|
HC I-131 SOL (TX) PER MCI
|
Facility
|
IP
|
$46.93
|
|
|
Service Code
|
HCPCS A9530
|
| Hospital Charge Code |
34400002
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$20.65 |
| Max. Negotiated Rate |
$42.24 |
| Rate for Payer: Aetna American Axle |
$30.50
|
| Rate for Payer: Aetna Commercial |
$39.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.50
|
| Rate for Payer: Cash Price |
$37.54
|
| Rate for Payer: Cofinity Commercial |
$32.85
|
| Rate for Payer: Cofinity Commercial |
$40.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.54
|
| Rate for Payer: Healthscope Commercial |
$42.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.89
|
| Rate for Payer: PHP Commercial |
$39.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.85
|
| Rate for Payer: Priority Health SBD |
$29.57
|
| Rate for Payer: UMR Bronson Commercial |
$20.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.20
|
|
|
HC IAPB MONITORING SERVICES HOURL
|
Facility
|
IP
|
$400.66
|
|
| Hospital Charge Code |
27000118
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$176.29 |
| Max. Negotiated Rate |
$360.59 |
| Rate for Payer: Aetna American Axle |
$260.43
|
| Rate for Payer: Aetna Commercial |
$340.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$260.43
|
| Rate for Payer: Cash Price |
$320.53
|
| Rate for Payer: Cofinity Commercial |
$280.46
|
| Rate for Payer: Cofinity Commercial |
$344.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$320.53
|
| Rate for Payer: Healthscope Commercial |
$360.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$280.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$300.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$340.56
|
| Rate for Payer: PHP Commercial |
$340.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.46
|
| Rate for Payer: Priority Health SBD |
$252.42
|
| Rate for Payer: UMR Bronson Commercial |
$176.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$300.50
|
|
|
HC IAPB MONITORING SERVICES HOURL
|
Facility
|
OP
|
$400.66
|
|
| Hospital Charge Code |
27000118
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$148.24 |
| Max. Negotiated Rate |
$360.59 |
| Rate for Payer: Aetna American Axle |
$260.43
|
| Rate for Payer: Aetna Commercial |
$340.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$260.43
|
| Rate for Payer: BCBS Complete |
$160.26
|
| Rate for Payer: Cash Price |
$320.53
|
| Rate for Payer: Cofinity Commercial |
$280.46
|
| Rate for Payer: Cofinity Commercial |
$344.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$320.53
|
| Rate for Payer: Healthscope Commercial |
$360.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$280.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$300.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$340.56
|
| Rate for Payer: PHP Commercial |
$340.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.46
|
| Rate for Payer: Priority Health SBD |
$252.42
|
| Rate for Payer: UMR Bronson Commercial |
$148.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$300.50
|
|
|
HC IAP CHEMO ADMINISTRATON
|
Facility
|
IP
|
$390.63
|
|
|
Service Code
|
CPT 96420
|
| Hospital Charge Code |
33500010
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$171.88 |
| Max. Negotiated Rate |
$351.57 |
| Rate for Payer: Aetna American Axle |
$253.91
|
| Rate for Payer: Aetna Commercial |
$332.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$253.91
|
| Rate for Payer: Cash Price |
$312.50
|
| Rate for Payer: Cofinity Commercial |
$273.44
|
| Rate for Payer: Cofinity Commercial |
$335.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$312.50
|
| Rate for Payer: Healthscope Commercial |
$351.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$273.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$292.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$332.04
|
| Rate for Payer: PHP Commercial |
$332.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$273.44
|
| Rate for Payer: Priority Health SBD |
$246.10
|
| Rate for Payer: UMR Bronson Commercial |
$171.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$292.97
|
|
|
HC IAP CHEMO ADMINISTRATON
|
Facility
|
OP
|
$390.63
|
|
|
Service Code
|
CPT 96420
|
| Hospital Charge Code |
33500010
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$100.20 |
| Max. Negotiated Rate |
$947.66 |
| Rate for Payer: Aetna American Axle |
$253.91
|
| Rate for Payer: Aetna Commercial |
$332.04
|
| Rate for Payer: Aetna Medicare |
$313.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$253.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$376.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$376.29
|
| Rate for Payer: BCBS Complete |
$172.91
|
| Rate for Payer: BCBS MAPPO |
$301.03
|
