|
HC INSULIN LIKE GROWTH FACTOR BP3
|
Facility
|
IP
|
$48.96
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100258
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.54 |
| Max. Negotiated Rate |
$44.06 |
| Rate for Payer: Aetna American Axle |
$31.82
|
| Rate for Payer: Aetna Commercial |
$41.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.82
|
| Rate for Payer: Cash Price |
$39.17
|
| Rate for Payer: Cofinity Commercial |
$34.27
|
| Rate for Payer: Cofinity Commercial |
$42.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.17
|
| Rate for Payer: Healthscope Commercial |
$44.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$41.62
|
| Rate for Payer: PHP Commercial |
$41.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.27
|
| Rate for Payer: Priority Health SBD |
$30.84
|
| Rate for Payer: UMR Bronson Commercial |
$21.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.72
|
|
|
HC INSULIN LIKE GROWTH FACTOR BP3
|
Facility
|
OP
|
$48.96
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100258
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.45 |
| Max. Negotiated Rate |
$44.06 |
| Rate for Payer: Aetna American Axle |
$31.82
|
| Rate for Payer: Aetna Commercial |
$41.62
|
| Rate for Payer: Aetna Medicare |
$17.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.59
|
| Rate for Payer: BCBS Complete |
$9.92
|
| Rate for Payer: BCBS MAPPO |
$17.27
|
| Rate for Payer: BCBS Trust/PPO |
$15.53
|
| Rate for Payer: BCN Medicare Advantage |
$17.27
|
| Rate for Payer: Cash Price |
$39.17
|
| Rate for Payer: Cash Price |
$39.17
|
| Rate for Payer: Cofinity Commercial |
$42.11
|
| Rate for Payer: Cofinity Commercial |
$34.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.27
|
| Rate for Payer: Healthscope Commercial |
$44.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.72
|
| Rate for Payer: Mclaren Medicaid |
$9.45
|
| Rate for Payer: Mclaren Medicare |
$17.27
|
| Rate for Payer: Meridian Medicaid |
$9.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$41.62
|
| Rate for Payer: PACE Medicare |
$16.41
|
| Rate for Payer: PACE SWMI |
$17.27
|
| Rate for Payer: PHP Commercial |
$41.62
|
| Rate for Payer: PHP Medicare Advantage |
$17.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.76
|
| Rate for Payer: Priority Health Medicare |
$17.27
|
| Rate for Payer: Priority Health Narrow Network |
$14.21
|
| Rate for Payer: Priority Health SBD |
$30.84
|
| Rate for Payer: Railroad Medicare Medicare |
$17.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.72
|
| Rate for Payer: UHC Core |
$21.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.27
|
| Rate for Payer: UHC Exchange |
$17.27
|
| Rate for Payer: UHC Medicare Advantage |
$17.79
|
| Rate for Payer: UMR Bronson Commercial |
$18.12
|
| Rate for Payer: VA VA |
$17.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.72
|
|
|
HC INTENSIVE CARE OBS OVERFLOW PER HR
|
Facility
|
OP
|
$186.06
|
|
| Hospital Charge Code |
76900004
|
|
Hospital Revenue Code
|
769
|
| Min. Negotiated Rate |
$68.84 |
| Max. Negotiated Rate |
$167.45 |
| Rate for Payer: Aetna American Axle |
$120.94
|
| Rate for Payer: Aetna Commercial |
$158.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.94
|
| Rate for Payer: BCBS Complete |
$74.42
|
| Rate for Payer: Cash Price |
$148.85
|
| Rate for Payer: Cofinity Commercial |
$130.24
|
| Rate for Payer: Cofinity Commercial |
$160.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.85
|
| Rate for Payer: Healthscope Commercial |
$167.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$130.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$158.15
|
| Rate for Payer: PHP Commercial |
$158.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.24
|
| Rate for Payer: Priority Health SBD |
$117.22
|
| Rate for Payer: UMR Bronson Commercial |
$68.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.54
|
|
|
HC INTENSIVE CARE OBS OVERFLOW PER HR
|
Facility
|
IP
|
$186.06
|
|
| Hospital Charge Code |
76900004
|
|
Hospital Revenue Code
|
769
|
| Min. Negotiated Rate |
$81.87 |
| Max. Negotiated Rate |
$167.45 |
| Rate for Payer: Aetna American Axle |
$120.94
|
| Rate for Payer: Aetna Commercial |
$158.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.94
|
| Rate for Payer: Cash Price |
$148.85
|
| Rate for Payer: Cofinity Commercial |
$130.24
|
| Rate for Payer: Cofinity Commercial |
