|
HC AORTA ILIAC ULTRA COMPL
|
Facility
|
OP
|
$1,320.82
|
|
|
Service Code
|
CPT 93978
|
| Hospital Charge Code |
92100015
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$126.36 |
| Max. Negotiated Rate |
$1,188.74 |
| Rate for Payer: Aetna American Axle |
$858.53
|
| Rate for Payer: Aetna Commercial |
$1,122.70
|
| Rate for Payer: Aetna Medicare |
$245.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$858.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$294.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$294.68
|
| Rate for Payer: BCBS Complete |
$132.67
|
| Rate for Payer: BCBS MAPPO |
$235.74
|
| Rate for Payer: BCN Medicare Advantage |
$235.74
|
| Rate for Payer: Cash Price |
$1,056.66
|
| Rate for Payer: Cash Price |
$1,056.66
|
| Rate for Payer: Cash Price |
$1,056.66
|
| Rate for Payer: Cofinity Commercial |
$1,135.91
|
| Rate for Payer: Cofinity Commercial |
$924.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$924.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,056.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.74
|
| Rate for Payer: Healthscope Commercial |
$1,188.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$924.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$990.62
|
| Rate for Payer: Mclaren Medicaid |
$126.36
|
| Rate for Payer: Mclaren Medicare |
$235.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$247.53
|
| Rate for Payer: Meridian Medicaid |
$132.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$271.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,122.70
|
| Rate for Payer: PACE Medicare |
$223.95
|
| Rate for Payer: PACE SWMI |
$235.74
|
| Rate for Payer: PHP Commercial |
$1,122.70
|
| Rate for Payer: PHP Medicare Advantage |
$235.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$858.53
|
| Rate for Payer: Priority Health Medicare |
$235.74
|
| Rate for Payer: Priority Health SBD |
$832.12
|
| Rate for Payer: Railroad Medicare Medicare |
$235.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$663.58
|
| Rate for Payer: UHC Core |
$587.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.74
|
| Rate for Payer: UHC Exchange |
$450.52
|
| Rate for Payer: UHC Medicare Advantage |
$235.74
|
| Rate for Payer: UHCCP Medicaid |
$126.36
|
| Rate for Payer: UMR Bronson Commercial |
$488.70
|
| Rate for Payer: VA VA |
$235.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$990.62
|
|
|
HC AORTA ILIAC ULTRA LIMITD
|
Facility
|
OP
|
$816.54
|
|
|
Service Code
|
CPT 93979
|
| Hospital Charge Code |
92100016
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$55.59 |
| Max. Negotiated Rate |
$734.89 |
| Rate for Payer: Aetna American Axle |
$530.75
|
| Rate for Payer: Aetna Commercial |
$694.06
|
| Rate for Payer: Aetna Medicare |
$107.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$530.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$129.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$129.64
|
| Rate for Payer: BCBS Complete |
$58.37
|
| Rate for Payer: BCBS MAPPO |
$103.71
|
| Rate for Payer: BCN Medicare Advantage |
$103.71
|
| Rate for Payer: Cash Price |
$653.23
|
| Rate for Payer: Cash Price |
$653.23
|
| Rate for Payer: Cash Price |
$653.23
|
| Rate for Payer: Cofinity Commercial |
$571.58
|
| Rate for Payer: Cofinity Commercial |
$702.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$571.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$653.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.71
|
| Rate for Payer: Healthscope Commercial |
$734.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$571.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$612.40
|
| Rate for Payer: Mclaren Medicaid |
$55.59
|
| Rate for Payer: Mclaren Medicare |
$103.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$108.90
|
| Rate for Payer: Meridian Medicaid |
$58.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$694.06
|
| Rate for Payer: PACE Medicare |
$98.52
|
| Rate for Payer: PACE SWMI |
$103.71
|
| Rate for Payer: PHP Commercial |
$694.06
|
| Rate for Payer: PHP Medicare Advantage |
$103.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$530.75
|
| Rate for Payer: Priority Health Medicare |
$103.71
|
| Rate for Payer: Priority Health SBD |
$514.42
|
| Rate for Payer: Railroad Medicare Medicare |
$103.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$291.93
|
| Rate for Payer: UHC Core |
$587.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.71
|
| Rate for Payer: UHC Exchange |
$198.20
|
| Rate for Payer: UHC Medicare Advantage |
$103.71
|
| Rate for Payer: UHCCP Medicaid |
$55.59
|
| Rate for Payer: UMR Bronson Commercial |
$302.12
|
| Rate for Payer: VA VA |
