|
HC ACAPELLA SUPPLY
|
Facility
|
IP
|
$195.98
|
|
| Hospital Charge Code |
27000025
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$86.23 |
| Max. Negotiated Rate |
$176.38 |
| Rate for Payer: Aetna American Axle |
$127.39
|
| Rate for Payer: Aetna Commercial |
$166.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.39
|
| Rate for Payer: Cash Price |
$156.78
|
| Rate for Payer: Cofinity Commercial |
$137.19
|
| Rate for Payer: Cofinity Commercial |
$168.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$137.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.78
|
| Rate for Payer: Healthscope Commercial |
$176.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$137.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$166.58
|
| Rate for Payer: PHP Commercial |
$166.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.39
|
| Rate for Payer: Priority Health SBD |
$123.47
|
| Rate for Payer: UMR Bronson Commercial |
$86.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.99
|
|
|
HC ACAPELLA SUPPLY
|
Facility
|
OP
|
$195.98
|
|
| Hospital Charge Code |
27000025
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$72.51 |
| Max. Negotiated Rate |
$176.38 |
| Rate for Payer: Aetna American Axle |
$127.39
|
| Rate for Payer: Aetna Commercial |
$166.58
|
| Rate for Payer: Aetna Medicare |
$97.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.39
|
| Rate for Payer: BCBS Complete |
$78.39
|
| Rate for Payer: Cash Price |
$156.78
|
| Rate for Payer: Cofinity Commercial |
$137.19
|
| Rate for Payer: Cofinity Commercial |
$168.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$137.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.78
|
| Rate for Payer: Healthscope Commercial |
$176.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$137.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$166.58
|
| Rate for Payer: PHP Commercial |
$166.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.39
|
| Rate for Payer: Priority Health SBD |
$123.47
|
| Rate for Payer: UMR Bronson Commercial |
$72.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.99
|
|
|
HC ACB APLIGRAF PER SQ CM
|
Facility
|
OP
|
$94.29
|
|
|
Service Code
|
HCPCS Q4101
|
| Hospital Charge Code |
63600031
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.89 |
| Max. Negotiated Rate |
$84.86 |
| Rate for Payer: Aetna American Axle |
$61.29
|
| Rate for Payer: Aetna Commercial |
$80.15
|
| Rate for Payer: Aetna Medicare |
$47.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.29
|
| Rate for Payer: BCBS Complete |
$37.72
|
| Rate for Payer: Cash Price |
$75.43
|
| Rate for Payer: Cofinity Commercial |
$66.00
|
| Rate for Payer: Cofinity Commercial |
$81.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$66.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.43
|
| Rate for Payer: Healthscope Commercial |
$84.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.15
|
| Rate for Payer: PHP Commercial |
$80.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.29
|
| Rate for Payer: Priority Health SBD |
$59.40
|
| Rate for Payer: UMR Bronson Commercial |
$34.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.72
|
|
|
HC ACB APLIGRAF PER SQ CM
|
Facility
|
IP
|
$94.29
|
|
|
Service Code
|
HCPCS Q4101
|
| Hospital Charge Code |
63600031
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.49 |
| Max. Negotiated Rate |
$84.86 |
| Rate for Payer: Aetna American Axle |
$61.29
|
| Rate for Payer: Aetna Commercial |
$80.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.29
|
| Rate for Payer: Cash Price |
$75.43
|
| Rate for Payer: Cofinity Commercial |
$66.00
|
| Rate for Payer: Cofinity Commercial |
$81.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$66.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.43
|
| Rate for Payer: Healthscope Commercial |
$84.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.15
|
| Rate for Payer: PHP Commercial |
$80.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.29
|
| Rate for Payer: Priority Health SBD |
$59.40
|
| Rate for Payer: UMR Bronson Commercial |
$41.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.72
|
|
|
HC ACB ESTABLISHED PT LEVEL 1
|
Facility
|
IP
|
$355.31
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000072
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$156.34 |
| Max. Negotiated Rate |
$319.78 |
| Rate for Payer: Aetna American Axle |
$230.95
|
| Rate for Payer: Aetna Commercial |
$302.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$230.95
|
| Rate for Payer: Cash Price |
$284.25
|
| Rate for Payer: Cofinity Commercial |
$248.72
|
| Rate for Payer: Cofinity Commercial |
$305.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$248.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$284.25
