: BCBS Trust/PPO |
$136.36
|
| Rate for Payer: BCN Medicare Advantage |
$177.95
|
| Rate for Payer: Cash Price |
$126.92
|
| Rate for Payer: Cash Price |
$126.92
|
| Rate for Payer: Cofinity Commercial |
$136.44
|
| Rate for Payer: Cofinity Commercial |
$111.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.95
|
| Rate for Payer: Healthscope Commercial |
$142.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$111.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$118.99
|
| Rate for Payer: Mclaren Medicaid |
$97.34
|
| Rate for Payer: Mclaren Medicare |
$177.95
|
| Rate for Payer: Meridian Medicaid |
$102.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$186.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$134.85
|
| Rate for Payer: PACE Medicare |
$169.05
|
| Rate for Payer: PACE SWMI |
$177.95
|
| Rate for Payer: PHP Commercial |
$134.85
|
| Rate for Payer: PHP Medicare Advantage |
$177.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$560.20
|
| Rate for Payer: Priority Health Medicare |
$177.95
|
| Rate for Payer: Priority Health Narrow Network |
$448.16
|
| Rate for Payer: Priority Health SBD |
$99.95
|
| Rate for Payer: Railroad Medicare Medicare |
$177.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$177.95
|
| Rate for Payer: UHC Exchange |
$69.42
|
| Rate for Payer: UHC Medicare Advantage |
$183.29
|
| Rate for Payer: UMR Bronson Commercial |
$58.70
|
| Rate for Payer: VA VA |
$177.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$118.99
|
|
|
HC DESTRUCT MALIGNANT LESION TRUNK, ARMS, LEGS 0.6 TO 1.0 CM
|
Facility
|
IP
|
$158.65
|
|
|
Service Code
|
CPT 17261
|
| Hospital Charge Code |
76100126
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$69.81 |
| Max. Negotiated Rate |
$142.78 |
| Rate for Payer: Aetna American Axle |
$103.12
|
| Rate for Payer: Aetna Commercial |
$134.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$103.12
|
| Rate for Payer: Cash Price |
$126.92
|
| Rate for Payer: Cofinity Commercial |
$111.06
|
| Rate for Payer: Cofinity Commercial |
$136.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.92
|
| Rate for Payer: Healthscope Commercial |
$142.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$111.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$118.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$134.85
|
| Rate for Payer: PHP Commercial |
$134.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.06
|
| Rate for Payer: Priority Health SBD |
$99.95
|
| Rate for Payer: UMR Bronson Commercial |
$69.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$118.99
|
|
|
HC DESTRUCT MALIGNANT LESION TRUNK, ARMS, LEGS 0.6 TO 1.0 CM
|
Facility
|
OP
|
$158.65
|
|
|
Service Code
|
CPT 17261
|
| Hospital Charge Code |
76100126
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$58.70 |
| Max. Negotiated Rate |
$560.20 |
| Rate for Payer: Aetna American Axle |
$103.12
|
| Rate for Payer: Aetna Commercial |
$134.85
|
| Rate for Payer: Aetna Medicare |
$185.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$103.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$222.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$222.44
|
| Rate for Payer: BCBS Complete |
$102.21
|
| Rate for Payer: BCBS MAPPO |
$177.95
|
| Rate for Payer: BCBS Trust/PPO |
$149.22
|
| Rate for Payer: BCN Medicare Advantage |
$177.95
|
| Rate for Payer: Cash Price |
$126.92
|
| Rate for Payer: Cash Price |
$126.92
|
| Rate for Payer: Cofinity Commercial |
$111.06
|
| Rate for Payer: Cofinity Commercial |
$136.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.95
|
| Rate for Payer: Healthscope Commercial |
$142.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$111.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$118.99
|
| Rate for Payer: Mclaren Medicaid |
$97.34
|
| Rate for Payer: Mclaren Medicare |
$177.95
|
| Rate for Payer: Meridian Medicaid |
$102.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$186.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$134.85
|
| Rate for Payer: PACE Medicare |
$169.05
|
| Rate for Payer: PACE SWMI |
$177.95
|
| Rate for Payer: PHP Commercial |
$134.85
|
| Rate for Payer: PHP Medicare Advantage |
$177.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$560.20
|
| Rate for Payer: Priority Health Medicare |
$177.95
|
| Rate for Payer: Priority Health Narrow Network |
$448.16
|
| Rate for Payer: Priority Health SBD |
$99.95
|
| Rate for Payer: Railroad Medicare Medicare |
$177.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$177.95
|
