|
HC ADD. ABLATION
|
Facility
|
IP
|
$9,080.04
|
|
|
Service Code
|
CPT 93655
|
| Hospital Charge Code |
48100093
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,995.22 |
| Max. Negotiated Rate |
$8,172.04 |
| Rate for Payer: Aetna American Axle |
$5,902.03
|
| Rate for Payer: Aetna Commercial |
$7,718.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,902.03
|
| Rate for Payer: Cash Price |
$7,264.03
|
| Rate for Payer: Cofinity Advantage |
$6,356.03
|
| Rate for Payer: Cofinity Commercial |
$7,808.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,264.03
|
| Rate for Payer: Healthscope Commercial |
$8,172.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,356.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,810.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,718.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,810.03
|
| Rate for Payer: PHP Commercial |
$7,718.03
|
| Rate for Payer: Priority Health SBD |
$5,720.43
|
| Rate for Payer: UMR Bronson Commercial |
$3,995.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,810.03
|
|
|
HC ADD. ABLATION
|
Facility
|
OP
|
$9,080.04
|
|
|
Service Code
|
CPT 93655
|
| Hospital Charge Code |
48100093
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$314.18 |
| Max. Negotiated Rate |
$8,172.04 |
| Rate for Payer: Aetna American Axle |
$5,902.03
|
| Rate for Payer: Aetna Commercial |
$7,718.03
|
| Rate for Payer: Aetna Medicare |
$4,540.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,902.03
|
| Rate for Payer: BCBS Complete |
$3,632.02
|
| Rate for Payer: BCBS Trust/PPO |
$314.18
|
| Rate for Payer: BCN Commercial |
$314.18
|
| Rate for Payer: Cash Price |
$7,264.03
|
| Rate for Payer: Cash Price |
$7,264.03
|
| Rate for Payer: Cofinity Advantage |
$6,356.03
|
| Rate for Payer: Cofinity Commercial |
$7,808.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,264.03
|
| Rate for Payer: Healthscope Commercial |
$8,172.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,356.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,810.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,264.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,718.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,810.03
|
| Rate for Payer: PHP Commercial |
$7,718.03
|
| Rate for Payer: Priority Health SBD |
$5,720.43
|
| Rate for Payer: UMR Bronson Commercial |
$3,359.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,810.03
|
|
|
HC ADD.AFIB ABL AFTER PVI
|
Facility
|
OP
|
$9,080.04
|
|
|
Service Code
|
CPT 93657
|
| Hospital Charge Code |
48100095
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$315.58 |
| Max. Negotiated Rate |
$8,172.04 |
| Rate for Payer: Aetna American Axle |
$5,902.03
|
| Rate for Payer: Aetna Commercial |
$7,718.03
|
| Rate for Payer: Aetna Medicare |
$4,540.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,902.03
|
| Rate for Payer: BCBS Complete |
$3,632.02
|
| Rate for Payer: BCBS Trust/PPO |
$315.58
|
| Rate for Payer: BCN Commercial |
$315.58
|
| Rate for Payer: Cash Price |
$7,264.03
|
| Rate for Payer: Cash Price |
$7,264.03
|
| Rate for Payer: Cofinity Advantage |
$6,356.03
|
| Rate for Payer: Cofinity Commercial |
$7,808.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,264.03
|
| Rate for Payer: Healthscope Commercial |
$8,172.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,356.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,810.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,264.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,718.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,810.03
|
| Rate for Payer: PHP Commercial |
$7,718.03
|
| Rate for Payer: Priority Health SBD |
$5,720.43
|
| Rate for Payer: UMR Bronson Commercial |
$3,359.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,810.03
|
|
|
HC ADD.AFIB ABL AFTER PVI
|
Facility
|
IP
|
$9,080.04
|
|
|
Service Code
|
CPT 93657
|
| Hospital Charge Code |
48100095
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,995.22 |
| Max. Negotiated Rate |
$8,172.04 |
| Rate for Payer: Aetna American Axle |
$5,902.03
|
| Rate for Payer: Aetna Commercial |
$7,718.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,902.03
|
| Rate for Payer: Cash Price |
$7,264.03
|
| Rate for Payer: Cofinity Advantage |
$6,356.03
|
| Rate for Payer: Cofinity Commercial |
$7,808.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,264.03
|
| Rate for Payer: Healthscope Commercial |
