|
HC APLIGRAF PER SQ CM
|
Facility
|
OP
|
$134.35
|
|
|
Service Code
|
HCPCS Q4101
|
| Hospital Charge Code |
63600001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$49.71 |
| Max. Negotiated Rate |
$6,247.41 |
| Rate for Payer: Aetna American Axle |
$87.33
|
| Rate for Payer: Aetna Commercial |
$114.20
|
| Rate for Payer: Aetna Medicare |
$128.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.00
|
| Rate for Payer: BCBS Complete |
$68.10
|
| Rate for Payer: BCBS MAPPO |
$124.00
|
| Rate for Payer: BCBS Trust/PPO |
$6,247.41
|
| Rate for Payer: BCN Commercial |
$6,247.41
|
| Rate for Payer: BCN Medicare Advantage |
$124.00
|
| Rate for Payer: Cash Price |
$107.48
|
| Rate for Payer: Cash Price |
$107.48
|
| Rate for Payer: Cofinity Advantage |
$94.05
|
| Rate for Payer: Cofinity Commercial |
$115.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.00
|
| Rate for Payer: Healthscope Commercial |
$120.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$94.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.76
|
| Rate for Payer: Mclaren Medicaid |
$124.00
|
| Rate for Payer: Mclaren Medicare |
$124.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.20
|
| Rate for Payer: Meridian Medicaid |
$130.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.20
|
| Rate for Payer: Nomi Health Commercial |
$372.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$100.76
|
| Rate for Payer: PACE Medicare |
$117.80
|
| Rate for Payer: PACE SWMI |
$124.00
|
| Rate for Payer: PHP Commercial |
$114.20
|
| Rate for Payer: PHP Medicare Advantage |
$124.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$401.00
|
| Rate for Payer: Priority Health Medicare |
$124.00
|
| Rate for Payer: Priority Health SBD |
$84.64
|
| Rate for Payer: Priority Health Tiered Network |
$320.80
|
| Rate for Payer: Railroad Medicare Medicare |
$124.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.78
|
| Rate for Payer: UHC Core |
$209.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$124.00
|
| Rate for Payer: UHC Exchange |
$209.78
|
| Rate for Payer: UHC Medicaid |
$64.85
|
| Rate for Payer: UHCCP Medicaid |
$64.85
|
| Rate for Payer: UMR Bronson Commercial |
$49.71
|
| Rate for Payer: VA VA |
$124.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.76
|
|
|
HC APLIGRAF PER SQ CM
|
Facility
|
IP
|
$134.35
|
|
|
Service Code
|
HCPCS Q4101
|
| Hospital Charge Code |
63600001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$59.11 |
| Max. Negotiated Rate |
$120.92 |
| Rate for Payer: Aetna American Axle |
$87.33
|
| Rate for Payer: Aetna Commercial |
$114.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.33
|
| Rate for Payer: Cash Price |
$107.48
|
| Rate for Payer: Cofinity Advantage |
$94.05
|
| Rate for Payer: Cofinity Commercial |
$115.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.48
|
| Rate for Payer: Healthscope Commercial |
$120.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$94.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$100.76
|
| Rate for Payer: PHP Commercial |
$114.20
|
| Rate for Payer: Priority Health SBD |
$84.64
|
| Rate for Payer: UMR Bronson Commercial |
$59.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.76
|
|
|
HC APOLIPO E GENE, WB
|
Facility
|
OP
|
$344.00
|
|
|
Service Code
|
CPT 81401
|
| Hospital Charge Code |
31000089
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$71.65 |
| Max. Negotiated Rate |
$411.00 |
| Rate for Payer: Aetna American Axle |
$223.60
|
| Rate for Payer: Aetna Commercial |
$292.40
|
| Rate for Payer: Aetna Medicare |
$142.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$223.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$171.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$171.25
|
| Rate for Payer: BCBS Complete |
$75.24
|
| Rate for Payer: BCBS MAPPO |
$137.00
|
| Rate for Payer: BCBS Trust/PPO |
$158.37
|
| Rate for Payer: BCN Commercial |
$158.37
|
| Rate for Payer: BCN Medicare Advantage |
$137.00
|
| Rate for Payer: Cash Price |
$275.20
|
| Rate for Payer: Cash Price |
$275.20
|
| Rate for Payer: Cofinity Advantage |
$240.80
|
| Rate for Payer: Cofinity Commercial |
$295.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$275.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$137.00
|
| Rate for Payer: Healthscope Commercial |
$309.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$240.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$258.00
|
| Rate for Payer: Mclaren Medicaid |
$137.00
|
| Rate for Payer: Mclaren Medicare |
$137.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$143.85
|
| Rate for Payer: Meridian Medicaid |
$143.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$157.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$150.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$292.40