| Rate for Payer: UHC Exchange |
$85.79
|
| Rate for Payer: UHC Medicare Advantage |
$183.29
|
| Rate for Payer: UMR Bronson Commercial |
$58.70
|
| Rate for Payer: VA VA |
$177.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$118.99
|
|
|
HC DESTRUCT MALIGNANT LESION TRUNK, ARMS, LEGS 1.1 TO 2.0 CM
|
Facility
|
IP
|
$158.65
|
|
|
Service Code
|
CPT 17262
|
| Hospital Charge Code |
76100127
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$69.81 |
| Max. Negotiated Rate |
$142.78 |
| Rate for Payer: Aetna American Axle |
$103.12
|
| Rate for Payer: Aetna Commercial |
$134.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$103.12
|
| Rate for Payer: Cash Price |
$126.92
|
| Rate for Payer: Cofinity Commercial |
$111.06
|
| Rate for Payer: Cofinity Commercial |
$136.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.92
|
| Rate for Payer: Healthscope Commercial |
$142.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$111.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$118.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$134.85
|
| Rate for Payer: PHP Commercial |
$134.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.06
|
| Rate for Payer: Priority Health SBD |
$99.95
|
| Rate for Payer: UMR Bronson Commercial |
$69.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$118.99
|
|
|
HC DESTRUCT MALIGNANT LESION TRUNK, ARMS, LEGS 1.1 TO 2.0 CM
|
Facility
|
OP
|
$158.65
|
|
|
Service Code
|
CPT 17262
|
| Hospital Charge Code |
76100127
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$58.70 |
| Max. Negotiated Rate |
$560.20 |
| Rate for Payer: Aetna American Axle |
$103.12
|
| Rate for Payer: Aetna Commercial |
$134.85
|
| Rate for Payer: Aetna Medicare |
$185.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$103.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$222.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$222.44
|
| Rate for Payer: BCBS Complete |
$102.21
|
| Rate for Payer: BCBS MAPPO |
$177.95
|
| Rate for Payer: BCBS Trust/PPO |
$148.23
|
| Rate for Payer: BCN Medicare Advantage |
$177.95
|
| Rate for Payer: Cash Price |
$126.92
|
| Rate for Payer: Cash Price |
$126.92
|
| Rate for Payer: Cofinity Commercial |
$111.06
|
| Rate for Payer: Cofinity Commercial |
$136.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.95
|
| Rate for Payer: Healthscope Commercial |
$142.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$111.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$118.99
|
| Rate for Payer: Mclaren Medicaid |
$97.34
|
| Rate for Payer: Mclaren Medicare |
$177.95
|
| Rate for Payer: Meridian Medicaid |
$102.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$186.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$134.85
|
| Rate for Payer: PACE Medicare |
$169.05
|
| Rate for Payer: PACE SWMI |
$177.95
|
| Rate for Payer: PHP Commercial |
$134.85
|
| Rate for Payer: PHP Medicare Advantage |
$177.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$560.20
|
| Rate for Payer: Priority Health Medicare |
$177.95
|
| Rate for Payer: Priority Health Narrow Network |
$448.16
|
| Rate for Payer: Priority Health SBD |
$99.95
|
| Rate for Payer: Railroad Medicare Medicare |
$177.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$119.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$177.95
|
| Rate for Payer: UHC Exchange |
$108.38
|
| Rate for Payer: UHC Medicare Advantage |
$183.29
|
| Rate for Payer: UMR Bronson Commercial |
$58.70
|
| Rate for Payer: VA VA |
$177.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$118.99
|
|
|
HC DESTRUCT MALIGNANT LESION TRUNK, ARMS, LEGS 2.1 TO 3.0 CM
|
Facility
|
OP
|
$522.00
|
|
|
Service Code
|
CPT 17263
|
| Hospital Charge Code |
76100372
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$97.34 |
| Max. Negotiated Rate |
$560.20 |
| Rate for Payer: Aetna American Axle |
$339.30
|
| Rate for Payer: Aetna Commercial |
$443.70
|
| Rate for Payer: Aetna Medicare |
$185.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$339.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$222.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$222.44
|
| Rate for Payer: BCBS Complete |
$102.21
|
| Rate for Payer: BCBS MAPPO |
$177.95
|
| Rate for Payer: BCBS Trust/PPO |
$136.36
|
| Rate for Payer: BCN Medicare Advantage |
$177.95
|
| Rate for Payer: Cash Price |
$417.60
|
| Rate for Payer: Cash Price |
$417.60
|
| Rate for Payer: Cofinity Commercial |
$365.40
|
| Rate for Payer: Cofinity Commercial |