$8,172.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,356.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,810.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,718.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,810.03
|
| Rate for Payer: PHP Commercial |
$7,718.03
|
| Rate for Payer: Priority Health SBD |
$5,720.43
|
| Rate for Payer: UMR Bronson Commercial |
$3,995.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,810.03
|
|
|
HC ADDL DOSE TC99M DOM PROD NON HEU
|
Facility
|
OP
|
$55.71
|
|
|
Service Code
|
HCPCS C9176
|
| Hospital Charge Code |
34300041
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$5.23 |
| Max. Negotiated Rate |
$50.14 |
| Rate for Payer: Aetna American Axle |
$36.21
|
| Rate for Payer: Aetna Commercial |
$47.35
|
| Rate for Payer: Aetna Medicare |
$10.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.50
|
| Rate for Payer: BCBS Complete |
$5.49
|
| Rate for Payer: BCBS MAPPO |
$10.00
|
| Rate for Payer: BCN Medicare Advantage |
$10.00
|
| Rate for Payer: Cash Price |
$44.57
|
| Rate for Payer: Cash Price |
$44.57
|
| Rate for Payer: Cofinity Advantage |
$39.00
|
| Rate for Payer: Cofinity Commercial |
$47.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.00
|
| Rate for Payer: Healthscope Commercial |
$50.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.78
|
| Rate for Payer: Mclaren Medicaid |
$10.00
|
| Rate for Payer: Mclaren Medicare |
$10.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.50
|
| Rate for Payer: Meridian Medicaid |
$10.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$11.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.35
|
| Rate for Payer: Nomi Health Commercial |
$30.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.78
|
| Rate for Payer: PACE Medicare |
$9.50
|
| Rate for Payer: PACE SWMI |
$10.00
|
| Rate for Payer: PHP Commercial |
$47.35
|
| Rate for Payer: PHP Medicare Advantage |
$10.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$31.54
|
| Rate for Payer: Priority Health Medicare |
$10.00
|
| Rate for Payer: Priority Health SBD |
$35.10
|
| Rate for Payer: Priority Health Tiered Network |
$25.23
|
| Rate for Payer: Railroad Medicare Medicare |
$10.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.50
|
| Rate for Payer: UHC Core |
$16.50
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10.00
|
| Rate for Payer: UHC Exchange |
$16.50
|
| Rate for Payer: UHC Medicaid |
$5.23
|
| Rate for Payer: UHCCP Medicaid |
$5.23
|
| Rate for Payer: UMR Bronson Commercial |
$20.61
|
| Rate for Payer: VA VA |
$10.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.78
|
|
|
HC ADDL DOSE TC99M DOM PROD NON HEU
|
Facility
|
IP
|
$55.71
|
|
|
Service Code
|
HCPCS C9176
|
| Hospital Charge Code |
34300041
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$24.51 |
| Max. Negotiated Rate |
$50.14 |
| Rate for Payer: Aetna American Axle |
$36.21
|
| Rate for Payer: Aetna Commercial |
$47.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.21
|
| Rate for Payer: Cash Price |
$44.57
|
| Rate for Payer: Cofinity Advantage |
$39.00
|
| Rate for Payer: Cofinity Commercial |
$47.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.57
|
| Rate for Payer: Healthscope Commercial |
$50.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.78
|
| Rate for Payer: PHP Commercial |
$47.35
|
| Rate for Payer: Priority Health SBD |
$35.10
|
| Rate for Payer: UMR Bronson Commercial |
$24.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.78
|
|
|
HC ADDL DOSE TC99M NON HEU
|
Facility
|
IP
|
$55.71
|
|
|
Service Code
|
HCPCS Q9969
|
| Hospital Charge Code |
34300036
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$24.51 |
| Max. Negotiated Rate |
$50.14 |
| Rate for Payer: Aetna American Axle |
$36.21
|
| Rate for Payer: Aetna Commercial |
$47.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.21
|
| Rate for Payer: Cash Price |
$44.57
|
| Rate for Payer: Cofinity Advantage |
$39.00
|
| Rate for Payer: Cofinity Commercial |
$47.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.57
|
| Rate for Payer: Healthscope Commercial |
$50.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.78
|
| Rate for Payer: PHP Commercial |
$47.35
|
| Rate for Payer: Priority Health SBD |
$35.10
|
| Rate for Payer: UMR Bronson Commercial |
$24.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.78
|
|
|
HC ADDL DOSE TC99M NON HEU
|
Facility
|
OP
|
$55.71
|
|
|
Service Code
|
HCPCS Q9969
|
| Hospital Charge Code |