$103.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$612.40
|
|
|
HC AORTA ILIAC ULTRA LIMITD
|
Facility
|
IP
|
$816.54
|
|
|
Service Code
|
CPT 93979
|
| Hospital Charge Code |
92100016
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$359.28 |
| Max. Negotiated Rate |
$734.89 |
| Rate for Payer: Aetna American Axle |
$530.75
|
| Rate for Payer: Aetna Commercial |
$694.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$530.75
|
| Rate for Payer: Cash Price |
$653.23
|
| Rate for Payer: Cofinity Commercial |
$571.58
|
| Rate for Payer: Cofinity Commercial |
$702.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$571.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$653.23
|
| Rate for Payer: Healthscope Commercial |
$734.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$571.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$612.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$694.06
|
| Rate for Payer: PHP Commercial |
$694.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$530.75
|
| Rate for Payer: Priority Health SBD |
$514.42
|
| Rate for Payer: UMR Bronson Commercial |
$359.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$612.40
|
|
|
HC APHERESIS
|
Facility
|
IP
|
$2,555.49
|
|
| Hospital Charge Code |
36000006
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,124.42 |
| Max. Negotiated Rate |
$2,299.94 |
| Rate for Payer: Aetna American Axle |
$1,661.07
|
| Rate for Payer: Aetna Commercial |
$2,172.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,661.07
|
| Rate for Payer: Cash Price |
$2,044.39
|
| Rate for Payer: Cofinity Commercial |
$1,788.84
|
| Rate for Payer: Cofinity Commercial |
$2,197.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,788.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,044.39
|
| Rate for Payer: Healthscope Commercial |
$2,299.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,788.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,916.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,172.17
|
| Rate for Payer: PHP Commercial |
$2,172.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,661.07
|
| Rate for Payer: Priority Health SBD |
$1,609.96
|
| Rate for Payer: UMR Bronson Commercial |
$1,124.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,916.62
|
|
|
HC APHERESIS
|
Facility
|
OP
|
$2,555.49
|
|
| Hospital Charge Code |
36000006
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$945.53 |
| Max. Negotiated Rate |
$2,299.94 |
| Rate for Payer: Aetna American Axle |
$1,661.07
|
| Rate for Payer: Aetna Commercial |
$2,172.17
|
| Rate for Payer: Aetna Medicare |
$1,277.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,661.07
|
| Rate for Payer: BCBS Complete |
$1,022.20
|
| Rate for Payer: Cash Price |
$2,044.39
|
| Rate for Payer: Cofinity Commercial |
$1,788.84
|
| Rate for Payer: Cofinity Commercial |
$2,197.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,788.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,044.39
|
| Rate for Payer: Healthscope Commercial |
$2,299.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,788.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,916.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,172.17
|
| Rate for Payer: PHP Commercial |
$2,172.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,661.07
|
| Rate for Payer: Priority Health SBD |
$1,609.96
|
| Rate for Payer: UMR Bronson Commercial |
$945.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,916.62
|
|
|
HC APIXABAN
|
Facility
|
OP
|
$153.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100758
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.99 |
| Max. Negotiated Rate |
$137.70 |
| Rate for Payer: Aetna American Axle |
$99.45
|
| Rate for Payer: Aetna Commercial |
$130.05
|
| Rate for Payer: Aetna Medicare |
$19.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.30
|
| Rate for Payer: BCBS Complete |
$10.49
|
| Rate for Payer: BCBS MAPPO |
$18.64
|
| Rate for Payer: BCN Medicare Advantage |
$18.64
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cofinity Commercial |
$131.58
|
| Rate for Payer: Cofinity Commercial |
$107.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$107.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.64
|
| Rate for Payer: Healthscope Commercial |
$137.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$107.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.75
|
| Rate for Payer: Mclaren Medicaid |
$9.99
|
| Rate for Payer: Mclaren Medicare |
$18.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.57
|
| Rate for Payer: Meridian Medicaid |
$10.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.05
|
| Rate for Payer: PACE Medicare |
$17.71
|
| Rate for Payer: PACE SWMI |