$448.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$417.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.95
|
| Rate for Payer: Healthscope Commercial |
$469.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$365.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$391.50
|
| Rate for Payer: Mclaren Medicaid |
$97.34
|
| Rate for Payer: Mclaren Medicare |
$177.95
|
| Rate for Payer: Meridian Medicaid |
$102.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$186.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$443.70
|
| Rate for Payer: PACE Medicare |
$169.05
|
| Rate for Payer: PACE SWMI |
$177.95
|
| Rate for Payer: PHP Commercial |
$443.70
|
| Rate for Payer: PHP Medicare Advantage |
$177.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$365.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$560.20
|
| Rate for Payer: Priority Health Medicare |
$177.95
|
| Rate for Payer: Priority Health Narrow Network |
$448.16
|
| Rate for Payer: Priority Health SBD |
$328.86
|
| Rate for Payer: Railroad Medicare Medicare |
$177.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$131.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$177.95
|
| Rate for Payer: UHC Exchange |
$119.84
|
| Rate for Payer: UHC Medicare Advantage |
$183.29
|
| Rate for Payer: UMR Bronson Commercial |
$193.14
|
| Rate for Payer: VA VA |
$177.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$391.50
|
|
|
HC DESTRUCT MALIGNANT LESION TRUNK, ARMS, LEGS 2.1 TO 3.0 CM
|
Facility
|
IP
|
$522.00
|
|
|
Service Code
|
CPT 17263
|
| Hospital Charge Code |
76100372
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$229.68 |
| Max. Negotiated Rate |
$469.80 |
| Rate for Payer: Aetna American Axle |
$339.30
|
| Rate for Payer: Aetna Commercial |
$443.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$339.30
|
| Rate for Payer: Cash Price |
$417.60
|
| Rate for Payer: Cofinity Commercial |
$365.40
|
| Rate for Payer: Cofinity Commercial |
$448.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$417.60
|
| Rate for Payer: Healthscope Commercial |
$469.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$365.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$391.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$443.70
|
| Rate for Payer: PHP Commercial |
$443.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$365.40
|
| Rate for Payer: Priority Health SBD |
$328.86
|
| Rate for Payer: UMR Bronson Commercial |
$229.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$391.50
|
|
|
HC DESTRUCT NEURO AGENT PLANTAR DIGITAL NRV
|
Facility
|
OP
|
$400.86
|
|
|
Service Code
|
CPT 64632
|
| Hospital Charge Code |
36100608
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$50.70 |
| Max. Negotiated Rate |
$828.79 |
| Rate for Payer: Aetna American Axle |
$260.56
|
| Rate for Payer: Aetna Commercial |
$340.73
|
| Rate for Payer: Aetna Medicare |
$273.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$260.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$329.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$329.09
|
| Rate for Payer: BCBS Complete |
$151.22
|
| Rate for Payer: BCBS MAPPO |
$263.27
|
| Rate for Payer: BCBS Trust/PPO |
$50.70
|
| Rate for Payer: BCN Medicare Advantage |
$263.27
|
| Rate for Payer: Cash Price |
$320.69
|
| Rate for Payer: Cash Price |
$320.69
|
| Rate for Payer: Cofinity Commercial |
$344.74
|
| Rate for Payer: Cofinity Commercial |
$280.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$320.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$263.27
|
| Rate for Payer: Healthscope Commercial |
$360.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$280.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$300.64
|
| Rate for Payer: Mclaren Medicaid |
$144.01
|
| Rate for Payer: Mclaren Medicare |
$263.27
|
| Rate for Payer: Meridian Medicaid |
$151.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$276.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$302.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$340.73
|
| Rate for Payer: PACE Medicare |
$250.11
|
| Rate for Payer: PACE SWMI |
$263.27
|
| Rate for Payer: PHP Commercial |
$340.73
|
| Rate for Payer: PHP Medicare Advantage |
$263.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$144.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$828.79
|
| Rate for Payer: Priority Health Medicare |
$263.27
|
| Rate for Payer: Priority Health Narrow Network |
$663.03
|
| Rate for Payer: Priority Health SBD |
$252.54
|
| Rate for Payer: Railroad Medicare Medicare |