| Rate for Payer: BCBS Trust/PPO |
$550.12
|
| Rate for Payer: BCN Medicare Advantage |
$301.03
|
| Rate for Payer: Cash Price |
$312.50
|
| Rate for Payer: Cash Price |
$312.50
|
| Rate for Payer: Cofinity Commercial |
$273.44
|
| Rate for Payer: Cofinity Commercial |
$335.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$312.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$301.03
|
| Rate for Payer: Healthscope Commercial |
$351.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$273.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$292.97
|
| Rate for Payer: Mclaren Medicaid |
$164.66
|
| Rate for Payer: Mclaren Medicare |
$301.03
|
| Rate for Payer: Meridian Medicaid |
$172.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$316.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$346.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$332.04
|
| Rate for Payer: PACE Medicare |
$285.98
|
| Rate for Payer: PACE SWMI |
$301.03
|
| Rate for Payer: PHP Commercial |
$332.04
|
| Rate for Payer: PHP Medicare Advantage |
$301.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$164.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$273.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$947.66
|
| Rate for Payer: Priority Health Medicare |
$301.03
|
| Rate for Payer: Priority Health Narrow Network |
$758.13
|
| Rate for Payer: Priority Health SBD |
$246.10
|
| Rate for Payer: Railroad Medicare Medicare |
$301.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$110.22
|
| Rate for Payer: UHC Core |
$284.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$301.03
|
| Rate for Payer: UHC Exchange |
$100.20
|
| Rate for Payer: UHC Medicare Advantage |
$310.06
|
| Rate for Payer: UMR Bronson Commercial |
$144.53
|
| Rate for Payer: VA VA |
$301.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$292.97
|
|
|
HC IBD DIFF
|
Facility
|
OP
|
$61.00
|
|
|
Service Code
|
CPT 86036
|
| Hospital Charge Code |
30200488
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.59 |
| Max. Negotiated Rate |
$54.90 |
| Rate for Payer: Aetna American Axle |
$39.65
|
| Rate for Payer: Aetna Commercial |
$51.85
|
| Rate for Payer: Aetna Medicare |
$12.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: BCBS Complete |
$6.92
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$10.84
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Cofinity Commercial |
$42.70
|
| Rate for Payer: Cofinity Commercial |
$52.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$54.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.75
|
| Rate for Payer: Mclaren Medicaid |
$6.59
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Medicaid |
$6.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.85
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$51.85
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.05
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health Narrow Network |
$9.64
|
| Rate for Payer: Priority Health SBD |
$38.43
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.46
|
| Rate for Payer: UHC Core |
$14.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.05
|
| Rate for Payer: UHC Exchange |
$12.05
|
| Rate for Payer: UHC Medicare Advantage |
$12.41
|
| Rate for Payer: UMR Bronson Commercial |
$22.57
|
| Rate for Payer: VA VA |
$12.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.75
|
|
|
HC IBD DIFF
|
Facility
|
IP
|
$61.00
|
|
|
Service Code
|
CPT 86036
|
| Hospital Charge Code |
30200488
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$26.84 |
| Max. Negotiated Rate |
$54.90 |
| Rate for Payer: Aetna American Axle |
$39.65
|
| Rate for Payer: Aetna Commercial |
$51.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.65
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Cofinity Commercial |
$42.70
|
| Rate for Payer: Cofinity Commercial |
$52.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.80
|
| Rate for Payer: Healthscope Commercial |
$54.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.85
|
| Rate for Payer: PHP Commercial |
$51.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.70
|
| Rate for Payer: Priority Health SBD |
$38.43
|
| Rate for Payer: UMR Bronson Commercial |
$26.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.75
|
|
|
HC IBD DIFFERENTIATION
|
Facility
|
IP
|
$61.00
|
|
|
Service Code
|
CPT 86036
|
| Hospital Charge Code |
30200174
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$26.84 |
| Max. Negotiated Rate |
$54.90 |
| Rate for Payer: Aetna American Axle |
$39.65
|
| Rate for Payer: Aetna Commercial |
$51.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.65
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Cofinity Commercial |
$42.70
|
| Rate for Payer: Cofinity Commercial |