$18.64
|
| Rate for Payer: PHP Commercial |
$130.05
|
| Rate for Payer: PHP Medicare Advantage |
$18.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
| Rate for Payer: Priority Health Medicare |
$18.64
|
| Rate for Payer: Priority Health SBD |
$96.39
|
| Rate for Payer: Railroad Medicare Medicare |
$18.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.64
|
| Rate for Payer: UHC Exchange |
$35.62
|
| Rate for Payer: UHC Medicare Advantage |
$18.64
|
| Rate for Payer: UHCCP Medicaid |
$9.99
|
| Rate for Payer: UMR Bronson Commercial |
$56.61
|
| Rate for Payer: VA VA |
$18.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.75
|
|
|
HC APIXABAN
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100758
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$67.32 |
| Max. Negotiated Rate |
$137.70 |
| Rate for Payer: Aetna American Axle |
$99.45
|
| Rate for Payer: Aetna Commercial |
$130.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.45
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cofinity Commercial |
$107.10
|
| Rate for Payer: Cofinity Commercial |
$131.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$107.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.40
|
| Rate for Payer: Healthscope Commercial |
$137.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$107.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.05
|
| Rate for Payer: PHP Commercial |
$130.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
| Rate for Payer: Priority Health SBD |
$96.39
|
| Rate for Payer: UMR Bronson Commercial |
$67.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.75
|
|
|
HC APLIGRAF PER SQ CM
|
Facility
|
OP
|
$131.72
|
|
|
Service Code
|
HCPCS Q4101
|
| Hospital Charge Code |
63600001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$48.74 |
| Max. Negotiated Rate |
$118.55 |
| Rate for Payer: Aetna American Axle |
$85.62
|
| Rate for Payer: Aetna Commercial |
$111.96
|
| Rate for Payer: Aetna Medicare |
$65.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.62
|
| Rate for Payer: BCBS Complete |
$52.69
|
| Rate for Payer: Cash Price |
$105.38
|
| Rate for Payer: Cofinity Commercial |
$113.28
|
| Rate for Payer: Cofinity Commercial |
$92.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$92.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.38
|
| Rate for Payer: Healthscope Commercial |
$118.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.96
|
| Rate for Payer: PHP Commercial |
$111.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.62
|
| Rate for Payer: Priority Health SBD |
$82.98
|
| Rate for Payer: UMR Bronson Commercial |
$48.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.79
|
|
|
HC APLIGRAF PER SQ CM
|
Facility
|
IP
|
$131.72
|
|
|
Service Code
|
HCPCS Q4101
|
| Hospital Charge Code |
63600001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$57.96 |
| Max. Negotiated Rate |
$118.55 |
| Rate for Payer: Aetna American Axle |
$85.62
|
| Rate for Payer: Aetna Commercial |
$111.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.62
|
| Rate for Payer: Cash Price |
$105.38
|
| Rate for Payer: Cofinity Commercial |
$113.28
|
| Rate for Payer: Cofinity Commercial |
$92.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$92.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.38
|
| Rate for Payer: Healthscope Commercial |
$118.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.96
|
| Rate for Payer: PHP Commercial |
$111.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.62
|
| Rate for Payer: Priority Health SBD |
$82.98
|
| Rate for Payer: UMR Bronson Commercial |
$57.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.79
|
|
|
HC APNEALINK PLUS
|
Facility
|
IP
|
$747.76
|
|
|
Service Code
|
CPT 95806
|
| Hospital Charge Code |
92000014
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$329.01 |
| Max. Negotiated Rate |
$672.98 |
| Rate for Payer: Aetna American Axle |
$486.04
|
| Rate for Payer: Aetna Commercial |
$635.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$486.04
|
| Rate for Payer: Cash Price |
$598.21
|
| Rate for Payer: Cofinity Commercial |
$523.43
|
| Rate for Payer: Cofinity Commercial |
$643.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$523.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$598.21
|
| Rate for Payer: Healthscope Commercial |
$672.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$523.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$560.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$635.60
|
| Rate for Payer: PHP Commercial |
$635.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$486.04
|
| Rate for Payer: Priority Health SBD |
$471.09
|