$263.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.40
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$263.27
|
| Rate for Payer: UHC Exchange |
$65.82
|
| Rate for Payer: UHC Medicare Advantage |
$271.17
|
| Rate for Payer: UMR Bronson Commercial |
$148.32
|
| Rate for Payer: VA VA |
$263.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$300.64
|
|
|
HC DESTRUCT NEURO AGENT PLANTAR DIGITAL NRV
|
Facility
|
IP
|
$400.86
|
|
|
Service Code
|
CPT 64632
|
| Hospital Charge Code |
36100608
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$176.38 |
| Max. Negotiated Rate |
$360.77 |
| Rate for Payer: Aetna American Axle |
$260.56
|
| Rate for Payer: Aetna Commercial |
$340.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$260.56
|
| Rate for Payer: Cash Price |
$320.69
|
| Rate for Payer: Cofinity Commercial |
$280.60
|
| Rate for Payer: Cofinity Commercial |
$344.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$320.69
|
| Rate for Payer: Healthscope Commercial |
$360.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$280.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$300.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$340.73
|
| Rate for Payer: PHP Commercial |
$340.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.60
|
| Rate for Payer: Priority Health SBD |
$252.54
|
| Rate for Payer: UMR Bronson Commercial |
$176.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$300.64
|
|
|
HC DESTRUCT PREMALIGNANT LESIONS 15 OR MORE LESIONS
|
Facility
|
IP
|
$276.07
|
|
|
Service Code
|
CPT 17004
|
| Hospital Charge Code |
76100122
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$121.47 |
| Max. Negotiated Rate |
$248.46 |
| Rate for Payer: Aetna American Axle |
$179.45
|
| Rate for Payer: Aetna Commercial |
$234.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.45
|
| Rate for Payer: Cash Price |
$220.86
|
| Rate for Payer: Cofinity Commercial |
$193.25
|
| Rate for Payer: Cofinity Commercial |
$237.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.86
|
| Rate for Payer: Healthscope Commercial |
$248.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$193.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$207.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$234.66
|
| Rate for Payer: PHP Commercial |
$234.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.25
|
| Rate for Payer: Priority Health SBD |
$173.92
|
| Rate for Payer: UMR Bronson Commercial |
$121.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.05
|
|
|
HC DESTRUCT PREMALIGNANT LESIONS 15 OR MORE LESIONS
|
Facility
|
OP
|
$276.07
|
|
|
Service Code
|
CPT 17004
|
| Hospital Charge Code |
76100122
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$96.60 |
| Max. Negotiated Rate |
$1,115.78 |
| Rate for Payer: Aetna American Axle |
$179.45
|
| Rate for Payer: Aetna Commercial |
$234.66
|
| Rate for Payer: Aetna Medicare |
$368.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$443.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$443.04
|
| Rate for Payer: BCBS Complete |
$203.58
|
| Rate for Payer: BCBS MAPPO |
$354.43
|
| Rate for Payer: BCBS Trust/PPO |
$155.83
|
| Rate for Payer: BCN Medicare Advantage |
$354.43
|
| Rate for Payer: Cash Price |
$220.86
|
| Rate for Payer: Cash Price |
$220.86
|
| Rate for Payer: Cofinity Commercial |
$237.42
|
| Rate for Payer: Cofinity Commercial |
$193.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.43
|
| Rate for Payer: Healthscope Commercial |
$248.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$193.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$207.05
|
| Rate for Payer: Mclaren Medicaid |
$193.87
|
| Rate for Payer: Mclaren Medicare |
$354.43
|
| Rate for Payer: Meridian Medicaid |
$203.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$372.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$407.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$234.66
|
| Rate for Payer: PACE Medicare |
$336.71
|
| Rate for Payer: PACE SWMI |
$354.43
|
| Rate for Payer: PHP Commercial |
$234.66
|
| Rate for Payer: PHP Medicare Advantage |
$354.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$193.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,115.78
|
| Rate for Payer: Priority Health Medicare |
$354.43
|
| Rate for Payer: Priority Health Narrow Network |
$892.62
|
| Rate for Payer: Priority Health SBD |
$173.92
|
| Rate for Payer: Railroad Medicare Medicare |
$354.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$106.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$354.43