|
| Rate for Payer: Healthscope Commercial |
$319.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$248.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$266.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$302.01
|
| Rate for Payer: PHP Commercial |
$302.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.95
|
| Rate for Payer: Priority Health SBD |
$223.85
|
| Rate for Payer: UMR Bronson Commercial |
$156.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$266.48
|
|
|
HC ACB ESTABLISHED PT LEVEL 1
|
Facility
|
OP
|
$355.31
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000072
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$131.46 |
| Max. Negotiated Rate |
$319.78 |
| Rate for Payer: Aetna American Axle |
$230.95
|
| Rate for Payer: Aetna Commercial |
$302.01
|
| Rate for Payer: Aetna Medicare |
$177.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$230.95
|
| Rate for Payer: BCBS Complete |
$142.12
|
| Rate for Payer: Cash Price |
$284.25
|
| Rate for Payer: Cofinity Commercial |
$248.72
|
| Rate for Payer: Cofinity Commercial |
$305.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$248.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$284.25
|
| Rate for Payer: Healthscope Commercial |
$319.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$248.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$266.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$302.01
|
| Rate for Payer: PHP Commercial |
$302.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.95
|
| Rate for Payer: Priority Health SBD |
$223.85
|
| Rate for Payer: UMR Bronson Commercial |
$131.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$266.48
|
|
|
HC ACB ESTABLISHED PT LEVEL 2
|
Facility
|
IP
|
$494.43
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
51000073
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$217.55 |
| Max. Negotiated Rate |
$444.99 |
| Rate for Payer: Aetna American Axle |
$321.38
|
| Rate for Payer: Aetna Commercial |
$420.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$321.38
|
| Rate for Payer: Cash Price |
$395.54
|
| Rate for Payer: Cofinity Commercial |
$346.10
|
| Rate for Payer: Cofinity Commercial |
$425.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$346.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$395.54
|
| Rate for Payer: Healthscope Commercial |
$444.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$346.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$370.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$420.27
|
| Rate for Payer: PHP Commercial |
$420.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$321.38
|
| Rate for Payer: Priority Health SBD |
$311.49
|
| Rate for Payer: UMR Bronson Commercial |
$217.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$370.82
|
|
|
HC ACB ESTABLISHED PT LEVEL 2
|
Facility
|
OP
|
$494.43
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
51000073
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$182.94 |
| Max. Negotiated Rate |
$444.99 |
| Rate for Payer: Aetna American Axle |
$321.38
|
| Rate for Payer: Aetna Commercial |
$420.27
|
| Rate for Payer: Aetna Medicare |
$247.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$321.38
|
| Rate for Payer: BCBS Complete |
$197.77
|
| Rate for Payer: Cash Price |
$395.54
|
| Rate for Payer: Cofinity Commercial |
$346.10
|
| Rate for Payer: Cofinity Commercial |
$425.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$346.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$395.54
|
| Rate for Payer: Healthscope Commercial |
$444.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$346.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$370.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$420.27
|
| Rate for Payer: PHP Commercial |
$420.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$321.38
|
| Rate for Payer: Priority Health SBD |
$311.49
|
| Rate for Payer: UMR Bronson Commercial |
$182.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$370.82
|
|
|
HC ACB ESTABLISHED PT LEVEL 3
|
Facility
|
OP
|
$688.85
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
51000074
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$254.87 |
| Max. Negotiated Rate |
$619.97 |
| Rate for Payer: Aetna American Axle |
$447.75
|
| Rate for Payer: Aetna Commercial |
$585.52
|
| Rate for Payer: Aetna Medicare |
$344.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$447.75
|
| Rate for Payer: BCBS Complete |
$275.54
|
| Rate for Payer: Cash Price |
$551.08
|
| Rate for Payer: Cofinity Commercial |
$482.19
|
| Rate for Payer: Cofinity Commercial |
$592.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$482.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$551.08