|
| Rate for Payer: Nomi Health Commercial |
$411.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$258.00
|
| Rate for Payer: PACE Medicare |
$130.15
|
| Rate for Payer: PACE SWMI |
$137.00
|
| Rate for Payer: PHP Commercial |
$292.40
|
| Rate for Payer: PHP Medicare Advantage |
$137.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$71.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$137.00
|
| Rate for Payer: Priority Health Medicare |
$137.00
|
| Rate for Payer: Priority Health SBD |
$216.72
|
| Rate for Payer: Priority Health Tiered Network |
$109.60
|
| Rate for Payer: Railroad Medicare Medicare |
$137.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$205.50
|
| Rate for Payer: UHC Core |
$205.50
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$137.00
|
| Rate for Payer: UHC Exchange |
$205.50
|
| Rate for Payer: UHC Medicaid |
$71.65
|
| Rate for Payer: UHCCP Medicaid |
$71.65
|
| Rate for Payer: UMR Bronson Commercial |
$127.28
|
| Rate for Payer: VA VA |
$137.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$258.00
|
|
|
HC APOLIPO E GENE, WB
|
Facility
|
IP
|
$344.00
|
|
|
Service Code
|
CPT 81401
|
| Hospital Charge Code |
31000089
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$151.36 |
| Max. Negotiated Rate |
$309.60 |
| Rate for Payer: Aetna American Axle |
$223.60
|
| Rate for Payer: Aetna Commercial |
$292.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$223.60
|
| Rate for Payer: Cash Price |
$275.20
|
| Rate for Payer: Cofinity Advantage |
$240.80
|
| Rate for Payer: Cofinity Commercial |
$295.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$275.20
|
| Rate for Payer: Healthscope Commercial |
$309.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$240.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$258.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$292.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$258.00
|
| Rate for Payer: PHP Commercial |
$292.40
|
| Rate for Payer: Priority Health SBD |
$216.72
|
| Rate for Payer: UMR Bronson Commercial |
$151.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$258.00
|
|
|
HC APOLIPOPROTEIN A1
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 82172
|
| Hospital Charge Code |
30100106
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.03 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna American Axle |
$33.15
|
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna Medicare |
$21.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.36
|
| Rate for Payer: BCBS Complete |
$11.58
|
| Rate for Payer: BCBS MAPPO |
$21.09
|
| Rate for Payer: BCBS Trust/PPO |
$24.38
|
| Rate for Payer: BCN Commercial |
$24.38
|
| Rate for Payer: BCN Medicare Advantage |
$21.09
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Advantage |
$35.70
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.09
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.25
|
| Rate for Payer: Mclaren Medicaid |
$21.09
|
| Rate for Payer: Mclaren Medicare |
$21.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.14
|
| Rate for Payer: Meridian Medicaid |
$22.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$23.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.35
|
| Rate for Payer: Nomi Health Commercial |
$31.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.25
|
| Rate for Payer: PACE Medicare |
$20.04
|
| Rate for Payer: PACE SWMI |
$21.09
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: PHP Medicare Advantage |
$21.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$21.09
|
| Rate for Payer: Priority Health Medicare |
$21.09
|
| Rate for Payer: Priority Health SBD |
$32.13
|
| Rate for Payer: Priority Health Tiered Network |
$16.87
|
| Rate for Payer: Railroad Medicare Medicare |
$21.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.64
|
| Rate for Payer: UHC Core |
$31.64
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$21.09
|
| Rate for Payer: UHC Exchange |
$31.64
|
| Rate for Payer: UHC Medicaid |
$11.03
|
| Rate for Payer: UHCCP Medicaid |
$11.03
|
| Rate for Payer: UMR Bronson Commercial |
$18.87
|
| Rate for Payer: VA VA |
$21.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.25
|
|
|
HC APOLIPOPROTEIN A1
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 82172
|
| Hospital Charge Code |
30100106
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.44 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna American Axle |
$33.15
|
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.15
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Advantage |
$35.70
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.25