|
| Rate for Payer: UHC Exchange |
$96.60
|
| Rate for Payer: UHC Medicare Advantage |
$365.06
|
| Rate for Payer: UMR Bronson Commercial |
$102.15
|
| Rate for Payer: VA VA |
$354.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.05
|
|
|
HC DESTRUCT PREMALIGNANT LESIONS FIRST LESION
|
Facility
|
IP
|
$173.07
|
|
|
Service Code
|
CPT 17000
|
| Hospital Charge Code |
76100120
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$76.15 |
| Max. Negotiated Rate |
$155.76 |
| Rate for Payer: Aetna American Axle |
$112.50
|
| Rate for Payer: Aetna Commercial |
$147.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.50
|
| Rate for Payer: Cash Price |
$138.46
|
| Rate for Payer: Cofinity Commercial |
$121.15
|
| Rate for Payer: Cofinity Commercial |
$148.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.46
|
| Rate for Payer: Healthscope Commercial |
$155.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$121.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$129.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$147.11
|
| Rate for Payer: PHP Commercial |
$147.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.15
|
| Rate for Payer: Priority Health SBD |
$109.03
|
| Rate for Payer: UMR Bronson Commercial |
$76.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$129.80
|
|
|
HC DESTRUCT PREMALIGNANT LESIONS FIRST LESION
|
Facility
|
OP
|
$173.07
|
|
|
Service Code
|
CPT 17000
|
| Hospital Charge Code |
76100120
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$54.36 |
| Max. Negotiated Rate |
$560.20 |
| Rate for Payer: Aetna American Axle |
$112.50
|
| Rate for Payer: Aetna Commercial |
$147.11
|
| Rate for Payer: Aetna Medicare |
$185.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$222.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$222.44
|
| Rate for Payer: BCBS Complete |
$102.21
|
| Rate for Payer: BCBS MAPPO |
$177.95
|
| Rate for Payer: BCBS Trust/PPO |
$121.91
|
| Rate for Payer: BCN Medicare Advantage |
$177.95
|
| Rate for Payer: Cash Price |
$138.46
|
| Rate for Payer: Cash Price |
$138.46
|
| Rate for Payer: Cofinity Commercial |
$121.15
|
| Rate for Payer: Cofinity Commercial |
$148.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.95
|
| Rate for Payer: Healthscope Commercial |
$155.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$121.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$129.80
|
| Rate for Payer: Mclaren Medicaid |
$97.34
|
| Rate for Payer: Mclaren Medicare |
$177.95
|
| Rate for Payer: Meridian Medicaid |
$102.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$186.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$147.11
|
| Rate for Payer: PACE Medicare |
$169.05
|
| Rate for Payer: PACE SWMI |
$177.95
|
| Rate for Payer: PHP Commercial |
$147.11
|
| Rate for Payer: PHP Medicare Advantage |
$177.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$560.20
|
| Rate for Payer: Priority Health Medicare |
$177.95
|
| Rate for Payer: Priority Health Narrow Network |
$448.16
|
| Rate for Payer: Priority Health SBD |
$109.03
|
| Rate for Payer: Railroad Medicare Medicare |
$177.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$177.95
|
| Rate for Payer: UHC Exchange |
$54.36
|
| Rate for Payer: UHC Medicare Advantage |
$183.29
|
| Rate for Payer: UMR Bronson Commercial |
$64.04
|
| Rate for Payer: VA VA |
$177.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$129.80
|
|
|
HC DESTRUCT PREMALIGNANT LESIONS SECOND THRU 14 LESIONS EACH
|
Facility
|
IP
|
$34.78
|
|
|
Service Code
|
CPT 17003
|
| Hospital Charge Code |
76100121
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$15.30 |
| Max. Negotiated Rate |
$31.30 |
| Rate for Payer: Aetna American Axle |
$22.61
|
| Rate for Payer: Aetna Commercial |
$29.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.61
|
| Rate for Payer: Cash Price |
$27.82
|
| Rate for Payer: Cofinity Commercial |
$24.35
|
| Rate for Payer: Cofinity Commercial |
$29.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.82
|
| Rate for Payer: Healthscope Commercial |
$31.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.56
|
| Rate for Payer: PHP Commercial |
$29.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.35
|
| Rate for Payer: Priority Health SBD |
$21.91
|
| Rate for Payer: UMR Bronson Commercial |
$15.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.08
|
|
|
HC DESTRUCT PREMALIGNANT LESIONS SECOND THRU 14 LESIONS EACH
|
Facility
|
OP
|
$34.78
|
|
|
Service Code
|
CPT 17003
|
| Hospital Charge Code |