|
| Rate for Payer: Healthscope Commercial |
$619.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$482.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$516.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$585.52
|
| Rate for Payer: PHP Commercial |
$585.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$447.75
|
| Rate for Payer: Priority Health SBD |
$433.98
|
| Rate for Payer: UMR Bronson Commercial |
$254.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$516.64
|
|
|
HC ACB ESTABLISHED PT LEVEL 3
|
Facility
|
IP
|
$688.85
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
51000074
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$303.09 |
| Max. Negotiated Rate |
$619.97 |
| Rate for Payer: Aetna American Axle |
$447.75
|
| Rate for Payer: Aetna Commercial |
$585.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$447.75
|
| Rate for Payer: Cash Price |
$551.08
|
| Rate for Payer: Cofinity Commercial |
$482.19
|
| Rate for Payer: Cofinity Commercial |
$592.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$482.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$551.08
|
| Rate for Payer: Healthscope Commercial |
$619.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$482.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$516.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$585.52
|
| Rate for Payer: PHP Commercial |
$585.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$447.75
|
| Rate for Payer: Priority Health SBD |
$433.98
|
| Rate for Payer: UMR Bronson Commercial |
$303.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$516.64
|
|
|
HC ACB ESTABLISHED PT LEVEL 4
|
Facility
|
IP
|
$874.52
|
|
|
Service Code
|
CPT 99214
|
| Hospital Charge Code |
51000075
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$384.79 |
| Max. Negotiated Rate |
$787.07 |
| Rate for Payer: Aetna American Axle |
$568.44
|
| Rate for Payer: Aetna Commercial |
$743.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$568.44
|
| Rate for Payer: Cash Price |
$699.62
|
| Rate for Payer: Cofinity Commercial |
$612.16
|
| Rate for Payer: Cofinity Commercial |
$752.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$612.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$699.62
|
| Rate for Payer: Healthscope Commercial |
$787.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$612.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$655.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$743.34
|
| Rate for Payer: PHP Commercial |
$743.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$568.44
|
| Rate for Payer: Priority Health SBD |
$550.95
|
| Rate for Payer: UMR Bronson Commercial |
$384.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$655.89
|
|
|
HC ACB ESTABLISHED PT LEVEL 4
|
Facility
|
OP
|
$874.52
|
|
|
Service Code
|
CPT 99214
|
| Hospital Charge Code |
51000075
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$323.57 |
| Max. Negotiated Rate |
$787.07 |
| Rate for Payer: Aetna American Axle |
$568.44
|
| Rate for Payer: Aetna Commercial |
$743.34
|
| Rate for Payer: Aetna Medicare |
$437.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$568.44
|
| Rate for Payer: BCBS Complete |
$349.81
|
| Rate for Payer: Cash Price |
$699.62
|
| Rate for Payer: Cofinity Commercial |
$612.16
|
| Rate for Payer: Cofinity Commercial |
$752.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$612.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$699.62
|
| Rate for Payer: Healthscope Commercial |
$787.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$612.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$655.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$743.34
|
| Rate for Payer: PHP Commercial |
$743.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$568.44
|
| Rate for Payer: Priority Health SBD |
$550.95
|
| Rate for Payer: UMR Bronson Commercial |
$323.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$655.89
|
|
|
HC ACB ESTABLISHED PT LEVEL 5
|
Facility
|
IP
|
$1,042.88
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
51000076
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$458.87 |
| Max. Negotiated Rate |
$938.59 |
| Rate for Payer: Aetna American Axle |
$677.87
|
| Rate for Payer: Aetna Commercial |
$886.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$677.87
|
| Rate for Payer: Cash Price |
$834.30
|
| Rate for Payer: Cofinity Commercial |
$730.02
|
| Rate for Payer: Cofinity Commercial |
$896.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$730.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$834.30
|
| Rate for Payer: Healthscope Commercial |
$938.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$730.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$782.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$886.45