$52.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.80
|
| Rate for Payer: Healthscope Commercial |
$54.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.85
|
| Rate for Payer: PHP Commercial |
$51.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.70
|
| Rate for Payer: Priority Health SBD |
$38.43
|
| Rate for Payer: UMR Bronson Commercial |
$26.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.75
|
|
|
HC IBD DIFFERENTIATION
|
Facility
|
OP
|
$61.00
|
|
|
Service Code
|
CPT 86036
|
| Hospital Charge Code |
30200174
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.59 |
| Max. Negotiated Rate |
$54.90 |
| Rate for Payer: Aetna American Axle |
$39.65
|
| Rate for Payer: Aetna Commercial |
$51.85
|
| Rate for Payer: Aetna Medicare |
$12.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: BCBS Complete |
$6.92
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$10.84
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Cofinity Commercial |
$52.46
|
| Rate for Payer: Cofinity Commercial |
$42.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$54.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.75
|
| Rate for Payer: Mclaren Medicaid |
$6.59
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Medicaid |
$6.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.85
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$51.85
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.05
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health Narrow Network |
$9.64
|
| Rate for Payer: Priority Health SBD |
$38.43
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.46
|
| Rate for Payer: UHC Core |
$14.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.05
|
| Rate for Payer: UHC Exchange |
$12.05
|
| Rate for Payer: UHC Medicare Advantage |
$12.41
|
| Rate for Payer: UMR Bronson Commercial |
$22.57
|
| Rate for Payer: VA VA |
$12.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.75
|
|
|
HC IBD DIFFERENTIATION CMPT
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
CPT 86671
|
| Hospital Charge Code |
30200386
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.70 |
| Max. Negotiated Rate |
$51.30 |
| Rate for Payer: Aetna American Axle |
$37.05
|
| Rate for Payer: Aetna Commercial |
$48.45
|
| Rate for Payer: Aetna Medicare |
$12.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.31
|
| Rate for Payer: BCBS Complete |
$7.04
|
| Rate for Payer: BCBS MAPPO |
$12.25
|
| Rate for Payer: BCBS Trust/PPO |
$11.02
|
| Rate for Payer: BCN Medicare Advantage |
$12.25
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cofinity Commercial |
$39.90
|
| Rate for Payer: Cofinity Commercial |
$49.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.25
|
| Rate for Payer: Healthscope Commercial |
$51.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.75
|
| Rate for Payer: Mclaren Medicaid |
$6.70
|
| Rate for Payer: Mclaren Medicare |
$12.25
|
| Rate for Payer: Meridian Medicaid |
$7.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$48.45
|
| Rate for Payer: PACE Medicare |
$11.64
|
| Rate for Payer: PACE SWMI |
$12.25
|
| Rate for Payer: PHP Commercial |
$48.45
|
| Rate for Payer: PHP Medicare Advantage |
$12.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.81
|
| Rate for Payer: Priority Health Medicare |
$12.25
|
| Rate for Payer: Priority Health Narrow Network |
$13.45
|
| Rate for Payer: Priority Health SBD |
$35.91
|
| Rate for Payer: Railroad Medicare Medicare |
$12.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.70
|
| Rate for Payer: UHC Core |
$20.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.25
|
| Rate for Payer: UHC Exchange |
$12.25
|
| Rate for Payer: UHC Medicare Advantage |
$12.62
|
| Rate for Payer: UMR Bronson Commercial |
$21.09
|
| Rate for Payer: VA VA |
$12.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.75
|
|
|
HC IBD DIFFERENTIATION CMPT
|
Facility
|
IP
|
$57.00
|
|
|
Service Code
|
CPT 86671
|
| Hospital Charge Code |
30200386
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$25.08 |
| Max. Negotiated Rate |
$51.30 |
| Rate for Payer: Aetna American Axle |
$37.05
|
| Rate for Payer: Aetna Commercial |
$48.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.05
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cofinity Commercial |
$39.90
|
| Rate for Payer: Cofinity Commercial |
$49.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.60
|
| Rate for Payer: Healthscope Commercial |
$51.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$48.45
|
| Rate for Payer: PHP Commercial |
$48.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.90
|
| Rate for Payer: Priority Health SBD |
$35.91
|
| Rate for Payer: UMR Bronson Commercial |