$160.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.85
|
| Rate for Payer: Healthscope Commercial |
$167.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$130.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$158.15
|
| Rate for Payer: PHP Commercial |
$158.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.24
|
| Rate for Payer: Priority Health SBD |
$117.22
|
| Rate for Payer: UMR Bronson Commercial |
$81.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.54
|
|
|
HC INTERCEDE ANTIADHESIVE
|
Facility
|
OP
|
$1,162.39
|
|
| Hospital Charge Code |
27200134
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$430.08 |
| Max. Negotiated Rate |
$1,046.15 |
| Rate for Payer: Aetna American Axle |
$755.55
|
| Rate for Payer: Aetna Commercial |
$988.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$755.55
|
| Rate for Payer: BCBS Complete |
$464.96
|
| Rate for Payer: Cash Price |
$929.91
|
| Rate for Payer: Cofinity Commercial |
$813.67
|
| Rate for Payer: Cofinity Commercial |
$999.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$929.91
|
| Rate for Payer: Healthscope Commercial |
$1,046.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$813.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$871.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$988.03
|
| Rate for Payer: PHP Commercial |
$988.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$813.67
|
| Rate for Payer: Priority Health SBD |
$732.31
|
| Rate for Payer: UMR Bronson Commercial |
$430.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$871.79
|
|
|
HC INTERCEDE ANTIADHESIVE
|
Facility
|
IP
|
$1,162.39
|
|
| Hospital Charge Code |
27200134
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$511.45 |
| Max. Negotiated Rate |
$1,046.15 |
| Rate for Payer: Aetna American Axle |
$755.55
|
| Rate for Payer: Aetna Commercial |
$988.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$755.55
|
| Rate for Payer: Cash Price |
$929.91
|
| Rate for Payer: Cofinity Commercial |
$813.67
|
| Rate for Payer: Cofinity Commercial |
$999.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$929.91
|
| Rate for Payer: Healthscope Commercial |
$1,046.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$813.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$871.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$988.03
|
| Rate for Payer: PHP Commercial |
$988.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$813.67
|
| Rate for Payer: Priority Health SBD |
$732.31
|
| Rate for Payer: UMR Bronson Commercial |
$511.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$871.79
|
|
|
HC INTERLEUKIN 6, PLASMA
|
Facility
|
OP
|
$129.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100710
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.45 |
| Max. Negotiated Rate |
$116.10 |
| Rate for Payer: Aetna American Axle |
$83.85
|
| Rate for Payer: Aetna Commercial |
$109.65
|
| Rate for Payer: Aetna Medicare |
$17.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.59
|
| Rate for Payer: BCBS Complete |
$9.92
|
| Rate for Payer: BCBS MAPPO |
$17.27
|
| Rate for Payer: BCBS Trust/PPO |
$15.53
|
| Rate for Payer: BCN Medicare Advantage |
$17.27
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cofinity Commercial |
$90.30
|
| Rate for Payer: Cofinity Commercial |
$110.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.27
|
| Rate for Payer: Healthscope Commercial |
$116.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$90.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.75
|
| Rate for Payer: Mclaren Medicaid |
$9.45
|
| Rate for Payer: Mclaren Medicare |
$17.27
|
| Rate for Payer: Meridian Medicaid |
$9.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$109.65
|
| Rate for Payer: PACE Medicare |
$16.41
|
| Rate for Payer: PACE SWMI |
$17.27
|
| Rate for Payer: PHP Commercial |
$109.65
|
| Rate for Payer: PHP Medicare Advantage |
$17.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.76
|
| Rate for Payer: Priority Health Medicare |
$17.27
|
| Rate for Payer: Priority Health Narrow Network |
$14.21
|
| Rate for Payer: Priority Health SBD |
$81.27
|
| Rate for Payer: Railroad Medicare Medicare |
$17.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.72
|
| Rate for Payer: UHC Core |
$21.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.27
|
| Rate for Payer: UHC Exchange |
$17.27
|
| Rate for Payer: UHC Medicare Advantage |