34300036
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$15.41 |
| Max. Negotiated Rate |
$50.14 |
| Rate for Payer: Aetna American Axle |
$36.21
|
| Rate for Payer: Aetna Commercial |
$47.35
|
| Rate for Payer: Aetna Medicare |
$27.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.21
|
| Rate for Payer: BCBS Complete |
$22.28
|
| Rate for Payer: BCBS Trust/PPO |
$15.41
|
| Rate for Payer: BCN Commercial |
$15.41
|
| Rate for Payer: Cash Price |
$44.57
|
| Rate for Payer: Cash Price |
$44.57
|
| Rate for Payer: Cofinity Advantage |
$39.00
|
| Rate for Payer: Cofinity Commercial |
$47.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.57
|
| Rate for Payer: Healthscope Commercial |
$50.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.78
|
| Rate for Payer: PHP Commercial |
$47.35
|
| Rate for Payer: Priority Health SBD |
$35.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.86
|
| Rate for Payer: UHC Core |
$27.86
|
| Rate for Payer: UHC Exchange |
$27.86
|
| Rate for Payer: UMR Bronson Commercial |
$20.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.78
|
|
|
HC ADENOVIRUS ANTIBODY
|
Facility
|
IP
|
$106.12
|
|
|
Service Code
|
CPT 86603
|
| Hospital Charge Code |
30200219
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$46.69 |
| Max. Negotiated Rate |
$95.51 |
| Rate for Payer: Aetna American Axle |
$68.98
|
| Rate for Payer: Aetna Commercial |
$90.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.98
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cofinity Advantage |
$74.28
|
| Rate for Payer: Cofinity Commercial |
$91.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.90
|
| Rate for Payer: Healthscope Commercial |
$95.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$74.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$79.59
|
| Rate for Payer: PHP Commercial |
$90.20
|
| Rate for Payer: Priority Health SBD |
$66.86
|
| Rate for Payer: UMR Bronson Commercial |
$46.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.59
|
|
|
HC ADENOVIRUS ANTIBODY
|
Facility
|
OP
|
$106.12
|
|
|
Service Code
|
CPT 86603
|
| Hospital Charge Code |
30200219
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.73 |
| Max. Negotiated Rate |
$95.51 |
| Rate for Payer: Aetna American Axle |
$68.98
|
| Rate for Payer: Aetna Commercial |
$90.20
|
| Rate for Payer: Aetna Medicare |
$13.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.09
|
| Rate for Payer: BCBS Complete |
$7.07
|
| Rate for Payer: BCBS MAPPO |
$12.87
|
| Rate for Payer: BCBS Trust/PPO |
$14.87
|
| Rate for Payer: BCN Commercial |
$14.87
|
| Rate for Payer: BCN Medicare Advantage |
$12.87
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cofinity Advantage |
$74.28
|
| Rate for Payer: Cofinity Commercial |
$91.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.87
|
| Rate for Payer: Healthscope Commercial |
$95.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$74.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.59
|
| Rate for Payer: Mclaren Medicaid |
$12.87
|
| Rate for Payer: Mclaren Medicare |
$12.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.51
|
| Rate for Payer: Meridian Medicaid |
$13.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.20
|
| Rate for Payer: Nomi Health Commercial |
$19.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$79.59
|
| Rate for Payer: PACE Medicare |
$12.23
|
| Rate for Payer: PACE SWMI |
$12.87
|
| Rate for Payer: PHP Commercial |
$90.20
|
| Rate for Payer: PHP Medicare Advantage |
$12.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12.87
|
| Rate for Payer: Priority Health Medicare |
$12.87
|
| Rate for Payer: Priority Health SBD |
$66.86
|
| Rate for Payer: Priority Health Tiered Network |
$10.30
|
| Rate for Payer: Railroad Medicare Medicare |
$12.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.31
|
| Rate for Payer: UHC Core |
$19.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.87
|
| Rate for Payer: UHC Exchange |
$19.31
|
| Rate for Payer: UHC Medicaid |
$6.73
|
| Rate for Payer: UHCCP Medicaid |
$6.73
|
| Rate for Payer: UMR Bronson Commercial |
$39.26
|
| Rate for Payer: VA VA |
$12.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.59
|
|
|
HC ADENOVIRUS PCR
|
Facility
|
IP
|
$105.06
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600279
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$46.23 |
| Max. Negotiated Rate |
$94.55 |
| Rate for Payer: Aetna American Axle |
$68.29
|