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: Priority Health SBD |
$32.13
|
| Rate for Payer: UMR Bronson Commercial |
$22.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.25
|
|
|
HC APOLIPOPROTEIN B
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
CPT 82172
|
| Hospital Charge Code |
30100107
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.03 |
| Max. Negotiated Rate |
$46.80 |
| Rate for Payer: Aetna American Axle |
$33.80
|
| Rate for Payer: Aetna Commercial |
$44.20
|
| Rate for Payer: Aetna Medicare |
$21.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.36
|
| Rate for Payer: BCBS Complete |
$11.58
|
| Rate for Payer: BCBS MAPPO |
$21.09
|
| Rate for Payer: BCBS Trust/PPO |
$24.38
|
| Rate for Payer: BCN Commercial |
$24.38
|
| Rate for Payer: BCN Medicare Advantage |
$21.09
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Cofinity Advantage |
$36.40
|
| Rate for Payer: Cofinity Commercial |
$44.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.09
|
| Rate for Payer: Healthscope Commercial |
$46.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$36.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.00
|
| Rate for Payer: Mclaren Medicaid |
$21.09
|
| Rate for Payer: Mclaren Medicare |
$21.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.14
|
| Rate for Payer: Meridian Medicaid |
$22.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$23.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.20
|
| Rate for Payer: Nomi Health Commercial |
$31.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.00
|
| Rate for Payer: PACE Medicare |
$20.04
|
| Rate for Payer: PACE SWMI |
$21.09
|
| Rate for Payer: PHP Commercial |
$44.20
|
| Rate for Payer: PHP Medicare Advantage |
$21.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$21.09
|
| Rate for Payer: Priority Health Medicare |
$21.09
|
| Rate for Payer: Priority Health SBD |
$32.76
|
| Rate for Payer: Priority Health Tiered Network |
$16.87
|
| Rate for Payer: Railroad Medicare Medicare |
$21.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.64
|
| Rate for Payer: UHC Core |
$31.64
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$21.09
|
| Rate for Payer: UHC Exchange |
$31.64
|
| Rate for Payer: UHC Medicaid |
$11.03
|
| Rate for Payer: UHCCP Medicaid |
$11.03
|
| Rate for Payer: UMR Bronson Commercial |
$19.24
|
| Rate for Payer: VA VA |
$21.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.00
|
|
|
HC APOLIPOPROTEIN B
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
CPT 82172
|
| Hospital Charge Code |
30100107
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.88 |
| Max. Negotiated Rate |
$46.80 |
| Rate for Payer: Aetna American Axle |
$33.80
|
| Rate for Payer: Aetna Commercial |
$44.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.80
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Cofinity Advantage |
$36.40
|
| Rate for Payer: Cofinity Commercial |
$44.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.60
|
| Rate for Payer: Healthscope Commercial |
$46.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$36.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.00
|
| Rate for Payer: PHP Commercial |
$44.20
|
| Rate for Payer: Priority Health SBD |
$32.76
|
| Rate for Payer: UMR Bronson Commercial |
$22.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.00
|
|
|
HC APOLIPOPROTEIN B LMPP
|
Facility
|
IP
|
$40.33
|
|
|
Service Code
|
CPT 82172
|
| Hospital Charge Code |
30100637
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.75 |
| Max. Negotiated Rate |
$36.30 |
| Rate for Payer: Aetna American Axle |
$26.21
|
| Rate for Payer: Aetna Commercial |
$34.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.21
|
| Rate for Payer: Cash Price |
$32.26
|
| Rate for Payer: Cofinity Advantage |
$28.23
|
| Rate for Payer: Cofinity Commercial |
$34.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.26
|
| Rate for Payer: Healthscope Commercial |
$36.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.25
|
| Rate for Payer: PHP Commercial |
$34.28
|
| Rate for Payer: Priority Health SBD |
$25.41
|
| Rate for Payer: UMR Bronson Commercial |
$17.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.25
|
|
|
HC APOLIPOPROTEIN B LMPP
|
Facility
|
OP
|
$40.33
|
|
|
Service Code
|
CPT 82172
|
| Hospital Charge Code |
30100637
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.03 |
| Max. Negotiated Rate |
$36.30 |
| Rate for Payer: Aetna American Axle |
$26.21
|
| Rate for Payer: Aetna Commercial |
$34.28
|
| Rate for Payer: Aetna Medicare |
$21.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.36
|
| Rate for Payer: BCBS Complete |
$11.58
|
| Rate for Payer: BCBS MAPPO |
$21.09
|
| Rate for Payer: BCBS Trust/PPO |