|
| Rate for Payer: PHP Commercial |
$886.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$677.87
|
| Rate for Payer: Priority Health SBD |
$657.01
|
| Rate for Payer: UMR Bronson Commercial |
$458.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$782.16
|
|
|
HC ACB ESTABLISHED PT LEVEL 5
|
Facility
|
OP
|
$1,042.88
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
51000076
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$385.87 |
| Max. Negotiated Rate |
$938.59 |
| Rate for Payer: Aetna American Axle |
$677.87
|
| Rate for Payer: Aetna Commercial |
$886.45
|
| Rate for Payer: Aetna Medicare |
$521.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$677.87
|
| Rate for Payer: BCBS Complete |
$417.15
|
| Rate for Payer: Cash Price |
$834.30
|
| Rate for Payer: Cofinity Commercial |
$730.02
|
| Rate for Payer: Cofinity Commercial |
$896.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$730.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$834.30
|
| Rate for Payer: Healthscope Commercial |
$938.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$730.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$782.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$886.45
|
| Rate for Payer: PHP Commercial |
$886.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$677.87
|
| Rate for Payer: Priority Health SBD |
$657.01
|
| Rate for Payer: UMR Bronson Commercial |
$385.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$782.16
|
|
|
HC ACB GARMENT MEASURE VISIT
|
Facility
|
IP
|
$372.74
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000048
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$164.01 |
| Max. Negotiated Rate |
$335.47 |
| Rate for Payer: Aetna American Axle |
$242.28
|
| Rate for Payer: Aetna Commercial |
$316.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$242.28
|
| Rate for Payer: Cash Price |
$298.19
|
| Rate for Payer: Cofinity Commercial |
$260.92
|
| Rate for Payer: Cofinity Commercial |
$320.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$260.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$298.19
|
| Rate for Payer: Healthscope Commercial |
$335.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$260.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$279.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$316.83
|
| Rate for Payer: PHP Commercial |
$316.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$242.28
|
| Rate for Payer: Priority Health SBD |
$234.83
|
| Rate for Payer: UMR Bronson Commercial |
$164.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$279.56
|
|
|
HC ACB GARMENT MEASURE VISIT
|
Facility
|
OP
|
$372.74
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000048
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$137.91 |
| Max. Negotiated Rate |
$335.47 |
| Rate for Payer: Aetna American Axle |
$242.28
|
| Rate for Payer: Aetna Commercial |
$316.83
|
| Rate for Payer: Aetna Medicare |
$186.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$242.28
|
| Rate for Payer: BCBS Complete |
$149.10
|
| Rate for Payer: Cash Price |
$298.19
|
| Rate for Payer: Cofinity Commercial |
$260.92
|
| Rate for Payer: Cofinity Commercial |
$320.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$260.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$298.19
|
| Rate for Payer: Healthscope Commercial |
$335.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$260.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$279.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$316.83
|
| Rate for Payer: PHP Commercial |
$316.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$242.28
|
| Rate for Payer: Priority Health SBD |
$234.83
|
| Rate for Payer: UMR Bronson Commercial |
$137.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$279.56
|
|
|
HC ACB NEW PATIENT VISIT
|
Facility
|
OP
|
$165.16
|
|
|
Service Code
|
HCPCS 99211
|
| Hospital Charge Code |
51000100
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$61.11 |
| Max. Negotiated Rate |
$148.64 |
| Rate for Payer: Aetna American Axle |
$107.35
|
| Rate for Payer: Aetna Commercial |
$140.39
|
| Rate for Payer: Aetna Medicare |
$82.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.35
|
| Rate for Payer: BCBS Complete |
$66.06
|
| Rate for Payer: Cash Price |
$132.13
|
| Rate for Payer: Cofinity Commercial |
$115.61
|
| Rate for Payer: Cofinity Commercial |
$142.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$115.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.13
|
| Rate for Payer: Healthscope Commercial |
$148.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$115.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.39