| Rate for Payer: Aetna Commercial |
$89.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.29
|
| Rate for Payer: Cash Price |
$84.05
|
| Rate for Payer: Cofinity Advantage |
$73.54
|
| Rate for Payer: Cofinity Commercial |
$90.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.05
|
| Rate for Payer: Healthscope Commercial |
$94.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$73.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.80
|
| Rate for Payer: PHP Commercial |
$89.30
|
| Rate for Payer: Priority Health SBD |
$66.19
|
| Rate for Payer: UMR Bronson Commercial |
$46.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.80
|
|
|
HC ADENOVIRUS PCR
|
Facility
|
OP
|
$105.06
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600279
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.35 |
| Max. Negotiated Rate |
$94.55 |
| Rate for Payer: Aetna American Axle |
$68.29
|
| Rate for Payer: Aetna Commercial |
$89.30
|
| Rate for Payer: Aetna Medicare |
$36.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.29
|
| 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 |
$19.27
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$40.57
|
| Rate for Payer: BCN Commercial |
$40.57
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$84.05
|
| Rate for Payer: Cash Price |
$84.05
|
| Rate for Payer: Cofinity Advantage |
$73.54
|
| Rate for Payer: Cofinity Commercial |
$90.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$94.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$73.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.80
|
| Rate for Payer: Mclaren Medicaid |
$35.09
|
| 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 |
$36.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$38.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.30
|
| Rate for Payer: Nomi Health Commercial |
$52.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.80
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$89.30
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.35
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health SBD |
$66.19
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.64
|
| Rate for Payer: UHC Core |
$52.64
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$35.09
|
| Rate for Payer: UHC Exchange |
$52.64
|
| Rate for Payer: UHC Medicaid |
$18.35
|
| Rate for Payer: UHCCP Medicaid |
$18.35
|
| Rate for Payer: UMR Bronson Commercial |
$38.87
|
| Rate for Payer: VA VA |
$35.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.80
|
|
|
HC ADHESIVE RELEASER 50 ML
|
Facility
|
IP
|
$27.13
|
|
|
Service Code
|
HCPCS A4455
|
| Hospital Charge Code |
27000626
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.94 |
| Max. Negotiated Rate |
$24.42 |
| Rate for Payer: Aetna American Axle |
$17.63
|
| Rate for Payer: Aetna Commercial |
$23.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.63
|
| Rate for Payer: Cash Price |
$21.70
|
| Rate for Payer: Cofinity Advantage |
$18.99
|
| Rate for Payer: Cofinity Commercial |
$23.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.70
|
| Rate for Payer: Healthscope Commercial |
$24.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.35
|
| Rate for Payer: PHP Commercial |
$23.06
|
| Rate for Payer: Priority Health SBD |
$17.09
|
| Rate for Payer: UMR Bronson Commercial |
$11.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.35
|
|
|
HC ADHESIVE RELEASER 50 ML
|
Facility
|
OP
|
$27.13
|
|
|
Service Code
|
HCPCS A4455
|
| Hospital Charge Code |
27000626
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.04 |
| Max. Negotiated Rate |
$24.42 |
| Rate for Payer: Aetna American Axle |
$17.63
|
| Rate for Payer: Aetna Commercial |
$23.06
|
| Rate for Payer: Aetna Medicare |
$13.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.63
|
| Rate for Payer: BCBS Complete |
$10.85
|
| Rate for Payer: Cash Price |
$21.70
|
| Rate for Payer: Cofinity Advantage |
$18.99
|
| Rate for Payer: Cofinity Commercial |
$23.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.70
|
| Rate for Payer: Healthscope Commercial |
$24.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.35
|
| Rate for Payer: PHP Commercial |
$23.06
|
| Rate for Payer: Priority Health SBD |
$17.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.63
|
| Rate for Payer: UHC Core |
$14.13
|
| Rate for Payer: UHC Exchange |
$10.66
|
| Rate for Payer: UMR Bronson Commercial |
$10.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.35