$17.79
|
| Rate for Payer: UMR Bronson Commercial |
$47.73
|
| Rate for Payer: VA VA |
$17.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.75
|
|
|
HC INTERLEUKIN 6, PLASMA
|
Facility
|
IP
|
$129.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100710
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$56.76 |
| Max. Negotiated Rate |
$116.10 |
| Rate for Payer: Aetna American Axle |
$83.85
|
| Rate for Payer: Aetna Commercial |
$109.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.85
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cofinity Commercial |
$110.94
|
| Rate for Payer: Cofinity Commercial |
$90.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.20
|
| Rate for Payer: Healthscope Commercial |
$116.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$90.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$109.65
|
| Rate for Payer: PHP Commercial |
$109.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.30
|
| Rate for Payer: Priority Health SBD |
$81.27
|
| Rate for Payer: UMR Bronson Commercial |
$56.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.75
|
|
|
HC INTERMEDIATE CARE R & B
|
Facility
|
IP
|
$4,800.09
|
|
| Hospital Charge Code |
20600001
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$2,112.04 |
| Max. Negotiated Rate |
$4,320.08 |
| Rate for Payer: Aetna American Axle |
$3,120.06
|
| Rate for Payer: Aetna Commercial |
$4,080.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,120.06
|
| Rate for Payer: Cash Price |
$3,840.07
|
| Rate for Payer: Cofinity Commercial |
$3,360.06
|
| Rate for Payer: Cofinity Commercial |
$4,128.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,840.07
|
| Rate for Payer: Healthscope Commercial |
$4,320.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,360.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,600.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,080.08
|
| Rate for Payer: PHP Commercial |
$4,080.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,360.06
|
| Rate for Payer: Priority Health SBD |
$3,024.06
|
| Rate for Payer: UMR Bronson Commercial |
$2,112.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,600.07
|
|
|
HC INTERMEDIATE NURSERY CARE
|
Facility
|
IP
|
$2,824.42
|
|
| Hospital Charge Code |
17100001
|
|
Hospital Revenue Code
|
171
|
| Min. Negotiated Rate |
$919.00 |
| Max. Negotiated Rate |
$2,541.98 |
| Rate for Payer: Aetna American Axle |
$1,835.87
|
| Rate for Payer: Aetna Commercial |
$2,400.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,835.87
|
| Rate for Payer: Cash Price |
$2,259.54
|
| Rate for Payer: Cash Price |
$2,259.54
|
| Rate for Payer: Cofinity Commercial |
$2,429.00
|
| Rate for Payer: Cofinity Commercial |
$1,977.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,259.54
|
| Rate for Payer: Healthscope Commercial |
$2,541.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,977.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,118.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,400.76
|
| Rate for Payer: PHP Commercial |
$2,400.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,977.09
|
| Rate for Payer: Priority Health SBD |
$1,779.38
|
| Rate for Payer: UHC Exchange |
$919.00
|
| Rate for Payer: UMR Bronson Commercial |
$1,242.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,118.32
|
|
|
HC INTERMEDIATE REPAIR WOUND NECK, HANDS, FEET, GENITALIA 2.6 TO 7.5 CM
|
Facility
|
IP
|
$526.32
|
|
|
Service Code
|
CPT 12042
|
| Hospital Charge Code |
76100117
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$231.58 |
| Max. Negotiated Rate |
$473.69 |
| Rate for Payer: Aetna American Axle |
$342.11
|
| Rate for Payer: Aetna Commercial |
$447.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$342.11
|
| Rate for Payer: Cash Price |
$421.06
|
| Rate for Payer: Cofinity Commercial |
$368.42
|
| Rate for Payer: Cofinity Commercial |
$452.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$421.06
|
| Rate for Payer: Healthscope Commercial |
$473.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$368.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$394.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$447.37
|
| Rate for Payer: PHP Commercial |
$447.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$368.42
|
| Rate for Payer: Priority Health SBD |
$331.58
|
| Rate for Payer: UMR Bronson Commercial |