$25.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.75
|
|
|
HC ICD CRT/DUAL IMPLANT/REPLACE
|
Facility
|
IP
|
$24,480.00
|
|
|
Service Code
|
CPT 33249
|
| Hospital Charge Code |
36100080
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$10,771.20 |
| Max. Negotiated Rate |
$22,032.00 |
| Rate for Payer: Aetna American Axle |
$15,912.00
|
| Rate for Payer: Aetna Commercial |
$20,808.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15,912.00
|
| Rate for Payer: Cash Price |
$19,584.00
|
| Rate for Payer: Cofinity Commercial |
$17,136.00
|
| Rate for Payer: Cofinity Commercial |
$21,052.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19,584.00
|
| Rate for Payer: Healthscope Commercial |
$22,032.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17,136.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18,360.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20,808.00
|
| Rate for Payer: PHP Commercial |
$20,808.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17,136.00
|
| Rate for Payer: Priority Health SBD |
$15,422.40
|
| Rate for Payer: UMR Bronson Commercial |
$10,771.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18,360.00
|
|
|
HC ICD CRT/DUAL IMPLANT/REPLACE
|
Facility
|
OP
|
$24,480.00
|
|
|
Service Code
|
CPT 33249
|
| Hospital Charge Code |
36100080
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$879.18 |
| Max. Negotiated Rate |
$92,059.21 |
| Rate for Payer: Aetna American Axle |
$15,912.00
|
| Rate for Payer: Aetna Commercial |
$20,808.00
|
| Rate for Payer: Aetna Medicare |
$30,413.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15,912.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36,554.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36,554.11
|
| Rate for Payer: BCBS Complete |
$16,797.35
|
| Rate for Payer: BCBS MAPPO |
$29,243.29
|
| Rate for Payer: BCBS Trust/PPO |
$36,268.20
|
| Rate for Payer: BCN Medicare Advantage |
$29,243.29
|
| Rate for Payer: Cash Price |
$19,584.00
|
| Rate for Payer: Cash Price |
$19,584.00
|
| Rate for Payer: Cofinity Commercial |
$21,052.80
|
| Rate for Payer: Cofinity Commercial |
$17,136.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19,584.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29,243.29
|
| Rate for Payer: Healthscope Commercial |
$22,032.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17,136.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18,360.00
|
| Rate for Payer: Mclaren Medicaid |
$15,996.08
|
| Rate for Payer: Mclaren Medicare |
$29,243.29
|
| Rate for Payer: Meridian Medicaid |
$16,797.35
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$30,705.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33,629.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20,808.00
|
| Rate for Payer: PACE Medicare |
$27,781.13
|
| Rate for Payer: PACE SWMI |
$29,243.29
|
| Rate for Payer: PHP Commercial |
$20,808.00
|
| Rate for Payer: PHP Medicare Advantage |
$29,243.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$15,996.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17,136.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$92,059.21
|
| Rate for Payer: Priority Health Medicare |
$29,243.29
|
| Rate for Payer: Priority Health Narrow Network |
$73,647.37
|
| Rate for Payer: Priority Health SBD |
$15,422.40
|
| Rate for Payer: Railroad Medicare Medicare |
$29,243.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$967.10
|
| Rate for Payer: UHC Core |
$52,490.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$29,243.29
|
| Rate for Payer: UHC Exchange |
$879.18
|
| Rate for Payer: UHC Medicare Advantage |
$30,120.59
|
| Rate for Payer: UMR Bronson Commercial |
$9,057.60
|
| Rate for Payer: VA VA |
$29,243.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18,360.00
|
|
|
HC ICD CRT/DUAL REPLACEMENT
|
Facility
|
OP
|
$11,220.00
|
|
|
Service Code
|
CPT 33240
|
| Hospital Charge Code |
36100075
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$356.26 |
| Max. Negotiated Rate |
$65,958.25 |
| Rate for Payer: Aetna American Axle |
$7,293.00
|
| Rate for Payer: Aetna Commercial |
$9,537.00
|
| Rate for Payer: Aetna Medicare |
$21,790.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,293.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26,190.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26,190.15
|
| Rate for Payer: BCBS Complete |
$12,034.90
|
| Rate for Payer: BCBS MAPPO |
$20,952.12
|
| Rate for Payer: BCBS Trust/PPO |
$33,501.80
|
| Rate for Payer: BCN Medicare Advantage |
$20,952.12
|
| Rate for Payer: Cash Price |
$8,976.00
|
| Rate for Payer: Cash Price |
$8,976.00
|
| Rate for Payer: Cofinity Commercial |
$7,854.00
|
| Rate for Payer: Cofinity Commercial |