$24.38
|
| Rate for Payer: BCN Commercial |
$24.38
|
| Rate for Payer: BCN Medicare Advantage |
$21.09
|
| Rate for Payer: Cash Price |
$32.26
|
| Rate for Payer: Cash Price |
$32.26
|
| Rate for Payer: Cofinity Advantage |
$28.23
|
| Rate for Payer: Cofinity Commercial |
$34.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.09
|
| Rate for Payer: Healthscope Commercial |
$36.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.25
|
| Rate for Payer: Mclaren Medicaid |
$21.09
|
| Rate for Payer: Mclaren Medicare |
$21.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.14
|
| Rate for Payer: Meridian Medicaid |
$22.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$23.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.28
|
| Rate for Payer: Nomi Health Commercial |
$31.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.25
|
| Rate for Payer: PACE Medicare |
$20.04
|
| Rate for Payer: PACE SWMI |
$21.09
|
| Rate for Payer: PHP Commercial |
$34.28
|
| Rate for Payer: PHP Medicare Advantage |
$21.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$21.09
|
| Rate for Payer: Priority Health Medicare |
$21.09
|
| Rate for Payer: Priority Health SBD |
$25.41
|
| Rate for Payer: Priority Health Tiered Network |
$16.87
|
| Rate for Payer: Railroad Medicare Medicare |
$21.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.64
|
| Rate for Payer: UHC Core |
$31.64
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$21.09
|
| Rate for Payer: UHC Exchange |
$31.64
|
| Rate for Payer: UHC Medicaid |
$11.03
|
| Rate for Payer: UHCCP Medicaid |
$11.03
|
| Rate for Payer: UMR Bronson Commercial |
$14.92
|
| Rate for Payer: VA VA |
$21.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.25
|
|
|
HC APPLE IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200072
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna American Axle |
$16.84
|
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: BCBS Complete |
$2.87
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$6.04
|
| Rate for Payer: BCN Commercial |
$6.04
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Advantage |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.43
|
| Rate for Payer: Mclaren Medicaid |
$5.22
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$7.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.22
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$16.32
|
| Rate for Payer: Priority Health Tiered Network |
$4.18
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.83
|
| Rate for Payer: UHC Core |
$7.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.22
|
| Rate for Payer: UHC Exchange |
$7.83
|
| Rate for Payer: UHC Medicaid |
$2.73
|
| Rate for Payer: UHCCP Medicaid |
$2.73
|
| Rate for Payer: UMR Bronson Commercial |
$9.58
|
| Rate for Payer: VA VA |
$5.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.43
|
|
|
HC APPLE IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200072
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.40 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna American Axle |
$16.84
|
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Advantage |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: Priority Health SBD |
$16.32
|
| Rate for Payer: UMR Bronson Commercial |
$11.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.43
|
|
|
HC APPLIANCE BELT
|
Facility
|
IP
|
$25.41
|
|
| Hospital Charge Code |
27000027
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.18 |
| Max. Negotiated Rate |
$22.87 |
| Rate for Payer: Aetna American Axle |
$16.52
|
| Rate for Payer: Aetna Commercial |
$21.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.52
|
| Rate for Payer: Cash Price |
$20.33
|
| Rate for Payer: Cofinity Advantage |
$17.79
|
| Rate for Payer: Cofinity Commercial |
$21.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.33
|
| Rate for Payer: Healthscope Commercial |
$22.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.06
|
| Rate for Payer: PHP Commercial |
$21.60
|
| Rate for Payer: Priority Health SBD |
$16.01
|
| Rate for Payer: UMR Bronson Commercial |
$11.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.06
|
|
|
HC APPLIANCE BELT
|
Facility
|
OP
|
$25.41
|
|
| Hospital Charge Code |
27000027
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.40 |
| Max. Negotiated Rate |
$22.87 |
| Rate for Payer: Aetna American Axle |
$16.52
|
| Rate for Payer: Aetna Commercial |
$21.60
|
| Rate for Payer: Aetna Medicare |
$12.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.52
|
| Rate for Payer: BCBS Complete |
$10.16
|
| Rate for Payer: Cash Price |
$20.33
|
| Rate for Payer: Cofinity Advantage |
$17.79
|
| Rate for Payer: Cofinity Commercial |