|
|
|
HC ADJT TIS REARRGMT EYE/NOSE/EAR/LIP 10.1-30.0 SQ CM
|
Facility
|
OP
|
$6,690.76
|
|
|
Service Code
|
CPT 14061
|
| Hospital Charge Code |
76100556
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,075.21 |
| Max. Negotiated Rate |
$6,648.46 |
| Rate for Payer: Aetna American Axle |
$4,348.99
|
| Rate for Payer: Aetna Commercial |
$5,687.15
|
| Rate for Payer: Aetna Medicare |
$2,138.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,348.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,569.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,569.82
|
| Rate for Payer: BCBS Complete |
$1,129.08
|
| Rate for Payer: BCBS MAPPO |
$2,055.86
|
| Rate for Payer: BCBS Trust/PPO |
$3,285.08
|
| Rate for Payer: BCN Commercial |
$3,285.08
|
| Rate for Payer: BCN Medicare Advantage |
$2,055.86
|
| Rate for Payer: Cash Price |
$5,352.61
|
| Rate for Payer: Cash Price |
$5,352.61
|
| Rate for Payer: Cash Price |
$5,352.61
|
| Rate for Payer: Cofinity Advantage |
$4,683.53
|
| Rate for Payer: Cofinity Commercial |
$5,754.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,352.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,055.86
|
| Rate for Payer: Healthscope Commercial |
$6,021.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,683.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,018.07
|
| Rate for Payer: Mclaren Medicaid |
$2,055.86
|
| Rate for Payer: Mclaren Medicare |
$2,055.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,158.65
|
| Rate for Payer: Meridian Medicaid |
$2,158.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,364.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,261.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,687.15
|
| Rate for Payer: Nomi Health Commercial |
$6,167.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,018.07
|
| Rate for Payer: PACE Medicare |
$1,953.07
|
| Rate for Payer: PACE SWMI |
$2,055.86
|
| Rate for Payer: PHP Commercial |
$5,687.15
|
| Rate for Payer: PHP Medicare Advantage |
$2,055.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,075.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,648.46
|
| Rate for Payer: Priority Health Medicare |
$2,055.86
|
| Rate for Payer: Priority Health SBD |
$4,215.18
|
| Rate for Payer: Priority Health Tiered Network |
$5,318.77
|
| Rate for Payer: Railroad Medicare Medicare |
$2,055.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,348.99
|
| Rate for Payer: UHC Core |
$3,485.89
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,055.86
|
| Rate for Payer: UHC Exchange |
$2,629.47
|
| Rate for Payer: UHC Medicaid |
$1,075.21
|
| Rate for Payer: UHCCP Medicaid |
$1,075.21
|
| Rate for Payer: UMR Bronson Commercial |
$2,475.58
|
| Rate for Payer: VA VA |
$2,055.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,018.07
|
|
|
HC ADJT TIS REARRGMT EYE/NOSE/EAR/LIP 10.1-30.0 SQ CM
|
Facility
|
IP
|
$6,690.76
|
|
|
Service Code
|
CPT 14061
|
| Hospital Charge Code |
76100556
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,943.93 |
| Max. Negotiated Rate |
$6,021.68 |
| Rate for Payer: Aetna American Axle |
$4,348.99
|
| Rate for Payer: Aetna Commercial |
$5,687.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,348.99
|
| Rate for Payer: Cash Price |
$5,352.61
|
| Rate for Payer: Cofinity Advantage |
$4,683.53
|
| Rate for Payer: Cofinity Commercial |
$5,754.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,352.61
|
| Rate for Payer: Healthscope Commercial |
$6,021.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,683.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,018.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,687.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,018.07
|
| Rate for Payer: PHP Commercial |
$5,687.15
|
| Rate for Payer: Priority Health SBD |
$4,215.18
|
| Rate for Payer: UMR Bronson Commercial |
$2,943.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,018.07
|
|
|
HC ADJT TIS TRNSFR/REARRGMT DEFEC EA ADDL 30 SQ CM
|
Facility
|
IP
|
$1,988.00
|
|
|
Service Code
|
CPT 14302
|
| Hospital Charge Code |
76100553
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$874.72 |
| Max. Negotiated Rate |
$1,789.20 |
| Rate for Payer: Aetna American Axle |
$1,292.20
|
| Rate for Payer: Aetna Commercial |
$1,689.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,292.20
|
| Rate for Payer: Cash Price |
$1,590.40
|
| Rate for Payer: Cofinity Advantage |
$1,391.60
|
| Rate for Payer: Cofinity Commercial |