$9,649.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,976.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20,952.12
|
| Rate for Payer: Healthscope Commercial |
$10,098.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7,854.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,415.00
|
| Rate for Payer: Mclaren Medicaid |
$11,460.81
|
| Rate for Payer: Mclaren Medicare |
$20,952.12
|
| Rate for Payer: Meridian Medicaid |
$12,034.90
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$21,999.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24,094.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9,537.00
|
| Rate for Payer: PACE Medicare |
$19,904.51
|
| Rate for Payer: PACE SWMI |
$20,952.12
|
| Rate for Payer: PHP Commercial |
$9,537.00
|
| Rate for Payer: PHP Medicare Advantage |
$20,952.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,460.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,854.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$65,958.25
|
| Rate for Payer: Priority Health Medicare |
$20,952.12
|
| Rate for Payer: Priority Health Narrow Network |
$52,766.60
|
| Rate for Payer: Priority Health SBD |
$7,068.60
|
| Rate for Payer: Railroad Medicare Medicare |
$20,952.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$391.89
|
| Rate for Payer: UHC Core |
$52,490.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$20,952.12
|
| Rate for Payer: UHC Exchange |
$356.26
|
| Rate for Payer: UHC Medicare Advantage |
$21,580.68
|
| Rate for Payer: UMR Bronson Commercial |
$4,151.40
|
| Rate for Payer: VA VA |
$20,952.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,415.00
|
|
|
HC ICD CRT/DUAL REPLACEMENT
|
Facility
|
IP
|
$11,220.00
|
|
|
Service Code
|
CPT 33240
|
| Hospital Charge Code |
36100075
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,936.80 |
| Max. Negotiated Rate |
$10,098.00 |
| Rate for Payer: Aetna American Axle |
$7,293.00
|
| Rate for Payer: Aetna Commercial |
$9,537.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,293.00
|
| Rate for Payer: Cash Price |
$8,976.00
|
| Rate for Payer: Cofinity Commercial |
$7,854.00
|
| Rate for Payer: Cofinity Commercial |
$9,649.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,976.00
|
| Rate for Payer: Healthscope Commercial |
$10,098.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7,854.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,415.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9,537.00
|
| Rate for Payer: PHP Commercial |
$9,537.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,854.00
|
| Rate for Payer: Priority Health SBD |
$7,068.60
|
| Rate for Payer: UMR Bronson Commercial |
$4,936.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,415.00
|
|
|
HC ICD LEAD REMOVAL
|
Facility
|
IP
|
$2,664.59
|
|
|
Service Code
|
CPT 33244
|
| Hospital Charge Code |
36100078
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,172.42 |
| Max. Negotiated Rate |
$2,398.13 |
| Rate for Payer: Aetna American Axle |
$1,731.98
|
| Rate for Payer: Aetna Commercial |
$2,264.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,731.98
|
| Rate for Payer: Cash Price |
$2,131.67
|
| Rate for Payer: Cofinity Commercial |
$1,865.21
|
| Rate for Payer: Cofinity Commercial |
$2,291.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,131.67
|
| Rate for Payer: Healthscope Commercial |
$2,398.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,865.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,998.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,264.90
|
| Rate for Payer: PHP Commercial |
$2,264.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,865.21
|
| Rate for Payer: Priority Health SBD |
$1,678.69
|
| Rate for Payer: UMR Bronson Commercial |
$1,172.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,998.44
|
|
|
HC ICD LEAD REMOVAL
|
Facility
|
OP
|
$2,664.59
|
|
|
Service Code
|
CPT 33244
|
| Hospital Charge Code |
36100078
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$833.01 |
| Max. Negotiated Rate |
$10,988.67 |
| Rate for Payer: Aetna American Axle |
$1,731.98
|
| Rate for Payer: Aetna Commercial |
$2,264.90
|
| Rate for Payer: Aetna Medicare |
$3,630.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,731.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,363.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,363.29
|
| Rate for Payer: BCBS Complete |
$2,005.02
|
| Rate for Payer: BCBS MAPPO |
$3,490.63
|
| Rate for Payer: BCBS Trust/PPO |
$2,279.35
|
| Rate for Payer: BCN Medicare Advantage |
$3,490.63
|
| Rate for Payer: Cash Price |
$2,131.67
|
| Rate for Payer: Cash Price |
$2,131.67
|
| Rate for Payer: Cofinity Commercial |
$2,291.55
|
| Rate for Payer: Cofinity Commercial |