76100121
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1.96 |
| Max. Negotiated Rate |
$31.30 |
| Rate for Payer: Aetna American Axle |
$22.61
|
| Rate for Payer: Aetna Commercial |
$29.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.61
|
| Rate for Payer: BCBS Complete |
$13.91
|
| Rate for Payer: BCBS Trust/PPO |
$19.28
|
| Rate for Payer: Cash Price |
$27.82
|
| Rate for Payer: Cash Price |
$27.82
|
| Rate for Payer: Cofinity Commercial |
$24.35
|
| Rate for Payer: Cofinity Commercial |
$29.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.82
|
| Rate for Payer: Healthscope Commercial |
$31.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.56
|
| Rate for Payer: PHP Commercial |
$29.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.35
|
| Rate for Payer: Priority Health SBD |
$21.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.16
|
| Rate for Payer: UHC Exchange |
$1.96
|
| Rate for Payer: UMR Bronson Commercial |
$12.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.08
|
|
|
HC DESTRUCT VAGINAL LESION(S) SIMPLE
|
Facility
|
OP
|
$3,822.09
|
|
|
Service Code
|
CPT 57061
|
| Hospital Charge Code |
36100583
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$79.25 |
| Max. Negotiated Rate |
$8,748.29 |
| Rate for Payer: Aetna American Axle |
$2,484.36
|
| Rate for Payer: Aetna Commercial |
$3,248.78
|
| Rate for Payer: Aetna Medicare |
$2,890.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,484.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,473.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,473.69
|
| Rate for Payer: BCBS Complete |
$1,596.23
|
| Rate for Payer: BCBS MAPPO |
$2,778.95
|
| Rate for Payer: BCBS Trust/PPO |
$79.25
|
| Rate for Payer: BCN Medicare Advantage |
$2,778.95
|
| Rate for Payer: Cash Price |
$3,057.67
|
| Rate for Payer: Cash Price |
$3,057.67
|
| Rate for Payer: Cofinity Commercial |
$3,287.00
|
| Rate for Payer: Cofinity Commercial |
$2,675.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,057.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,778.95
|
| Rate for Payer: Healthscope Commercial |
$3,439.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,675.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,866.57
|
| Rate for Payer: Mclaren Medicaid |
$1,520.09
|
| Rate for Payer: Mclaren Medicare |
$2,778.95
|
| Rate for Payer: Meridian Medicaid |
$1,596.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,917.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,195.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,248.78
|
| Rate for Payer: PACE Medicare |
$2,640.00
|
| Rate for Payer: PACE SWMI |
$2,778.95
|
| Rate for Payer: PHP Commercial |
$3,248.78
|
| Rate for Payer: PHP Medicare Advantage |
$2,778.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,520.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,675.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,748.29
|
| Rate for Payer: Priority Health Medicare |
$2,778.95
|
| Rate for Payer: Priority Health Narrow Network |
$6,998.63
|
| Rate for Payer: Priority Health SBD |
$2,407.92
|
| Rate for Payer: Railroad Medicare Medicare |
$2,778.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$126.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,778.95
|
| Rate for Payer: UHC Exchange |
$114.60
|
| Rate for Payer: UHC Medicare Advantage |
$2,862.32
|
| Rate for Payer: UMR Bronson Commercial |
$1,414.17
|
| Rate for Payer: VA VA |
$2,778.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,866.57
|
|
|
HC DESTRUCT VAGINAL LESION(S) SIMPLE
|
Facility
|
IP
|
$3,822.09
|
|
|
Service Code
|
CPT 57061
|
| Hospital Charge Code |
36100583
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,681.72 |
| Max. Negotiated Rate |
$3,439.88 |
| Rate for Payer: Aetna American Axle |
$2,484.36
|
| Rate for Payer: Aetna Commercial |
$3,248.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,484.36
|
| Rate for Payer: Cash Price |
$3,057.67
|
| Rate for Payer: Cofinity Commercial |
$2,675.46
|
| Rate for Payer: Cofinity Commercial |
$3,287.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,057.67
|
| Rate for Payer: Healthscope Commercial |
$3,439.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,675.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,866.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,248.78
|
| Rate for Payer: PHP Commercial |
$3,248.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,675.46
|
| Rate for Payer: Priority Health SBD |
$2,407.92
|
| Rate for Payer: UMR Bronson Commercial |