$21.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.33
|
| Rate for Payer: Healthscope Commercial |
$22.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.06
|
| Rate for Payer: PHP Commercial |
$21.60
|
| Rate for Payer: Priority Health SBD |
$16.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.52
|
| Rate for Payer: UHC Core |
$13.24
|
| Rate for Payer: UHC Exchange |
$9.99
|
| Rate for Payer: UMR Bronson Commercial |
$9.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.06
|
|
|
HC APPLICATION OF TOPICAL FLUORIDE VARNISH BY PHYS/QHP
|
Facility
|
IP
|
$36.21
|
|
|
Service Code
|
CPT 99188
|
| Hospital Charge Code |
51000097
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$15.93 |
| Max. Negotiated Rate |
$32.59 |
| Rate for Payer: Aetna American Axle |
$23.54
|
| Rate for Payer: Aetna Commercial |
$30.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.54
|
| Rate for Payer: Cash Price |
$28.97
|
| Rate for Payer: Cofinity Advantage |
$25.35
|
| Rate for Payer: Cofinity Commercial |
$31.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.97
|
| Rate for Payer: Healthscope Commercial |
$32.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.16
|
| Rate for Payer: PHP Commercial |
$30.78
|
| Rate for Payer: Priority Health SBD |
$22.81
|
| Rate for Payer: UMR Bronson Commercial |
$15.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.16
|
|
|
HC APPLICATION OF TOPICAL FLUORIDE VARNISH BY PHYS/QHP
|
Facility
|
OP
|
$36.21
|
|
|
Service Code
|
CPT 99188
|
| Hospital Charge Code |
51000097
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$13.40 |
| Max. Negotiated Rate |
$32.59 |
| Rate for Payer: Aetna American Axle |
$23.54
|
| Rate for Payer: Aetna Commercial |
$30.78
|
| Rate for Payer: Aetna Medicare |
$18.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.54
|
| Rate for Payer: BCBS Complete |
$14.48
|
| Rate for Payer: BCBS Trust/PPO |
$19.73
|
| Rate for Payer: BCN Commercial |
$19.73
|
| Rate for Payer: Cash Price |
$28.97
|
| Rate for Payer: Cash Price |
$28.97
|
| Rate for Payer: Cofinity Advantage |
$25.35
|
| Rate for Payer: Cofinity Commercial |
$31.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.97
|
| Rate for Payer: Healthscope Commercial |
$32.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.16
|
| Rate for Payer: PHP Commercial |
$30.78
|
| Rate for Payer: Priority Health SBD |
$22.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.54
|
| Rate for Payer: UHC Core |
$18.87
|
| Rate for Payer: UHC Exchange |
$14.23
|
| Rate for Payer: UMR Bronson Commercial |
$13.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.16
|
|
|
HC APPLICATION ON-BODY INJECTOR
|
Facility
|
OP
|
$152.79
|
|
|
Service Code
|
CPT 96377
|
| Hospital Charge Code |
76100069
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$24.40 |
| Max. Negotiated Rate |
$150.88 |
| Rate for Payer: Aetna American Axle |
$99.31
|
| Rate for Payer: Aetna Commercial |
$129.87
|
| Rate for Payer: Aetna Medicare |
$48.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$58.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$58.33
|
| Rate for Payer: BCBS Complete |
$25.63
|
| Rate for Payer: BCBS MAPPO |
$46.66
|
| Rate for Payer: BCBS Trust/PPO |
$91.53
|
| Rate for Payer: BCN Commercial |
$91.53
|
| Rate for Payer: BCN Medicare Advantage |
$46.66
|
| Rate for Payer: Cash Price |
$122.23
|
| Rate for Payer: Cash Price |
$122.23
|
| Rate for Payer: Cofinity Advantage |
$106.95
|
| Rate for Payer: Cofinity Commercial |
$131.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.66
|
| Rate for Payer: Healthscope Commercial |
$137.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$106.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.59
|
| Rate for Payer: Mclaren Medicaid |
$46.66
|
| Rate for Payer: Mclaren Medicare |
$46.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.99
|
| Rate for Payer: Meridian Medicaid |
$48.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$51.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.87
|
| Rate for Payer: Nomi Health Commercial |
$139.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$114.59
|
| Rate for Payer: PACE Medicare |
$44.33
|
| Rate for Payer: PACE SWMI |
$46.66
|
| Rate for Payer: PHP Commercial |
$129.87
|
| Rate for Payer: PHP Medicare Advantage |
$46.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$150.88
|
| Rate for Payer: Priority Health Medicare |
$46.66
|
| Rate for Payer: Priority Health SBD |
$96.26
|
| Rate for Payer: Priority Health Tiered Network |
$120.70
|
| Rate for Payer: Railroad Medicare Medicare |
$46.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$99.31
|
| Rate for Payer: UHC Core |
$79.60
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$46.66
|