$1,865.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,131.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,490.63
|
| Rate for Payer: Healthscope Commercial |
$2,398.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,865.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,998.44
|
| Rate for Payer: Mclaren Medicaid |
$1,909.37
|
| Rate for Payer: Mclaren Medicare |
$3,490.63
|
| Rate for Payer: Meridian Medicaid |
$2,005.02
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,665.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,014.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,264.90
|
| Rate for Payer: PACE Medicare |
$3,316.10
|
| Rate for Payer: PACE SWMI |
$3,490.63
|
| Rate for Payer: PHP Commercial |
$2,264.90
|
| Rate for Payer: PHP Medicare Advantage |
$3,490.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,909.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,865.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,988.67
|
| Rate for Payer: Priority Health Medicare |
$3,490.63
|
| Rate for Payer: Priority Health Narrow Network |
$8,790.94
|
| Rate for Payer: Priority Health SBD |
$1,678.69
|
| Rate for Payer: Railroad Medicare Medicare |
$3,490.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$916.31
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,490.63
|
| Rate for Payer: UHC Exchange |
$833.01
|
| Rate for Payer: UHC Medicare Advantage |
$3,595.35
|
| Rate for Payer: UMR Bronson Commercial |
$985.90
|
| Rate for Payer: VA VA |
$3,490.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,998.44
|
|
|
HC ICD POCKET REVISION
|
Facility
|
OP
|
$3,102.18
|
|
|
Service Code
|
CPT 33223
|
| Hospital Charge Code |
36100068
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$395.88 |
| Max. Negotiated Rate |
$5,102.91 |
| Rate for Payer: Aetna American Axle |
$2,016.42
|
| Rate for Payer: Aetna Commercial |
$2,636.85
|
| Rate for Payer: Aetna Medicare |
$1,685.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,016.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,026.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,026.22
|
| Rate for Payer: BCBS Complete |
$931.09
|
| Rate for Payer: BCBS MAPPO |
$1,620.98
|
| Rate for Payer: BCBS Trust/PPO |
$1,336.74
|
| Rate for Payer: BCN Medicare Advantage |
$1,620.98
|
| Rate for Payer: Cash Price |
$2,481.74
|
| Rate for Payer: Cash Price |
$2,481.74
|
| Rate for Payer: Cofinity Commercial |
$2,667.87
|
| Rate for Payer: Cofinity Commercial |
$2,171.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,481.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,620.98
|
| Rate for Payer: Healthscope Commercial |
$2,791.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,171.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,326.64
|
| Rate for Payer: Mclaren Medicaid |
$886.68
|
| Rate for Payer: Mclaren Medicare |
$1,620.98
|
| Rate for Payer: Meridian Medicaid |
$931.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,702.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,864.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,636.85
|
| Rate for Payer: PACE Medicare |
$1,539.93
|
| Rate for Payer: PACE SWMI |
$1,620.98
|
| Rate for Payer: PHP Commercial |
$2,636.85
|
| Rate for Payer: PHP Medicare Advantage |
$1,620.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$886.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,171.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,102.91
|
| Rate for Payer: Priority Health Medicare |
$1,620.98
|
| Rate for Payer: Priority Health Narrow Network |
$4,082.33
|
| Rate for Payer: Priority Health SBD |
$1,954.37
|
| Rate for Payer: Railroad Medicare Medicare |
$1,620.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$435.47
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,620.98
|
| Rate for Payer: UHC Exchange |
$395.88
|
| Rate for Payer: UHC Medicare Advantage |
$1,669.61
|
| Rate for Payer: UMR Bronson Commercial |
$1,147.81
|
| Rate for Payer: VA VA |
$1,620.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,326.64
|
|
|
HC ICD POCKET REVISION
|
Facility
|
IP
|
$3,102.18
|
|
|
Service Code
|
CPT 33223
|
| Hospital Charge Code |
36100068
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,364.96 |
| Max. Negotiated Rate |
$2,791.96 |
| Rate for Payer: Aetna American Axle |
$2,016.42
|
| Rate for Payer: Aetna Commercial |
$2,636.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,016.42
|
| Rate for Payer: Cash Price |
$2,481.74
|
| Rate for Payer: Cofinity Commercial |
$2,171.53
|
| Rate for Payer: Cofinity Commercial |
$2,667.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,481.74
|
| Rate for Payer: Healthscope Commercial |