| Rate for Payer: UMR Bronson Commercial |
$329.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$560.82
|
|
|
HC APNEALINK PLUS
|
Facility
|
OP
|
$747.76
|
|
|
Service Code
|
CPT 95806
|
| Hospital Charge Code |
92000014
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$81.79 |
| Max. Negotiated Rate |
$983.00 |
| Rate for Payer: Aetna American Axle |
$486.04
|
| Rate for Payer: Aetna Commercial |
$635.60
|
| Rate for Payer: Aetna Medicare |
$158.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$486.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$190.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$190.74
|
| Rate for Payer: BCBS Complete |
$85.88
|
| Rate for Payer: BCBS MAPPO |
$152.59
|
| Rate for Payer: BCN Medicare Advantage |
$152.59
|
| Rate for Payer: Cash Price |
$598.21
|
| Rate for Payer: Cash Price |
$598.21
|
| Rate for Payer: Cash Price |
$598.21
|
| Rate for Payer: Cofinity Commercial |
$523.43
|
| Rate for Payer: Cofinity Commercial |
$643.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$523.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$598.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$152.59
|
| Rate for Payer: Healthscope Commercial |
$672.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$523.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$560.82
|
| Rate for Payer: Mclaren Medicaid |
$81.79
|
| Rate for Payer: Mclaren Medicare |
$152.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$160.22
|
| Rate for Payer: Meridian Medicaid |
$85.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$175.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$635.60
|
| Rate for Payer: PACE Medicare |
$144.96
|
| Rate for Payer: PACE SWMI |
$152.59
|
| Rate for Payer: PHP Commercial |
$635.60
|
| Rate for Payer: PHP Medicare Advantage |
$152.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$81.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$486.04
|
| Rate for Payer: Priority Health Medicare |
$152.59
|
| Rate for Payer: Priority Health SBD |
$471.09
|
| Rate for Payer: Railroad Medicare Medicare |
$152.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$429.53
|
| Rate for Payer: UHC Core |
$983.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$152.59
|
| Rate for Payer: UHC Exchange |
$291.61
|
| Rate for Payer: UHC Medicare Advantage |
$152.59
|
| Rate for Payer: UHCCP Medicaid |
$81.79
|
| Rate for Payer: UMR Bronson Commercial |
$276.67
|
| Rate for Payer: VA VA |
$152.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$560.82
|
|
|
HC APOLIPOPROTEIN A1
|
Facility
|
IP
|
$70.38
|
|
|
Service Code
|
CPT 82172
|
| Hospital Charge Code |
30100106
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.97 |
| Max. Negotiated Rate |
$63.34 |
| Rate for Payer: Aetna American Axle |
$45.75
|
| Rate for Payer: Aetna Commercial |
$59.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.75
|
| Rate for Payer: Cash Price |
$56.30
|
| Rate for Payer: Cofinity Commercial |
$49.27
|
| Rate for Payer: Cofinity Commercial |
$60.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$49.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.30
|
| Rate for Payer: Healthscope Commercial |
$63.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.82
|
| Rate for Payer: PHP Commercial |
$59.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.75
|
| Rate for Payer: Priority Health SBD |
$44.34
|
| Rate for Payer: UMR Bronson Commercial |
$30.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.78
|
|
|
HC APOLIPOPROTEIN A1
|
Facility
|
OP
|
$70.38
|
|
|
Service Code
|
CPT 82172
|
| Hospital Charge Code |
30100106
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.30 |
| Max. Negotiated Rate |
$63.34 |
| Rate for Payer: Aetna American Axle |
$45.75
|
| Rate for Payer: Aetna Commercial |
$59.82
|
| Rate for Payer: Aetna Medicare |
$21.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.75
|
| 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 |
$11.87
|
| Rate for Payer: BCBS MAPPO |
$21.09
|
| Rate for Payer: BCN Medicare Advantage |
$21.09
|
| Rate for Payer: Cash Price |
$56.30
|
| Rate for Payer: Cash Price |
$56.30
|
| Rate for Payer: Cofinity Commercial |
$60.53
|
| Rate for Payer: Cofinity Commercial |
$49.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$49.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.09
|
| Rate for Payer: Healthscope Commercial |
$63.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.78
|
| Rate for Payer: Mclaren Medicaid |
$11.30
|
| 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 |
$11.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.82
|
| Rate for Payer: PACE Medicare |
$20.04
|
| Rate for Payer: PACE SWMI |
$21.09