$1,709.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,590.40
|
| Rate for Payer: Healthscope Commercial |
$1,789.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,391.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,491.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,689.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,491.00
|
| Rate for Payer: PHP Commercial |
$1,689.80
|
| Rate for Payer: Priority Health SBD |
$1,252.44
|
| Rate for Payer: UMR Bronson Commercial |
$874.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,491.00
|
|
|
HC ADJT TIS TRNSFR/REARRGMT DEFEC EA ADDL 30 SQ CM
|
Facility
|
OP
|
$1,988.00
|
|
|
Service Code
|
CPT 14302
|
| Hospital Charge Code |
76100553
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$735.56 |
| Max. Negotiated Rate |
$1,789.20 |
| Rate for Payer: Aetna American Axle |
$1,292.20
|
| Rate for Payer: Aetna Commercial |
$1,689.80
|
| Rate for Payer: Aetna Medicare |
$994.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,292.20
|
| Rate for Payer: BCBS Complete |
$795.20
|
| Rate for Payer: BCBS Trust/PPO |
$976.90
|
| Rate for Payer: BCN Commercial |
$976.90
|
| Rate for Payer: Cash Price |
$1,590.40
|
| Rate for Payer: Cash Price |
$1,590.40
|
| Rate for Payer: Cash Price |
$1,590.40
|
| Rate for Payer: Cofinity Advantage |
$1,391.60
|
| Rate for Payer: Cofinity Commercial |
$1,709.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,590.40
|
| Rate for Payer: Healthscope Commercial |
$1,789.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,391.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,491.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,590.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,689.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,491.00
|
| Rate for Payer: PHP Commercial |
$1,689.80
|
| Rate for Payer: Priority Health SBD |
$1,252.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,292.20
|
| Rate for Payer: UHC Core |
$1,035.75
|
| Rate for Payer: UHC Exchange |
$781.28
|
| Rate for Payer: UMR Bronson Commercial |
$735.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,491.00
|
|
|
HC ADJT TIS TRNSFR/REARRGMT E/N/E/L DFCT 10 SQ CM/<
|
Facility
|
OP
|
$3,515.06
|
|
|
Service Code
|
CPT 14060
|
| Hospital Charge Code |
76100552
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,075.21 |
| Max. Negotiated Rate |
$6,648.46 |
| Rate for Payer: Aetna American Axle |
$2,284.79
|
| Rate for Payer: Aetna Commercial |
$2,987.80
|
| Rate for Payer: Aetna Medicare |
$2,138.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,284.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,569.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,569.82
|
| Rate for Payer: BCBS Complete |
$1,129.08
|
| Rate for Payer: BCBS MAPPO |
$2,055.86
|
| Rate for Payer: BCBS Trust/PPO |
$1,725.85
|
| Rate for Payer: BCN Commercial |
$1,725.85
|
| Rate for Payer: BCN Medicare Advantage |
$2,055.86
|
| Rate for Payer: Cash Price |
$2,812.05
|
| Rate for Payer: Cash Price |
$2,812.05
|
| Rate for Payer: Cash Price |
$2,812.05
|
| Rate for Payer: Cofinity Advantage |
$2,460.54
|
| Rate for Payer: Cofinity Commercial |
$3,022.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,812.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,055.86
|
| Rate for Payer: Healthscope Commercial |
$3,163.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,460.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,636.30
|
| Rate for Payer: Mclaren Medicaid |
$2,055.86
|
| Rate for Payer: Mclaren Medicare |
$2,055.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,158.65
|
| Rate for Payer: Meridian Medicaid |
$2,158.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,364.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,261.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,987.80
|
| Rate for Payer: Nomi Health Commercial |
$6,167.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,636.30
|
| Rate for Payer: PACE Medicare |
$1,953.07
|
| Rate for Payer: PACE SWMI |
$2,055.86
|
| Rate for Payer: PHP Commercial |
$2,987.80
|
| Rate for Payer: PHP Medicare Advantage |
$2,055.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,075.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,648.46
|
| Rate for Payer: Priority Health Medicare |
$2,055.86
|
| Rate for Payer: Priority Health SBD |
$2,214.49
|
| Rate for Payer: Priority Health Tiered Network |
$5,318.77
|