$2,791.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,171.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,326.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,636.85
|
| Rate for Payer: PHP Commercial |
$2,636.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,171.53
|
| Rate for Payer: Priority Health SBD |
$1,954.37
|
| Rate for Payer: UMR Bronson Commercial |
$1,364.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,326.64
|
|
|
HC ICD SINGLE IMPLANT
|
Facility
|
IP
|
$17,340.00
|
|
|
Service Code
|
CPT 33249
|
| Hospital Charge Code |
36100079
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,629.60 |
| Max. Negotiated Rate |
$15,606.00 |
| Rate for Payer: Aetna American Axle |
$11,271.00
|
| Rate for Payer: Aetna Commercial |
$14,739.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,271.00
|
| Rate for Payer: Cash Price |
$13,872.00
|
| Rate for Payer: Cofinity Commercial |
$12,138.00
|
| Rate for Payer: Cofinity Commercial |
$14,912.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,872.00
|
| Rate for Payer: Healthscope Commercial |
$15,606.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12,138.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13,005.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14,739.00
|
| Rate for Payer: PHP Commercial |
$14,739.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,138.00
|
| Rate for Payer: Priority Health SBD |
$10,924.20
|
| Rate for Payer: UMR Bronson Commercial |
$7,629.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13,005.00
|
|
|
HC ICD SINGLE IMPLANT
|
Facility
|
OP
|
$17,340.00
|
|
|
Service Code
|
CPT 33249
|
| Hospital Charge Code |
36100079
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$879.18 |
| Max. Negotiated Rate |
$92,059.21 |
| Rate for Payer: Aetna American Axle |
$11,271.00
|
| Rate for Payer: Aetna Commercial |
$14,739.00
|
| Rate for Payer: Aetna Medicare |
$30,413.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,271.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36,554.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36,554.11
|
| Rate for Payer: BCBS Complete |
$16,797.35
|
| Rate for Payer: BCBS MAPPO |
$29,243.29
|
| Rate for Payer: BCBS Trust/PPO |
$36,268.20
|
| Rate for Payer: BCN Medicare Advantage |
$29,243.29
|
| Rate for Payer: Cash Price |
$13,872.00
|
| Rate for Payer: Cash Price |
$13,872.00
|
| Rate for Payer: Cofinity Commercial |
$12,138.00
|
| Rate for Payer: Cofinity Commercial |
$14,912.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,872.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29,243.29
|
| Rate for Payer: Healthscope Commercial |
$15,606.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12,138.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13,005.00
|
| Rate for Payer: Mclaren Medicaid |
$15,996.08
|
| Rate for Payer: Mclaren Medicare |
$29,243.29
|
| Rate for Payer: Meridian Medicaid |
$16,797.35
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$30,705.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33,629.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14,739.00
|
| Rate for Payer: PACE Medicare |
$27,781.13
|
| Rate for Payer: PACE SWMI |
$29,243.29
|
| Rate for Payer: PHP Commercial |
$14,739.00
|
| Rate for Payer: PHP Medicare Advantage |
$29,243.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$15,996.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,138.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$92,059.21
|
| Rate for Payer: Priority Health Medicare |
$29,243.29
|
| Rate for Payer: Priority Health Narrow Network |
$73,647.37
|
| Rate for Payer: Priority Health SBD |
$10,924.20
|
| Rate for Payer: Railroad Medicare Medicare |
$29,243.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$967.10
|
| Rate for Payer: UHC Core |
$52,490.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$29,243.29
|
| Rate for Payer: UHC Exchange |
$879.18
|
| Rate for Payer: UHC Medicare Advantage |
$30,120.59
|
| Rate for Payer: UMR Bronson Commercial |
$6,415.80
|
| Rate for Payer: VA VA |
$29,243.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13,005.00
|
|
|
HC ICP MONITOR
|
Facility
|
IP
|
$1,957.50
|
|
| Hospital Charge Code |
27800143
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$861.30 |
| Max. Negotiated Rate |
$1,761.75 |
| Rate for Payer: Aetna American Axle |
$1,272.38
|
| Rate for Payer: Aetna Commercial |
$1,663.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,272.38
|
| Rate for Payer: Cash Price |
$1,566.00
|
| Rate for Payer: Cofinity Commercial |
$1,370.25
|
| Rate for Payer: Cofinity Commercial |
$1,683.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,566.00
|
| Rate for Payer: Healthscope Commercial |