$231.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$394.74
|
|
|
HC INTERMEDIATE REPAIR WOUND NECK, HANDS, FEET, GENITALIA 2.6 TO 7.5 CM
|
Facility
|
OP
|
$526.32
|
|
|
Service Code
|
CPT 12042
|
| Hospital Charge Code |
76100117
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$191.88 |
| Max. Negotiated Rate |
$1,115.78 |
| Rate for Payer: Aetna American Axle |
$342.11
|
| Rate for Payer: Aetna Commercial |
$447.37
|
| Rate for Payer: Aetna Medicare |
$368.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$342.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$443.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$443.04
|
| Rate for Payer: BCBS Complete |
$203.58
|
| Rate for Payer: BCBS MAPPO |
$354.43
|
| Rate for Payer: BCBS Trust/PPO |
$426.65
|
| Rate for Payer: BCN Medicare Advantage |
$354.43
|
| Rate for Payer: Cash Price |
$421.06
|
| Rate for Payer: Cash Price |
$421.06
|
| Rate for Payer: Cofinity Commercial |
$452.64
|
| Rate for Payer: Cofinity Commercial |
$368.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$421.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.43
|
| Rate for Payer: Healthscope Commercial |
$473.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$368.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$394.74
|
| Rate for Payer: Mclaren Medicaid |
$193.87
|
| Rate for Payer: Mclaren Medicare |
$354.43
|
| Rate for Payer: Meridian Medicaid |
$203.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$372.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$407.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$447.37
|
| Rate for Payer: PACE Medicare |
$336.71
|
| Rate for Payer: PACE SWMI |
$354.43
|
| Rate for Payer: PHP Commercial |
$447.37
|
| Rate for Payer: PHP Medicare Advantage |
$354.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$193.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$368.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,115.78
|
| Rate for Payer: Priority Health Medicare |
$354.43
|
| Rate for Payer: Priority Health Narrow Network |
$892.62
|
| Rate for Payer: Priority Health SBD |
$331.58
|
| Rate for Payer: Railroad Medicare Medicare |
$354.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$211.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$354.43
|
| Rate for Payer: UHC Exchange |
$191.88
|
| Rate for Payer: UHC Medicare Advantage |
$365.06
|
| Rate for Payer: UMR Bronson Commercial |
$194.74
|
| Rate for Payer: VA VA |
$354.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$394.74
|
|
|
HC INTERP REN/VISC PTRA ADD VESS
|
Facility
|
IP
|
$1,851.36
|
|
| Hospital Charge Code |
32000266
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$814.60 |
| Max. Negotiated Rate |
$1,666.22 |
| Rate for Payer: Aetna American Axle |
$1,203.38
|
| Rate for Payer: Aetna Commercial |
$1,573.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,203.38
|
| Rate for Payer: Cash Price |
$1,481.09
|
| Rate for Payer: Cofinity Commercial |
$1,295.95
|
| Rate for Payer: Cofinity Commercial |
$1,592.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,481.09
|
| Rate for Payer: Healthscope Commercial |
$1,666.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,295.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,388.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,573.66
|
| Rate for Payer: PHP Commercial |
$1,573.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,295.95
|
| Rate for Payer: Priority Health SBD |
$1,166.36
|
| Rate for Payer: UMR Bronson Commercial |
$814.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,388.52
|
|
|
HC INTERP REN/VISC PTRA ADD VESS
|
Facility
|
OP
|
$1,851.36
|
|
| Hospital Charge Code |
32000266
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$262.00 |
| Max. Negotiated Rate |
$1,666.22 |
| Rate for Payer: Aetna American Axle |
$1,203.38
|
| Rate for Payer: Aetna Commercial |
$1,573.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,203.38
|
| Rate for Payer: BCBS Complete |
$740.54
|
| Rate for Payer: Cash Price |
$1,481.09
|
| Rate for Payer: Cash Price |
$1,481.09
|
| Rate for Payer: Cofinity Commercial |
$1,592.17
|
| Rate for Payer: Cofinity Commercial |
$1,295.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,481.09
|
| Rate for Payer: Healthscope Commercial |
$1,666.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,295.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,388.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,573.66