| Rate for Payer: UHC Exchange |
$60.05
|
| Rate for Payer: UHC Medicaid |
$24.40
|
| Rate for Payer: UHCCP Medicaid |
$24.40
|
| Rate for Payer: UMR Bronson Commercial |
$56.53
|
| Rate for Payer: VA VA |
$46.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.59
|
|
|
HC APPLICATION ON-BODY INJECTOR
|
Facility
|
IP
|
$152.79
|
|
|
Service Code
|
CPT 96377
|
| Hospital Charge Code |
76100069
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$67.23 |
| Max. Negotiated Rate |
$137.51 |
| Rate for Payer: Aetna American Axle |
$99.31
|
| Rate for Payer: Aetna Commercial |
$129.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.31
|
| Rate for Payer: Cash Price |
$122.23
|
| Rate for Payer: Cofinity Advantage |
$106.95
|
| Rate for Payer: Cofinity Commercial |
$131.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.23
|
| Rate for Payer: Healthscope Commercial |
$137.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$106.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$114.59
|
| Rate for Payer: PHP Commercial |
$129.87
|
| Rate for Payer: Priority Health SBD |
$96.26
|
| Rate for Payer: UMR Bronson Commercial |
$67.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.59
|
|
|
HC APPLY LC SKIN SUB 100 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
OP
|
$1,986.46
|
|
|
Service Code
|
HCPCS 15277
|
| Hospital Charge Code |
76100055
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$734.99 |
| Max. Negotiated Rate |
$6,648.46 |
| Rate for Payer: Aetna American Axle |
$1,291.20
|
| Rate for Payer: Aetna Commercial |
$1,688.49
|
| Rate for Payer: Aetna Medicare |
$2,138.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,291.20
|
| 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 |
$5,236.15
|
| Rate for Payer: BCN Commercial |
$5,236.15
|
| Rate for Payer: BCN Medicare Advantage |
$2,055.86
|
| Rate for Payer: Cash Price |
$1,589.17
|
| Rate for Payer: Cash Price |
$1,589.17
|
| Rate for Payer: Cash Price |
$1,589.17
|
| Rate for Payer: Cofinity Advantage |
$1,390.52
|
| Rate for Payer: Cofinity Commercial |
$1,708.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,589.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,055.86
|
| Rate for Payer: Healthscope Commercial |
$1,787.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,390.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,489.85
|
| 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 |
$1,688.49
|
| Rate for Payer: Nomi Health Commercial |
$6,167.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,489.85
|
| Rate for Payer: PACE Medicare |
$1,953.07
|
| Rate for Payer: PACE SWMI |
$2,055.86
|
| Rate for Payer: PHP Commercial |
$1,688.49
|
| 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 |
$1,251.47
|
| 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) |
$1,291.20
|
| Rate for Payer: UHC Core |
$1,034.95
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,055.86
|
| Rate for Payer: UHC Exchange |
$780.68
|
| Rate for Payer: UHC Medicaid |
$1,075.21
|
| Rate for Payer: UHCCP Medicaid |
$1,075.21
|
| Rate for Payer: UMR Bronson Commercial |
$734.99
|
| Rate for Payer: VA VA |
$2,055.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,489.85
|
|
|
HC APPLY LC SKIN SUB 100 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
IP
|
$1,986.46
|
|
|
Service Code
|
HCPCS 15277
|
| Hospital Charge Code |
76100055
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$874.04 |
| Max. Negotiated Rate |
$1,787.81 |
| Rate for Payer: Aetna American Axle |
$1,291.20
|
| Rate for Payer: Aetna Commercial |
$1,688.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,291.20
|
| Rate for Payer: Cash Price |
$1,589.17
|
| Rate for Payer: Cofinity Advantage |
$1,390.52
|
| Rate for Payer: Cofinity Commercial |
$1,708.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,589.17
|
| Rate for Payer: Healthscope Commercial |
$1,787.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,390.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,489.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,688.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,489.85
|
| Rate for Payer: PHP Commercial |
$1,688.49
|
| Rate for Payer: Priority Health SBD |
$1,251.47
|
| Rate for Payer: UMR Bronson Commercial |
$874.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,489.85
|
|
|
HC APPLY LC SKIN SUB 1ST 100 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
OP
|
$2,622.12
|
|
|
Service Code
|
HCPCS 15273
|
| Hospital Charge Code |
76100051
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$970.18 |
| Max. Negotiated Rate |
$6,648.46 |
| Rate for Payer: Aetna American Axle |
$1,704.38
|
| Rate for Payer: Aetna Commercial |
$2,228.80
|
| Rate for Payer: Aetna Medicare |