|
| Rate for Payer: PHP Commercial |
$59.82
|
| Rate for Payer: PHP Medicare Advantage |
$21.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.75
|
| Rate for Payer: Priority Health Medicare |
$21.09
|
| Rate for Payer: Priority Health SBD |
$44.34
|
| Rate for Payer: Railroad Medicare Medicare |
$21.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.09
|
| Rate for Payer: UHC Exchange |
$40.31
|
| Rate for Payer: UHC Medicare Advantage |
$21.09
|
| Rate for Payer: UHCCP Medicaid |
$11.30
|
| Rate for Payer: UMR Bronson Commercial |
$26.04
|
| Rate for Payer: VA VA |
$21.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.78
|
|
|
HC APOLIPOPROTEIN B
|
Facility
|
IP
|
$50.98
|
|
|
Service Code
|
CPT 82172
|
| Hospital Charge Code |
30100107
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.43 |
| Max. Negotiated Rate |
$45.88 |
| Rate for Payer: Aetna American Axle |
$33.14
|
| Rate for Payer: Aetna Commercial |
$43.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.14
|
| Rate for Payer: Cash Price |
$40.78
|
| Rate for Payer: Cofinity Commercial |
$35.69
|
| Rate for Payer: Cofinity Commercial |
$43.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.78
|
| Rate for Payer: Healthscope Commercial |
$45.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.33
|
| Rate for Payer: PHP Commercial |
$43.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.14
|
| Rate for Payer: Priority Health SBD |
$32.12
|
| Rate for Payer: UMR Bronson Commercial |
$22.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.23
|
|
|
HC APOLIPOPROTEIN B
|
Facility
|
OP
|
$50.98
|
|
|
Service Code
|
CPT 82172
|
| Hospital Charge Code |
30100107
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.30 |
| Max. Negotiated Rate |
$59.37 |
| Rate for Payer: Aetna American Axle |
$33.14
|
| Rate for Payer: Aetna Commercial |
$43.33
|
| Rate for Payer: Aetna Medicare |
$21.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.14
|
| 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 |
$11.87
|
| Rate for Payer: BCBS MAPPO |
$21.09
|
| Rate for Payer: BCN Medicare Advantage |
$21.09
|
| Rate for Payer: Cash Price |
$40.78
|
| Rate for Payer: Cash Price |
$40.78
|
| Rate for Payer: Cofinity Commercial |
$43.84
|
| Rate for Payer: Cofinity Commercial |
$35.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.09
|
| Rate for Payer: Healthscope Commercial |
$45.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.23
|
| Rate for Payer: Mclaren Medicaid |
$11.30
|
| 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 |
$11.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.33
|
| Rate for Payer: PACE Medicare |
$20.04
|
| Rate for Payer: PACE SWMI |
$21.09
|
| Rate for Payer: PHP Commercial |
$43.33
|
| Rate for Payer: PHP Medicare Advantage |
$21.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.14
|
| Rate for Payer: Priority Health Medicare |
$21.09
|
| Rate for Payer: Priority Health SBD |
$32.12
|
| Rate for Payer: Railroad Medicare Medicare |
$21.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.09
|
| Rate for Payer: UHC Exchange |
$40.31
|
| Rate for Payer: UHC Medicare Advantage |
$21.09
|
| Rate for Payer: UHCCP Medicaid |
$11.30
|
| Rate for Payer: UMR Bronson Commercial |
$18.86
|
| Rate for Payer: VA VA |
$21.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.23
|
|
|
HC APOLIPOPROTEIN B LMPP
|
Facility
|
IP
|
$39.54
|
|
|
Service Code
|
CPT 82172
|
| Hospital Charge Code |
30100637
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.40 |
| Max. Negotiated Rate |
$35.59 |
| Rate for Payer: Aetna American Axle |
$25.70
|
| Rate for Payer: Aetna Commercial |
$33.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.70
|
| Rate for Payer: Cash Price |
$31.63
|
| Rate for Payer: Cofinity Commercial |
$27.68
|
| Rate for Payer: Cofinity Commercial |
$34.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.63
|
| Rate for Payer: Healthscope Commercial |
$35.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.61
|
| Rate for Payer: PHP Commercial |
$33.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.70
|
| Rate for Payer: Priority Health SBD |
$24.91
|
| Rate for Payer: UMR Bronson Commercial |
$17.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.66
|
|
|
HC APOLIPOPROTEIN B LMPP
|
Facility
|
OP
|
$39.54
|
|
|
Service Code
|
CPT 82172
|
| Hospital Charge Code |
30100637
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.30 |
| Max. Negotiated Rate |
$59.37 |
| Rate for Payer: Aetna American Axle |
$25.70
|
| Rate for Payer: Aetna Commercial |
$33.61
|
| Rate for Payer: Aetna Medicare |
$21.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.70
|
| 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 |