|
| Rate for Payer: PHP Commercial |
$1,573.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,295.95
|
| Rate for Payer: Priority Health SBD |
$1,166.36
|
| Rate for Payer: UHC Core |
$262.00
|
| Rate for Payer: UMR Bronson Commercial |
$685.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,388.52
|
|
|
HC INTER REPAIR WOUND SCALP, AXILLAE, TRUNK, EXTREMITIES 2.5 CM OR LESS
|
Facility
|
IP
|
$276.07
|
|
|
Service Code
|
CPT 12031
|
| Hospital Charge Code |
76100115
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$121.47 |
| Max. Negotiated Rate |
$248.46 |
| Rate for Payer: Aetna American Axle |
$179.45
|
| Rate for Payer: Aetna Commercial |
$234.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.45
|
| Rate for Payer: Cash Price |
$220.86
|
| Rate for Payer: Cofinity Commercial |
$193.25
|
| Rate for Payer: Cofinity Commercial |
$237.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.86
|
| Rate for Payer: Healthscope Commercial |
$248.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$193.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$207.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$234.66
|
| Rate for Payer: PHP Commercial |
$234.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.25
|
| Rate for Payer: Priority Health SBD |
$173.92
|
| Rate for Payer: UMR Bronson Commercial |
$121.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.05
|
|
|
HC INTER REPAIR WOUND SCALP, AXILLAE, TRUNK, EXTREMITIES 2.5 CM OR LESS
|
Facility
|
OP
|
$276.07
|
|
|
Service Code
|
CPT 12031
|
| Hospital Charge Code |
76100115
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$102.15 |
| Max. Negotiated Rate |
$1,115.78 |
| Rate for Payer: Aetna American Axle |
$179.45
|
| Rate for Payer: Aetna Commercial |
$234.66
|
| Rate for Payer: Aetna Medicare |
$368.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$443.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$443.04
|
| Rate for Payer: BCBS Complete |
$203.58
|
| Rate for Payer: BCBS MAPPO |
$354.43
|
| Rate for Payer: BCBS Trust/PPO |
$398.96
|
| Rate for Payer: BCN Medicare Advantage |
$354.43
|
| Rate for Payer: Cash Price |
$220.86
|
| Rate for Payer: Cash Price |
$220.86
|
| Rate for Payer: Cofinity Commercial |
$193.25
|
| Rate for Payer: Cofinity Commercial |
$237.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.43
|
| Rate for Payer: Healthscope Commercial |
$248.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$193.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$207.05
|
| Rate for Payer: Mclaren Medicaid |
$193.87
|
| Rate for Payer: Mclaren Medicare |
$354.43
|
| Rate for Payer: Meridian Medicaid |
$203.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$372.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$407.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$234.66
|
| Rate for Payer: PACE Medicare |
$336.71
|
| Rate for Payer: PACE SWMI |
$354.43
|
| Rate for Payer: PHP Commercial |
$234.66
|
| Rate for Payer: PHP Medicare Advantage |
$354.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$193.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,115.78
|
| Rate for Payer: Priority Health Medicare |
$354.43
|
| Rate for Payer: Priority Health Narrow Network |
$892.62
|
| Rate for Payer: Priority Health SBD |
$173.92
|
| Rate for Payer: Railroad Medicare Medicare |
$354.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$163.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$354.43
|
| Rate for Payer: UHC Exchange |
$148.66
|
| Rate for Payer: UHC Medicare Advantage |
$365.06
|
| Rate for Payer: UMR Bronson Commercial |
$102.15
|
| Rate for Payer: VA VA |
$354.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.05
|
|
|
HC INTER REPAIR WOUND SCALP, AXILLAE, TRUNK, EXTREMITIES 2.6 TO 7.5 CM
|
Facility
|
IP
|
$303.68
|
|
|
Service Code
|
CPT 12032
|
| Hospital Charge Code |
76100116
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$133.62 |
| Max. Negotiated Rate |
$273.31 |
| Rate for Payer: Aetna American Axle |
$197.39
|
| Rate for Payer: Aetna Commercial |
$258.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$197.39
|
| Rate for Payer: Cash Price |
$242.94
|
| Rate for Payer: Cofinity Commercial |
$212.58
|
| Rate for Payer: Cofinity Commercial |
$261.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.94