$1,761.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,370.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,468.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,663.88
|
| Rate for Payer: PHP Commercial |
$1,663.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,370.25
|
| Rate for Payer: Priority Health SBD |
$1,233.22
|
| Rate for Payer: UMR Bronson Commercial |
$861.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,468.12
|
|
|
HC ICP MONITOR
|
Facility
|
OP
|
$1,957.50
|
|
| Hospital Charge Code |
27800143
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$724.28 |
| Max. Negotiated Rate |
$1,761.75 |
| Rate for Payer: Aetna American Axle |
$1,272.38
|
| Rate for Payer: Aetna Commercial |
$1,663.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,272.38
|
| Rate for Payer: BCBS Complete |
$783.00
|
| Rate for Payer: Cash Price |
$1,566.00
|
| Rate for Payer: Cofinity Commercial |
$1,370.25
|
| Rate for Payer: Cofinity Commercial |
$1,683.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,566.00
|
| Rate for Payer: Healthscope Commercial |
$1,761.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,370.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,468.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,663.88
|
| Rate for Payer: PHP Commercial |
$1,663.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,370.25
|
| Rate for Payer: Priority Health SBD |
$1,233.22
|
| Rate for Payer: UMR Bronson Commercial |
$724.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,468.12
|
|
|
HC I&D BARTHOLIN GLAND ABSCESS
|
Facility
|
IP
|
$253.98
|
|
|
Service Code
|
CPT 56420
|
| Hospital Charge Code |
36100573
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$111.75 |
| Max. Negotiated Rate |
$228.58 |
| Rate for Payer: Aetna American Axle |
$165.09
|
| Rate for Payer: Aetna Commercial |
$215.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.09
|
| Rate for Payer: Cash Price |
$203.18
|
| Rate for Payer: Cofinity Commercial |
$177.79
|
| Rate for Payer: Cofinity Commercial |
$218.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.18
|
| Rate for Payer: Healthscope Commercial |
$228.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$177.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$215.88
|
| Rate for Payer: PHP Commercial |
$215.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.79
|
| Rate for Payer: Priority Health SBD |
$160.01
|
| Rate for Payer: UMR Bronson Commercial |
$111.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.48
|
|
|
HC I&D BARTHOLIN GLAND ABSCESS
|
Facility
|
OP
|
$253.98
|
|
|
Service Code
|
CPT 56420
|
| Hospital Charge Code |
36100573
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$93.97 |
| Max. Negotiated Rate |
$557.61 |
| Rate for Payer: Aetna American Axle |
$165.09
|
| Rate for Payer: Aetna Commercial |
$215.88
|
| Rate for Payer: Aetna Medicare |
$184.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$221.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$221.40
|
| Rate for Payer: BCBS Complete |
$101.74
|
| Rate for Payer: BCBS MAPPO |
$177.12
|
| Rate for Payer: BCBS Trust/PPO |
$190.49
|
| Rate for Payer: BCN Medicare Advantage |
$177.12
|
| Rate for Payer: Cash Price |
$203.18
|
| Rate for Payer: Cash Price |
$203.18
|
| Rate for Payer: Cofinity Commercial |
$218.42
|
| Rate for Payer: Cofinity Commercial |
$177.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.12
|
| Rate for Payer: Healthscope Commercial |
$228.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$177.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.48
|
| Rate for Payer: Mclaren Medicaid |
$96.88
|
| Rate for Payer: Mclaren Medicare |
$177.12
|
| Rate for Payer: Meridian Medicaid |
$101.74
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$185.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$203.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$215.88
|
| Rate for Payer: PACE Medicare |
$168.26
|
| Rate for Payer: PACE SWMI |
$177.12
|
| Rate for Payer: PHP Commercial |
$215.88
|
| Rate for Payer: PHP Medicare Advantage |
$177.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$96.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$557.61
|
| Rate for Payer: Priority Health Medicare |
$177.12
|
| Rate for Payer: Priority Health Narrow Network |
$446.09
|
| Rate for Payer: Priority Health SBD |
$160.01
|
| Rate for Payer: Railroad Medicare Medicare |
$177.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$120.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$177.12
|
| Rate for Payer: UHC Exchange |
$109.69
|
| Rate for Payer: UHC Medicare Advantage |
$182.43
|
| Rate for Payer: UMR Bronson Commercial |
$93.97
|
| Rate for Payer: VA VA |
$177.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.48
|
|