$2,138.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,704.38
|
| 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 |
$2,060.47
|
| Rate for Payer: BCN Commercial |
$2,060.47
|
| Rate for Payer: BCN Medicare Advantage |
$2,055.86
|
| Rate for Payer: Cash Price |
$2,097.70
|
| Rate for Payer: Cash Price |
$2,097.70
|
| Rate for Payer: Cash Price |
$2,097.70
|
| Rate for Payer: Cofinity Advantage |
$1,835.48
|
| Rate for Payer: Cofinity Commercial |
$2,255.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,097.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,055.86
|
| Rate for Payer: Healthscope Commercial |
$2,359.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,835.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,966.59
|
| 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 |
$2,228.80
|
| Rate for Payer: Nomi Health Commercial |
$6,167.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,966.59
|
| Rate for Payer: PACE Medicare |
$1,953.07
|
| Rate for Payer: PACE SWMI |
$2,055.86
|
| Rate for Payer: PHP Commercial |
$2,228.80
|
| 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 |
$1,651.94
|
| 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) |
$1,704.38
|
| Rate for Payer: UHC Core |
$1,366.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,055.86
|
| Rate for Payer: UHC Exchange |
$1,030.49
|
| Rate for Payer: UHC Medicaid |
$1,075.21
|
| Rate for Payer: UHCCP Medicaid |
$1,075.21
|
| Rate for Payer: UMR Bronson Commercial |
$970.18
|
| Rate for Payer: VA VA |
$2,055.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,966.59
|
|
|
HC APPLY LC SKIN SUB 1ST 100 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
IP
|
$2,622.12
|
|
|
Service Code
|
HCPCS 15273
|
| Hospital Charge Code |
76100051
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,153.73 |
| Max. Negotiated Rate |
$2,359.91 |
| Rate for Payer: Aetna American Axle |
$1,704.38
|
| Rate for Payer: Aetna Commercial |
$2,228.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,704.38
|
| Rate for Payer: Cash Price |
$2,097.70
|
| Rate for Payer: Cofinity Advantage |
$1,835.48
|
| Rate for Payer: Cofinity Commercial |
$2,255.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,097.70
|
| Rate for Payer: Healthscope Commercial |
$2,359.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,835.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,966.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,228.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,966.59
|
| Rate for Payer: PHP Commercial |
$2,228.80
|
| Rate for Payer: Priority Health SBD |
$1,651.94
|
| Rate for Payer: UMR Bronson Commercial |
$1,153.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,966.59
|
|
|
HC APPLY LC SKIN SUB 1ST 25 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
OP
|
$2,656.59
|
|
|
Service Code
|
HCPCS 15275
|
| Hospital Charge Code |
76100053
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$385.14 |
| Max. Negotiated Rate |
$2,390.93 |
| Rate for Payer: Aetna American Axle |
$1,726.78
|
| Rate for Payer: Aetna Commercial |
$2,258.10
|
| Rate for Payer: Aetna Medicare |
$765.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,726.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$920.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$920.51
|
| Rate for Payer: BCBS Complete |
$404.44
|
| Rate for Payer: BCBS MAPPO |
$736.41
|
| Rate for Payer: BCBS Trust/PPO |
$2,000.05
|
| Rate for Payer: BCN Commercial |
$2,000.05
|
| Rate for Payer: BCN Medicare Advantage |
$736.41
|
| Rate for Payer: Cash Price |
$2,125.27
|
| Rate for Payer: Cash Price |
$2,125.27
|
| Rate for Payer: Cash Price |
$2,125.27
|
| Rate for Payer: Cofinity Advantage |
$1,859.61
|
| Rate for Payer: Cofinity Commercial |
$2,284.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,125.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$736.41
|
| Rate for Payer: Healthscope Commercial |
$2,390.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,859.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,992.44
|
| Rate for Payer: Mclaren Medicaid |
$736.41
|
| Rate for Payer: Mclaren Medicare |
$736.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$773.23
|
| Rate for Payer: Meridian Medicaid |
$773.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$846.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$810.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,258.10
|
| Rate for Payer: Nomi Health Commercial |
$2,209.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,992.44
|
| Rate for Payer: PACE Medicare |
$699.59
|
| Rate for Payer: PACE SWMI |
$736.41
|
| Rate for Payer: PHP Commercial |
$2,258.10
|
| Rate for Payer: PHP Medicare Advantage |