|
| Rate for Payer: Healthscope Commercial |
$273.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$212.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$227.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$258.13
|
| Rate for Payer: PHP Commercial |
$258.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.58
|
| Rate for Payer: Priority Health SBD |
$191.32
|
| Rate for Payer: UMR Bronson Commercial |
$133.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$227.76
|
|
|
HC INTER REPAIR WOUND SCALP, AXILLAE, TRUNK, EXTREMITIES 2.6 TO 7.5 CM
|
Facility
|
OP
|
$303.68
|
|
|
Service Code
|
CPT 12032
|
| Hospital Charge Code |
76100116
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$112.36 |
| Max. Negotiated Rate |
$1,115.78 |
| Rate for Payer: Aetna American Axle |
$197.39
|
| Rate for Payer: Aetna Commercial |
$258.13
|
| Rate for Payer: Aetna Medicare |
$368.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$197.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$443.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$443.04
|
| Rate for Payer: BCBS Complete |
$203.58
|
| Rate for Payer: BCBS MAPPO |
$354.43
|
| Rate for Payer: BCBS Trust/PPO |
$534.63
|
| Rate for Payer: BCN Medicare Advantage |
$354.43
|
| Rate for Payer: Cash Price |
$242.94
|
| Rate for Payer: Cash Price |
$242.94
|
| Rate for Payer: Cofinity Commercial |
$212.58
|
| Rate for Payer: Cofinity Commercial |
$261.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.43
|
| Rate for Payer: Healthscope Commercial |
$273.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$212.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$227.76
|
| Rate for Payer: Mclaren Medicaid |
$193.87
|
| Rate for Payer: Mclaren Medicare |
$354.43
|
| Rate for Payer: Meridian Medicaid |
$203.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$372.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$407.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$258.13
|
| Rate for Payer: PACE Medicare |
$336.71
|
| Rate for Payer: PACE SWMI |
$354.43
|
| Rate for Payer: PHP Commercial |
$258.13
|
| Rate for Payer: PHP Medicare Advantage |
$354.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$193.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,115.78
|
| Rate for Payer: Priority Health Medicare |
$354.43
|
| Rate for Payer: Priority Health Narrow Network |
$892.62
|
| Rate for Payer: Priority Health SBD |
$191.32
|
| Rate for Payer: Railroad Medicare Medicare |
$354.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$205.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$354.43
|
| Rate for Payer: UHC Exchange |
$186.64
|
| Rate for Payer: UHC Medicare Advantage |
$365.06
|
| Rate for Payer: UMR Bronson Commercial |
$112.36
|
| Rate for Payer: VA VA |
$354.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$227.76
|
|
|
HC INTER REPAIR WOUND SCALP, AXILLAE, TRUNK, EXTREMITIES 7.6CM TO 12.5CM
|
Facility
|
OP
|
$488.86
|
|
|
Service Code
|
CPT 12034
|
| Hospital Charge Code |
76100239
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$180.88 |
| Max. Negotiated Rate |
$1,115.78 |
| Rate for Payer: Aetna American Axle |
$317.76
|
| Rate for Payer: Aetna Commercial |
$415.53
|
| Rate for Payer: Aetna Medicare |
$368.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$317.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$443.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$443.04
|
| Rate for Payer: BCBS Complete |
$203.58
|
| Rate for Payer: BCBS MAPPO |
$354.43
|
| Rate for Payer: BCBS Trust/PPO |
$534.99
|
| Rate for Payer: BCN Medicare Advantage |
$354.43
|
| Rate for Payer: Cash Price |
$391.09
|
| Rate for Payer: Cash Price |
$391.09
|
| Rate for Payer: Cofinity Commercial |
$420.42
|
| Rate for Payer: Cofinity Commercial |
$342.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$391.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.43
|
| Rate for Payer: Healthscope Commercial |
$439.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$342.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$366.64
|
| Rate for Payer: Mclaren Medicaid |
$193.87
|
| Rate for Payer: Mclaren Medicare |
$354.43
|
| Rate for Payer: Meridian Medicaid |
$203.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$372.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$407.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$415.53