| Rate for Payer: Railroad Medicare Medicare |
$2,055.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,284.79
|
| Rate for Payer: UHC Core |
$1,831.35
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,055.86
|
| Rate for Payer: UHC Exchange |
$1,381.42
|
| Rate for Payer: UHC Medicaid |
$1,075.21
|
| Rate for Payer: UHCCP Medicaid |
$1,075.21
|
| Rate for Payer: UMR Bronson Commercial |
$1,300.57
|
| Rate for Payer: VA VA |
$2,055.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,636.30
|
|
|
HC ADJT TIS TRNSFR/REARRGMT E/N/E/L DFCT 10 SQ CM/<
|
Facility
|
IP
|
$3,515.06
|
|
|
Service Code
|
CPT 14060
|
| Hospital Charge Code |
76100552
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,546.63 |
| Max. Negotiated Rate |
$3,163.55 |
| Rate for Payer: Aetna American Axle |
$2,284.79
|
| Rate for Payer: Aetna Commercial |
$2,987.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,284.79
|
| Rate for Payer: Cash Price |
$2,812.05
|
| Rate for Payer: Cofinity Advantage |
$2,460.54
|
| Rate for Payer: Cofinity Commercial |
$3,022.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,812.05
|
| Rate for Payer: Healthscope Commercial |
$3,163.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,460.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,636.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,987.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,636.30
|
| Rate for Payer: PHP Commercial |
$2,987.80
|
| Rate for Payer: Priority Health SBD |
$2,214.49
|
| Rate for Payer: UMR Bronson Commercial |
$1,546.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,636.30
|
|
|
HC ADL TRAINING EA 15 MIN
|
Facility
|
IP
|
$104.00
|
|
|
Service Code
|
CPT 97535
|
| Hospital Charge Code |
42000030
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$45.76 |
| Max. Negotiated Rate |
$93.60 |
| Rate for Payer: Aetna American Axle |
$67.60
|
| Rate for Payer: Aetna Commercial |
$88.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.60
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Cofinity Advantage |
$72.80
|
| Rate for Payer: Cofinity Commercial |
$89.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.20
|
| Rate for Payer: Healthscope Commercial |
$93.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$72.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.00
|
| Rate for Payer: PHP Commercial |
$88.40
|
| Rate for Payer: Priority Health SBD |
$65.52
|
| Rate for Payer: UMR Bronson Commercial |
$45.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.00
|
|
|
HC ADL TRAINING EA 15 MIN
|
Facility
|
OP
|
$104.00
|
|
|
Service Code
|
CPT 97535
|
| Hospital Charge Code |
42000030
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna American Axle |
$67.60
|
| Rate for Payer: Aetna Commercial |
$88.40
|
| Rate for Payer: Aetna Medicare |
$52.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.60
|
| Rate for Payer: BCBS Complete |
$41.60
|
| Rate for Payer: BCBS Trust/PPO |
$29.93
|
| Rate for Payer: BCN Commercial |
$29.93
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Cofinity Advantage |
$72.80
|
| Rate for Payer: Cofinity Commercial |
$89.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.20
|
| Rate for Payer: Healthscope Commercial |
$93.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$72.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$83.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.40
|
| Rate for Payer: Nomi Health Commercial |
$135.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.00
|
| Rate for Payer: PHP Commercial |
$88.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$30.00
|
| Rate for Payer: Priority Health SBD |
$65.52
|
| Rate for Payer: Priority Health Tiered Network |
$24.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.60
|
| Rate for Payer: UHC Core |
$54.18
|
| Rate for Payer: UHC Exchange |
$40.87
|
| Rate for Payer: UMR Bronson Commercial |
$38.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.00
|
|
|
HC ADMIN DEVELOPMENTAL TEST EA ADDL 30 MIN
|
Facility
|
OP
|
$242.00
|
|
|
Service Code
|
CPT 96113
|
| Hospital Charge Code |
51000132
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$89.54 |
| Max. Negotiated Rate |
$217.80 |
| Rate for Payer: Aetna American Axle |
$157.30
|
| Rate for Payer: Aetna Commercial |
$205.70
|
| Rate for Payer: Aetna Medicare |
$121.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$157.30
|
| Rate for Payer: BCBS Complete |
$96.80