$1,681.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,866.57
|
|
|
HC DES VESSEL/BRANCH
|
Facility
|
IP
|
$24,183.90
|
|
|
Service Code
|
CPT C9600
|
| Hospital Charge Code |
48100075
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$10,640.92 |
| Max. Negotiated Rate |
$21,765.51 |
| Rate for Payer: Aetna American Axle |
$15,719.54
|
| Rate for Payer: Aetna Commercial |
$20,556.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15,719.54
|
| Rate for Payer: Cash Price |
$19,347.12
|
| Rate for Payer: Cofinity Commercial |
$16,928.73
|
| Rate for Payer: Cofinity Commercial |
$20,798.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19,347.12
|
| Rate for Payer: Healthscope Commercial |
$21,765.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16,928.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18,137.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20,556.32
|
| Rate for Payer: PHP Commercial |
$20,556.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16,928.73
|
| Rate for Payer: Priority Health SBD |
$15,235.86
|
| Rate for Payer: UMR Bronson Commercial |
$10,640.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18,137.92
|
|
|
HC DES VESSEL/BRANCH
|
Facility
|
OP
|
$24,183.90
|
|
|
Service Code
|
CPT C9600
|
| Hospital Charge Code |
48100075
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,348.94 |
| Max. Negotiated Rate |
$30,783.77 |
| Rate for Payer: Aetna American Axle |
$15,719.54
|
| Rate for Payer: Aetna Commercial |
$20,556.32
|
| Rate for Payer: Aetna Medicare |
$10,169.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15,719.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,223.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,223.36
|
| Rate for Payer: BCBS Complete |
$5,616.88
|
| Rate for Payer: BCBS MAPPO |
$9,778.69
|
| Rate for Payer: BCBS Trust/PPO |
$9,738.02
|
| Rate for Payer: BCN Medicare Advantage |
$9,778.69
|
| Rate for Payer: Cash Price |
$19,347.12
|
| Rate for Payer: Cash Price |
$19,347.12
|
| Rate for Payer: Cofinity Commercial |
$20,798.15
|
| Rate for Payer: Cofinity Commercial |
$16,928.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19,347.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,778.69
|
| Rate for Payer: Healthscope Commercial |
$21,765.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16,928.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18,137.92
|
| Rate for Payer: Mclaren Medicaid |
$5,348.94
|
| Rate for Payer: Mclaren Medicare |
$9,778.69
|
| Rate for Payer: Meridian Medicaid |
$5,616.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,267.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,245.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20,556.32
|
| Rate for Payer: PACE Medicare |
$9,289.76
|
| Rate for Payer: PACE SWMI |
$9,778.69
|
| Rate for Payer: PHP Commercial |
$20,556.32
|
| Rate for Payer: PHP Medicare Advantage |
$9,778.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,348.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16,928.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30,783.77
|
| Rate for Payer: Priority Health Medicare |
$9,778.69
|
| Rate for Payer: Priority Health Narrow Network |
$24,627.02
|
| Rate for Payer: Priority Health SBD |
$15,235.86
|
| Rate for Payer: Railroad Medicare Medicare |
$9,778.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27,416.51
|
| Rate for Payer: UHC Core |
$13,752.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,778.69
|
| Rate for Payer: UHC Exchange |
$18,688.05
|
| Rate for Payer: UHC Medicare Advantage |
$10,072.05
|
| Rate for Payer: UMR Bronson Commercial |
$8,948.04
|
| Rate for Payer: VA VA |
$9,778.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18,137.92
|
|
|
HC DEVELOPMENTAL TESTING
|
Facility
|
OP
|
$371.75
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
51000057
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$11.25 |
| Max. Negotiated Rate |
$334.58 |
| Rate for Payer: Aetna American Axle |
$241.64
|
| Rate for Payer: Aetna Commercial |
$315.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$241.64
|
| Rate for Payer: BCBS Complete |
$148.70
|
| Rate for Payer: BCBS Trust/PPO |
$11.25
|
| Rate for Payer: Cash Price |
$297.40
|
| Rate for Payer: Cash Price |
$297.40
|
| Rate for Payer: Cofinity Commercial |
$319.70
|
| Rate for Payer: Cofinity Commercial |
$260.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.40
|
| Rate for Payer: Healthscope Commercial |