|
| Rate for Payer: PACE Medicare |
$336.71
|
| Rate for Payer: PACE SWMI |
$354.43
|
| Rate for Payer: PHP Commercial |
$415.53
|
| Rate for Payer: PHP Medicare Advantage |
$354.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$193.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$342.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,115.78
|
| Rate for Payer: Priority Health Medicare |
$354.43
|
| Rate for Payer: Priority Health Narrow Network |
$892.62
|
| Rate for Payer: Priority Health SBD |
$307.98
|
| Rate for Payer: Railroad Medicare Medicare |
$354.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$221.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$354.43
|
| Rate for Payer: UHC Exchange |
$201.38
|
| Rate for Payer: UHC Medicare Advantage |
$365.06
|
| Rate for Payer: UMR Bronson Commercial |
$180.88
|
| Rate for Payer: VA VA |
$354.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$366.64
|
|
|
HC INTER REPAIR WOUND SCALP, AXILLAE, TRUNK, EXTREMITIES 7.6CM TO 12.5CM
|
Facility
|
IP
|
$488.86
|
|
|
Service Code
|
CPT 12034
|
| Hospital Charge Code |
76100239
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$215.10 |
| Max. Negotiated Rate |
$439.97 |
| Rate for Payer: Aetna American Axle |
$317.76
|
| Rate for Payer: Aetna Commercial |
$415.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$317.76
|
| Rate for Payer: Cash Price |
$391.09
|
| Rate for Payer: Cofinity Commercial |
$342.20
|
| Rate for Payer: Cofinity Commercial |
$420.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$391.09
|
| Rate for Payer: Healthscope Commercial |
$439.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$342.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$366.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$415.53
|
| Rate for Payer: PHP Commercial |
$415.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$342.20
|
| Rate for Payer: Priority Health SBD |
$307.98
|
| Rate for Payer: UMR Bronson Commercial |
$215.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$366.64
|
|
|
HC INTER REP WD FACE, EAR, EYELID, NOSE, LIP, MUC MEMBRS 2.5 CM OR LESS
|
Facility
|
IP
|
$276.07
|
|
|
Service Code
|
CPT 12051
|
| Hospital Charge Code |
76100118
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$121.47 |
| Max. Negotiated Rate |
$248.46 |
| Rate for Payer: Aetna American Axle |
$179.45
|
| Rate for Payer: Aetna Commercial |
$234.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.45
|
| Rate for Payer: Cash Price |
$220.86
|
| Rate for Payer: Cofinity Commercial |
$193.25
|
| Rate for Payer: Cofinity Commercial |
$237.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.86
|
| Rate for Payer: Healthscope Commercial |
$248.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$193.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$207.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$234.66
|
| Rate for Payer: PHP Commercial |
$234.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.25
|
| Rate for Payer: Priority Health SBD |
$173.92
|
| Rate for Payer: UMR Bronson Commercial |
$121.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.05
|
|
|
HC INTER REP WD FACE, EAR, EYELID, NOSE, LIP, MUC MEMBRS 2.5 CM OR LESS
|
Facility
|
OP
|
$276.07
|
|
|
Service Code
|
CPT 12051
|
| Hospital Charge Code |
76100118
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$102.15 |
| Max. Negotiated Rate |
$1,115.78 |
| Rate for Payer: Aetna American Axle |
$179.45
|
| Rate for Payer: Aetna Commercial |
$234.66
|
| Rate for Payer: Aetna Medicare |
$368.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$443.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$443.04
|
| Rate for Payer: BCBS Complete |
$203.58
|
| Rate for Payer: BCBS MAPPO |
$354.43
|
| Rate for Payer: BCBS Trust/PPO |
$235.46
|
| Rate for Payer: BCN Medicare Advantage |
$354.43
|
| Rate for Payer: Cash Price |
$220.86
|
| Rate for Payer: Cash Price |
$220.86
|
| Rate for Payer: Cofinity Commercial |
$193.25
|
| Rate for Payer: Cofinity Commercial |
$237.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.43
|
| Rate for Payer: Healthscope Commercial |
$248.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$193.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$207.05
|
| Rate for Payer: Mclaren Medicaid |
$193.87
|
| Rate for Payer: Mclaren Medicare |
$354.43
|