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Cofinity Advantage |
$169.40
|
| Rate for Payer: Cofinity Commercial |
$208.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$193.60
|
| Rate for Payer: Healthscope Commercial |
$217.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$169.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$181.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$193.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$205.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$181.50
|
| Rate for Payer: PHP Commercial |
$205.70
|
| Rate for Payer: Priority Health SBD |
$152.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$157.30
|
| Rate for Payer: UHC Core |
$126.08
|
| Rate for Payer: UHC Exchange |
$95.11
|
| Rate for Payer: UMR Bronson Commercial |
$89.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$181.50
|
|
|
HC ADMIN DEVELOPMENTAL TEST EA ADDL 30 MIN
|
Facility
|
IP
|
$242.00
|
|
|
Service Code
|
CPT 96113
|
| Hospital Charge Code |
51000132
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$106.48 |
| Max. Negotiated Rate |
$217.80 |
| Rate for Payer: Aetna American Axle |
$157.30
|
| Rate for Payer: Aetna Commercial |
$205.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$157.30
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Cofinity Advantage |
$169.40
|
| Rate for Payer: Cofinity Commercial |
$208.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$193.60
|
| Rate for Payer: Healthscope Commercial |
$217.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$169.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$181.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$205.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$181.50
|
| Rate for Payer: PHP Commercial |
$205.70
|
| Rate for Payer: Priority Health SBD |
$152.46
|
| Rate for Payer: UMR Bronson Commercial |
$106.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$181.50
|
|
|
HC ADMIN DEVELOPMENTAL TEST FIRST HOUR
|
Facility
|
OP
|
$483.00
|
|
|
Service Code
|
CPT 96112
|
| Hospital Charge Code |
51000131
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$67.05 |
| Max. Negotiated Rate |
$434.70 |
| Rate for Payer: Aetna American Axle |
$313.95
|
| Rate for Payer: Aetna Commercial |
$410.55
|
| Rate for Payer: Aetna Medicare |
$133.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$313.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$160.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$160.26
|
| Rate for Payer: BCBS Complete |
$70.41
|
| Rate for Payer: BCBS MAPPO |
$128.21
|
| Rate for Payer: BCN Medicare Advantage |
$128.21
|
| Rate for Payer: Cash Price |
$386.40
|
| Rate for Payer: Cash Price |
$386.40
|
| Rate for Payer: Cofinity Advantage |
$338.10
|
| Rate for Payer: Cofinity Commercial |
$415.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$386.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$128.21
|
| Rate for Payer: Healthscope Commercial |
$434.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$338.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$362.25
|
| Rate for Payer: Mclaren Medicaid |
$128.21
|
| Rate for Payer: Mclaren Medicare |
$128.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$134.62
|
| Rate for Payer: Meridian Medicaid |
$134.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$147.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$141.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$410.55
|
| Rate for Payer: Nomi Health Commercial |
$384.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$362.25
|
| Rate for Payer: PACE Medicare |
$121.80
|
| Rate for Payer: PACE SWMI |
$128.21
|
| Rate for Payer: PHP Commercial |
$410.55
|
| Rate for Payer: PHP Medicare Advantage |
$128.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$414.63
|
| Rate for Payer: Priority Health Medicare |
$128.21
|
| Rate for Payer: Priority Health SBD |
$304.29
|
| Rate for Payer: Priority Health Tiered Network |
$331.70
|
| Rate for Payer: Railroad Medicare Medicare |
$128.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$313.95
|
| Rate for Payer: UHC Core |
$251.64
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$128.21
|
| Rate for Payer: UHC Exchange |
$189.82
|
| Rate for Payer: UHC Medicaid |
$67.05
|
| Rate for Payer: UHCCP Medicaid |
$67.05
|
| Rate for Payer: UMR Bronson Commercial |
$178.71
|
| Rate for Payer: VA VA |
$128.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$362.25
|
|