$736.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$385.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,381.49
|
| Rate for Payer: Priority Health Medicare |
$736.41
|
| Rate for Payer: Priority Health SBD |
$1,673.65
|
| Rate for Payer: Priority Health Tiered Network |
$1,905.19
|
| Rate for Payer: Railroad Medicare Medicare |
$736.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,726.78
|
| Rate for Payer: UHC Core |
$1,384.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$736.41
|
| Rate for Payer: UHC Exchange |
$1,044.04
|
| Rate for Payer: UHC Medicaid |
$385.14
|
| Rate for Payer: UHCCP Medicaid |
$385.14
|
| Rate for Payer: UMR Bronson Commercial |
$982.94
|
| Rate for Payer: VA VA |
$736.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,992.44
|
|
|
HC APPLY LC SKIN SUB 1ST 25 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
IP
|
$2,656.59
|
|
|
Service Code
|
HCPCS 15275
|
| Hospital Charge Code |
76100053
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,168.90 |
| Max. Negotiated Rate |
$2,390.93 |
| Rate for Payer: Aetna American Axle |
$1,726.78
|
| Rate for Payer: Aetna Commercial |
$2,258.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,726.78
|
| Rate for Payer: Cash Price |
$2,125.27
|
| Rate for Payer: Cofinity Advantage |
$1,859.61
|
| Rate for Payer: Cofinity Commercial |
$2,284.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,125.27
|
| Rate for Payer: Healthscope Commercial |
$2,390.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,859.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,992.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,258.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,992.44
|
| Rate for Payer: PHP Commercial |
$2,258.10
|
| Rate for Payer: Priority Health SBD |
$1,673.65
|
| Rate for Payer: UMR Bronson Commercial |
$1,168.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,992.44
|
|
|
HC APPLY LC SKIN SUB 1ST 25 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
OP
|
$2,435.19
|
|
|
Service Code
|
HCPCS 15271
|
| Hospital Charge Code |
76100049
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$385.14 |
| Max. Negotiated Rate |
$2,498.25 |
| Rate for Payer: Aetna American Axle |
$1,582.87
|
| Rate for Payer: Aetna Commercial |
$2,069.91
|
| Rate for Payer: Aetna Medicare |
$765.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,582.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$920.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$920.51
|
| Rate for Payer: BCBS Complete |
$404.44
|
| Rate for Payer: BCBS MAPPO |
$736.41
|
| Rate for Payer: BCBS Trust/PPO |
$2,498.25
|
| Rate for Payer: BCN Commercial |
$2,498.25
|
| Rate for Payer: BCN Medicare Advantage |
$736.41
|
| Rate for Payer: Cash Price |
$1,948.15
|
| Rate for Payer: Cash Price |
$1,948.15
|
| Rate for Payer: Cash Price |
$1,948.15
|
| Rate for Payer: Cofinity Advantage |
$1,704.63
|
| Rate for Payer: Cofinity Commercial |
$2,094.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,948.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$736.41
|
| Rate for Payer: Healthscope Commercial |
$2,191.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,704.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,826.39
|
| Rate for Payer: Mclaren Medicaid |
$736.41
|
| Rate for Payer: Mclaren Medicare |
$736.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$773.23
|
| Rate for Payer: Meridian Medicaid |
$773.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$846.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$810.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,069.91
|
| Rate for Payer: Nomi Health Commercial |
$2,209.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,826.39
|
| Rate for Payer: PACE Medicare |
$699.59
|
| Rate for Payer: PACE SWMI |
$736.41
|
| Rate for Payer: PHP Commercial |
$2,069.91
|
| Rate for Payer: PHP Medicare Advantage |
$736.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$385.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,381.49
|
| Rate for Payer: Priority Health Medicare |
$736.41
|
| Rate for Payer: Priority Health SBD |
$1,534.17
|
| Rate for Payer: Priority Health Tiered Network |
$1,905.19
|
| Rate for Payer: Railroad Medicare Medicare |
$736.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,582.87
|
| Rate for Payer: UHC Core |
$1,268.73
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$736.41
|
| Rate for Payer: UHC Exchange |
$957.03
|
| Rate for Payer: UHC Medicaid |
$385.14
|
| Rate for Payer: UHCCP Medicaid |
$385.14
|
| Rate for Payer: UMR Bronson Commercial |
$901.02
|
| Rate for Payer: VA VA |
$736.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,826.39
|
|