|
| Rate for Payer: PHP Commercial |
$140.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.35
|
| Rate for Payer: Priority Health SBD |
$104.05
|
| Rate for Payer: UMR Bronson Commercial |
$61.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.87
|
|
|
HC ACB NEW PATIENT VISIT
|
Facility
|
IP
|
$165.16
|
|
|
Service Code
|
HCPCS 99211
|
| Hospital Charge Code |
51000100
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$72.67 |
| Max. Negotiated Rate |
$148.64 |
| Rate for Payer: Aetna American Axle |
$107.35
|
| Rate for Payer: Aetna Commercial |
$140.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.35
|
| Rate for Payer: Cash Price |
$132.13
|
| Rate for Payer: Cofinity Commercial |
$115.61
|
| Rate for Payer: Cofinity Commercial |
$142.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$115.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.13
|
| Rate for Payer: Healthscope Commercial |
$148.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$115.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.39
|
| Rate for Payer: PHP Commercial |
$140.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.35
|
| Rate for Payer: Priority Health SBD |
$104.05
|
| Rate for Payer: UMR Bronson Commercial |
$72.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.87
|
|
|
HC ACB NEW PT LEVEL 2
|
Facility
|
IP
|
$494.43
|
|
|
Service Code
|
CPT 99202
|
| Hospital Charge Code |
51000101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$217.55 |
| Max. Negotiated Rate |
$444.99 |
| Rate for Payer: Aetna American Axle |
$321.38
|
| Rate for Payer: Aetna Commercial |
$420.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$321.38
|
| Rate for Payer: Cash Price |
$395.54
|
| Rate for Payer: Cofinity Commercial |
$346.10
|
| Rate for Payer: Cofinity Commercial |
$425.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$346.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$395.54
|
| Rate for Payer: Healthscope Commercial |
$444.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$346.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$370.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$420.27
|
| Rate for Payer: PHP Commercial |
$420.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$321.38
|
| Rate for Payer: Priority Health SBD |
$311.49
|
| Rate for Payer: UMR Bronson Commercial |
$217.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$370.82
|
|
|
HC ACB NEW PT LEVEL 2
|
Facility
|
OP
|
$494.43
|
|
|
Service Code
|
CPT 99202
|
| Hospital Charge Code |
51000101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$182.94 |
| Max. Negotiated Rate |
$444.99 |
| Rate for Payer: Aetna American Axle |
$321.38
|
| Rate for Payer: Aetna Commercial |
$420.27
|
| Rate for Payer: Aetna Medicare |
$247.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$321.38
|
| Rate for Payer: BCBS Complete |
$197.77
|
| Rate for Payer: Cash Price |
$395.54
|
| Rate for Payer: Cofinity Commercial |
$346.10
|
| Rate for Payer: Cofinity Commercial |
$425.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$346.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$395.54
|
| Rate for Payer: Healthscope Commercial |
$444.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$346.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$370.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$420.27
|
| Rate for Payer: PHP Commercial |
$420.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$321.38
|
| Rate for Payer: Priority Health SBD |
$311.49
|
| Rate for Payer: UMR Bronson Commercial |
$182.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$370.82
|
|
|
HC ACB NEW PT LEVEL 3
|
Facility
|
IP
|
$688.85
|
|
|
Service Code
|
CPT 99203
|
| Hospital Charge Code |
51000102
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$303.09 |
| Max. Negotiated Rate |
$619.97 |
| Rate for Payer: Aetna American Axle |
$447.75
|
| Rate for Payer: Aetna Commercial |
$585.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$447.75
|
| Rate for Payer: Cash Price |
$551.08
|
| Rate for Payer: Cofinity Commercial |
$482.19
|
| Rate for Payer: Cofinity Commercial |
$592.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$482.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$551.08
|
| Rate for Payer: Healthscope Commercial |
$619.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$482.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$516.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$585.52
|
| Rate for Payer: PHP Commercial |
$585.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$447.75
|
| Rate for Payer: Priority Health SBD |
$433.98
|
| Rate for Payer: UMR Bronson Commercial |
$303.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$516.64