$11.87
|
| Rate for Payer: BCBS MAPPO |
$21.09
|
| Rate for Payer: BCN Medicare Advantage |
$21.09
|
| Rate for Payer: Cash Price |
$31.63
|
| Rate for Payer: Cash Price |
$31.63
|
| Rate for Payer: Cofinity Commercial |
$34.00
|
| Rate for Payer: Cofinity Commercial |
$27.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.09
|
| Rate for Payer: Healthscope Commercial |
$35.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.66
|
| Rate for Payer: Mclaren Medicaid |
$11.30
|
| 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 |
$11.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.61
|
| Rate for Payer: PACE Medicare |
$20.04
|
| Rate for Payer: PACE SWMI |
$21.09
|
| Rate for Payer: PHP Commercial |
$33.61
|
| Rate for Payer: PHP Medicare Advantage |
$21.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.70
|
| Rate for Payer: Priority Health Medicare |
$21.09
|
| Rate for Payer: Priority Health SBD |
$24.91
|
| Rate for Payer: Railroad Medicare Medicare |
$21.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.09
|
| Rate for Payer: UHC Exchange |
$40.31
|
| Rate for Payer: UHC Medicare Advantage |
$21.09
|
| Rate for Payer: UHCCP Medicaid |
$11.30
|
| Rate for Payer: UMR Bronson Commercial |
$14.63
|
| Rate for Payer: VA VA |
$21.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.66
|
|
|
HC APPLE IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200072
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna American Axle |
$16.50
|
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| 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 |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.04
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| 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 |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$16.00
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$9.98
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.80
|
| Rate for Payer: UMR Bronson Commercial |
$9.39
|
| Rate for Payer: VA VA |
$5.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.04
|
|
|
HC APPLE IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200072
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.17 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna American Axle |
$16.50
|
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health SBD |
$16.00
|
| Rate for Payer: UMR Bronson Commercial |
$11.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.04
|
|
|
HC APPLIANCE BELT
|
Facility
|
OP
|
$24.91
|
|
| Hospital Charge Code |
27000027
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.22 |
| Max. Negotiated Rate |
$22.42 |
| Rate for Payer: Aetna American Axle |
$16.19
|
| Rate for Payer: Aetna Commercial |
$21.17
|
| Rate for Payer: Aetna Medicare |
$12.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.19
|
| Rate for Payer: BCBS Complete |
$9.96
|
| Rate for Payer: Cash Price |
$19.93
|
| Rate for Payer: Cofinity Commercial |
$17.44
|
| Rate for Payer: Cofinity Commercial |
$21.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.93
|
| Rate for Payer: Healthscope Commercial |
$22.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.17
|
| Rate for Payer: PHP Commercial |
$21.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.19
|
| Rate for Payer: Priority Health SBD |
$15.69
|
| Rate for Payer: UMR Bronson Commercial |
$9.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.68
|
|
|
HC APPLIANCE BELT
|
Facility
|
IP
|
$24.91
|
|
| Hospital Charge Code |
27000027
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.96 |
| Max. Negotiated Rate |
$22.42 |
| Rate for Payer: Aetna American Axle |
$16.19
|
| Rate for Payer: Aetna Commercial |
$21.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.19
|
| Rate for Payer: Cash Price |
$19.93
|
| Rate for Payer: Cofinity Commercial |
$17.44
|
| Rate for Payer: Cofinity Commercial |
$21.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.93
|
| Rate for Payer: Healthscope Commercial |
$22.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.17
|
| Rate for Payer: PHP Commercial |
$21.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.19
|
| Rate for Payer: Priority Health SBD |
$15.69
|
| Rate for Payer: UMR Bronson Commercial |
$10.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.68
|
|
|
HC APPLICATION OF TOPICAL FLUORIDE VARNISH BY PHYS/QHP
|
Facility
|
IP
|
$35.50
|
|
|
Service Code
|
CPT 99188
|
| Hospital Charge Code |
51000097
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$15.62 |
| Max. Negotiated Rate |
$31.95 |
| Rate for Payer: Aetna American Axle |
$23.07
|
| Rate for Payer: Aetna Commercial |
$30.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.07