$334.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$260.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$278.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$315.99
|
| Rate for Payer: PHP Commercial |
$315.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$260.22
|
| Rate for Payer: Priority Health SBD |
$234.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.61
|
| Rate for Payer: UHC Exchange |
$11.46
|
| Rate for Payer: UMR Bronson Commercial |
$137.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$278.81
|
|
|
HC DEVELOPMENTAL TESTING
|
Facility
|
IP
|
$371.75
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
51000057
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$163.57 |
| Max. Negotiated Rate |
$334.58 |
| Rate for Payer: Aetna American Axle |
$241.64
|
| Rate for Payer: Aetna Commercial |
$315.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$241.64
|
| Rate for Payer: Cash Price |
$297.40
|
| Rate for Payer: Cofinity Commercial |
$260.22
|
| Rate for Payer: Cofinity Commercial |
$319.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.40
|
| Rate for Payer: Healthscope Commercial |
$334.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$260.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$278.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$315.99
|
| Rate for Payer: PHP Commercial |
$315.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$260.22
|
| Rate for Payer: Priority Health SBD |
$234.20
|
| Rate for Payer: UMR Bronson Commercial |
$163.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$278.81
|
|
|
HC DEVICE NOT RETURNED ACTIWATCH
|
Professional
|
Both
|
$949.00
|
|
|
Service Code
|
HCPCS 00615
|
| Hospital Charge Code |
27000615
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$379.60 |
| Max. Negotiated Rate |
$664.30 |
| Rate for Payer: BCBS Complete |
$379.60
|
| Rate for Payer: Cash Price |
$759.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$664.30
|
| Rate for Payer: UMR Bronson Commercial |
$436.54
|
|
|
HC DEVICE NOT RETURNED ACTIWATCH
|
Professional
|
Both
|
$949.00
|
|
|
Service Code
|
HCPCS 00615
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$379.60 |
| Max. Negotiated Rate |
$664.30 |
| Rate for Payer: BCBS Complete |
$379.60
|
| Rate for Payer: Cash Price |
$759.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$664.30
|
| Rate for Payer: UMR Bronson Commercial |
$436.54
|
|
|
HC DEVICE NOT RETURNED ACTIWATCH
|
Facility
|
OP
|
$949.00
|
|
| Hospital Charge Code |
27000615
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$351.13 |
| Max. Negotiated Rate |
$854.10 |
| Rate for Payer: Aetna American Axle |
$616.85
|
| Rate for Payer: Aetna Commercial |
$806.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$616.85
|
| Rate for Payer: BCBS Complete |
$379.60
|
| Rate for Payer: Cash Price |
$759.20
|
| Rate for Payer: Cofinity Commercial |
$664.30
|
| Rate for Payer: Cofinity Commercial |
$816.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$759.20
|
| Rate for Payer: Healthscope Commercial |
$854.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$664.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$711.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$806.65
|
| Rate for Payer: PHP Commercial |
$806.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$664.30
|
| Rate for Payer: Priority Health SBD |
$597.87
|
| Rate for Payer: UMR Bronson Commercial |
$351.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$711.75
|
|
|
HC DEVICE NOT RETURNED ACTIWATCH
|
Facility
|
IP
|
$949.00
|
|
| Hospital Charge Code |
27000615
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$417.56 |
| Max. Negotiated Rate |
$854.10 |
| Rate for Payer: Aetna American Axle |
$616.85
|
| Rate for Payer: Aetna Commercial |
$806.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$616.85
|
| Rate for Payer: Cash Price |
$759.20
|
| Rate for Payer: Cofinity Commercial |
$664.30
|
| Rate for Payer: Cofinity Commercial |
$816.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$759.20
|
| Rate for Payer: Healthscope Commercial |
$854.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$664.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$711.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$806.65
|
| Rate for Payer: PHP Commercial |
$806.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$664.30
|
| Rate for Payer: Priority Health SBD |
$597.87
|
| Rate for Payer: UMR Bronson Commercial |
$417.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$711.75
|
|