|
|
|
HC ACB NEW PT LEVEL 3
|
Facility
|
OP
|
$688.85
|
|
|
Service Code
|
CPT 99203
|
| Hospital Charge Code |
51000102
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$254.87 |
| Max. Negotiated Rate |
$619.97 |
| Rate for Payer: Aetna American Axle |
$447.75
|
| Rate for Payer: Aetna Commercial |
$585.52
|
| Rate for Payer: Aetna Medicare |
$344.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$447.75
|
| Rate for Payer: BCBS Complete |
$275.54
|
| Rate for Payer: Cash Price |
$551.08
|
| Rate for Payer: Cofinity Commercial |
$482.19
|
| Rate for Payer: Cofinity Commercial |
$592.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$482.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$551.08
|
| Rate for Payer: Healthscope Commercial |
$619.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$482.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$516.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$585.52
|
| Rate for Payer: PHP Commercial |
$585.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$447.75
|
| Rate for Payer: Priority Health SBD |
$433.98
|
| Rate for Payer: UMR Bronson Commercial |
$254.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$516.64
|
|
|
HC ACB NEW PT LEVEL 4
|
Facility
|
OP
|
$874.52
|
|
|
Service Code
|
CPT 99204
|
| Hospital Charge Code |
51000103
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$323.57 |
| Max. Negotiated Rate |
$787.07 |
| Rate for Payer: Aetna American Axle |
$568.44
|
| Rate for Payer: Aetna Commercial |
$743.34
|
| Rate for Payer: Aetna Medicare |
$437.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$568.44
|
| Rate for Payer: BCBS Complete |
$349.81
|
| Rate for Payer: Cash Price |
$699.62
|
| Rate for Payer: Cofinity Commercial |
$612.16
|
| Rate for Payer: Cofinity Commercial |
$752.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$612.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$699.62
|
| Rate for Payer: Healthscope Commercial |
$787.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$612.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$655.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$743.34
|
| Rate for Payer: PHP Commercial |
$743.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$568.44
|
| Rate for Payer: Priority Health SBD |
$550.95
|
| Rate for Payer: UMR Bronson Commercial |
$323.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$655.89
|
|
|
HC ACB NEW PT LEVEL 4
|
Facility
|
IP
|
$874.52
|
|
|
Service Code
|
CPT 99204
|
| Hospital Charge Code |
51000103
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$384.79 |
| Max. Negotiated Rate |
$787.07 |
| Rate for Payer: Aetna American Axle |
$568.44
|
| Rate for Payer: Aetna Commercial |
$743.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$568.44
|
| Rate for Payer: Cash Price |
$699.62
|
| Rate for Payer: Cofinity Commercial |
$612.16
|
| Rate for Payer: Cofinity Commercial |
$752.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$612.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$699.62
|
| Rate for Payer: Healthscope Commercial |
$787.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$612.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$655.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$743.34
|
| Rate for Payer: PHP Commercial |
$743.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$568.44
|
| Rate for Payer: Priority Health SBD |
$550.95
|
| Rate for Payer: UMR Bronson Commercial |
$384.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$655.89
|
|
|
HC ACB NEW PT LEVEL 5
|
Facility
|
OP
|
$1,042.88
|
|
|
Service Code
|
CPT 99205
|
| Hospital Charge Code |
51000104
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$385.87 |
| Max. Negotiated Rate |
$938.59 |
| Rate for Payer: Aetna American Axle |
$677.87
|
| Rate for Payer: Aetna Commercial |
$886.45
|
| Rate for Payer: Aetna Medicare |
$521.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$677.87
|
| Rate for Payer: BCBS Complete |
$417.15
|
| Rate for Payer: Cash Price |
$834.30
|
| Rate for Payer: Cofinity Commercial |
$730.02
|
| Rate for Payer: Cofinity Commercial |
$896.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$730.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$834.30
|
| Rate for Payer: Healthscope Commercial |
$938.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$730.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$782.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$886.45
|
| Rate for Payer: PHP Commercial |
$886.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$677.87
|
| Rate for Payer: Priority Health SBD |
$657.01
|
| Rate for Payer: UMR Bronson Commercial |
$385.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$782.16
|
|