|
| Rate for Payer: Cash Price |
$28.40
|
| Rate for Payer: Cofinity Commercial |
$24.85
|
| Rate for Payer: Cofinity Commercial |
$30.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.40
|
| Rate for Payer: Healthscope Commercial |
$31.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.18
|
| Rate for Payer: PHP Commercial |
$30.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.07
|
| Rate for Payer: Priority Health SBD |
$22.36
|
| Rate for Payer: UMR Bronson Commercial |
$15.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.62
|
|
|
HC APPLICATION OF TOPICAL FLUORIDE VARNISH BY PHYS/QHP
|
Facility
|
OP
|
$35.50
|
|
|
Service Code
|
CPT 99188
|
| Hospital Charge Code |
51000097
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$13.13 |
| Max. Negotiated Rate |
$31.95 |
| Rate for Payer: Aetna American Axle |
$23.07
|
| Rate for Payer: Aetna Commercial |
$30.18
|
| Rate for Payer: Aetna Medicare |
$17.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.07
|
| Rate for Payer: BCBS Complete |
$14.20
|
| Rate for Payer: Cash Price |
$28.40
|
| Rate for Payer: Cofinity Commercial |
$24.85
|
| Rate for Payer: Cofinity Commercial |
$30.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.40
|
| Rate for Payer: Healthscope Commercial |
$31.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.18
|
| Rate for Payer: PHP Commercial |
$30.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.07
|
| Rate for Payer: Priority Health SBD |
$22.36
|
| Rate for Payer: UMR Bronson Commercial |
$13.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.62
|
|
|
HC APPLICATION ON-BODY INJECTOR
|
Facility
|
IP
|
$149.79
|
|
|
Service Code
|
CPT 96377
|
| Hospital Charge Code |
76100069
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$65.91 |
| Max. Negotiated Rate |
$134.81 |
| Rate for Payer: Aetna American Axle |
$97.36
|
| Rate for Payer: Aetna Commercial |
$127.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.36
|
| Rate for Payer: Cash Price |
$119.83
|
| Rate for Payer: Cofinity Commercial |
$104.85
|
| Rate for Payer: Cofinity Commercial |
$128.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$104.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.83
|
| Rate for Payer: Healthscope Commercial |
$134.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$104.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.32
|
| Rate for Payer: PHP Commercial |
$127.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.36
|
| Rate for Payer: Priority Health SBD |
$94.37
|
| Rate for Payer: UMR Bronson Commercial |
$65.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.34
|
|
|
HC APPLICATION ON-BODY INJECTOR
|
Facility
|
OP
|
$149.79
|
|
|
Service Code
|
CPT 96377
|
| Hospital Charge Code |
76100069
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$24.12 |
| Max. Negotiated Rate |
$134.81 |
| Rate for Payer: Aetna American Axle |
$97.36
|
| Rate for Payer: Aetna Commercial |
$127.32
|
| Rate for Payer: Aetna Medicare |
$46.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56.25
|
| Rate for Payer: BCBS Complete |
$25.33
|
| Rate for Payer: BCBS MAPPO |
$45.00
|
| Rate for Payer: BCN Medicare Advantage |
$45.00
|
| Rate for Payer: Cash Price |
$119.83
|
| Rate for Payer: Cash Price |
$119.83
|
| Rate for Payer: Cofinity Commercial |
$128.82
|
| Rate for Payer: Cofinity Commercial |
$104.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$104.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.00
|
| Rate for Payer: Healthscope Commercial |
$134.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$104.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.34
|
| Rate for Payer: Mclaren Medicaid |
$24.12
|
| Rate for Payer: Mclaren Medicare |
$45.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$47.25
|
| Rate for Payer: Meridian Medicaid |
$25.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.32
|
| Rate for Payer: PACE Medicare |
$42.75
|
| Rate for Payer: PACE SWMI |
$45.00
|
| Rate for Payer: PHP Commercial |
$127.32
|
| Rate for Payer: PHP Medicare Advantage |
$45.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.36
|
| Rate for Payer: Priority Health Medicare |
$45.00
|
| Rate for Payer: Priority Health SBD |
$94.37
|
| Rate for Payer: Railroad Medicare Medicare |
$45.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$126.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$45.00
|
| Rate for Payer: UHC Exchange |
$86.00
|
| Rate for Payer: UHC Medicare Advantage |
$45.00
|
| Rate for Payer: UHCCP Medicaid |
$24.12
|
| Rate for Payer: UMR Bronson Commercial |
$55.42
|
| Rate for Payer: VA VA |
$45.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.34
|
|