| Rate for Payer: Meridian Medicaid |
$203.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$372.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$407.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$234.66
|
| Rate for Payer: PACE Medicare |
$336.71
|
| Rate for Payer: PACE SWMI |
$354.43
|
| Rate for Payer: PHP Commercial |
$234.66
|
| Rate for Payer: PHP Medicare Advantage |
$354.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$193.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,115.78
|
| Rate for Payer: Priority Health Medicare |
$354.43
|
| Rate for Payer: Priority Health Narrow Network |
$892.62
|
| Rate for Payer: Priority Health SBD |
$173.92
|
| Rate for Payer: Railroad Medicare Medicare |
$354.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$182.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$354.43
|
| Rate for Payer: UHC Exchange |
$166.34
|
| Rate for Payer: UHC Medicare Advantage |
$365.06
|
| Rate for Payer: UMR Bronson Commercial |
$102.15
|
| Rate for Payer: VA VA |
$354.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.05
|
|
|
HC INTER REP WD FACE, EARS, EYELIDS, NOSE, LIP, MUC MEMBRANES 2.6 TO 5.0 CM
|
Facility
|
OP
|
$303.68
|
|
|
Service Code
|
CPT 12052
|
| Hospital Charge Code |
76100119
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$112.36 |
| Max. Negotiated Rate |
$1,115.78 |
| Rate for Payer: Aetna American Axle |
$197.39
|
| Rate for Payer: Aetna Commercial |
$258.13
|
| Rate for Payer: Aetna Medicare |
$368.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$197.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$443.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$443.04
|
| Rate for Payer: BCBS Complete |
$203.58
|
| Rate for Payer: BCBS MAPPO |
$354.43
|
| Rate for Payer: BCBS Trust/PPO |
$425.18
|
| Rate for Payer: BCN Medicare Advantage |
$354.43
|
| Rate for Payer: Cash Price |
$242.94
|
| Rate for Payer: Cash Price |
$242.94
|
| Rate for Payer: Cofinity Commercial |
$212.58
|
| Rate for Payer: Cofinity Commercial |
$261.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.43
|
| Rate for Payer: Healthscope Commercial |
$273.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$212.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$227.76
|
| Rate for Payer: Mclaren Medicaid |
$193.87
|
| Rate for Payer: Mclaren Medicare |
$354.43
|
| Rate for Payer: Meridian Medicaid |
$203.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$372.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$407.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$258.13
|
| Rate for Payer: PACE Medicare |
$336.71
|
| Rate for Payer: PACE SWMI |
$354.43
|
| Rate for Payer: PHP Commercial |
$258.13
|
| Rate for Payer: PHP Medicare Advantage |
$354.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$193.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,115.78
|
| Rate for Payer: Priority Health Medicare |
$354.43
|
| Rate for Payer: Priority Health Narrow Network |
$892.62
|
| Rate for Payer: Priority Health SBD |
$191.32
|
| Rate for Payer: Railroad Medicare Medicare |
$354.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$215.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$354.43
|
| Rate for Payer: UHC Exchange |
$195.48
|
| Rate for Payer: UHC Medicare Advantage |
$365.06
|
| Rate for Payer: UMR Bronson Commercial |
$112.36
|
| Rate for Payer: VA VA |
$354.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$227.76
|
|
|
HC INTER REP WD FACE, EARS, EYELIDS, NOSE, LIP, MUC MEMBRANES 2.6 TO 5.0 CM
|
Facility
|
IP
|
$303.68
|
|
|
Service Code
|
CPT 12052
|
| Hospital Charge Code |
76100119
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$133.62 |
| Max. Negotiated Rate |
$273.31 |
| Rate for Payer: Aetna American Axle |
$197.39
|
| Rate for Payer: Aetna Commercial |
$258.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$197.39
|
| Rate for Payer: Cash Price |
$242.94
|
| Rate for Payer: Cofinity Commercial |
$212.58
|
| Rate for Payer: Cofinity Commercial |
$261.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.94
|
| Rate for Payer: Healthscope Commercial |
$273.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$212.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$227.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$258.13
|
| Rate for Payer: PHP Commercial |
$258.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.58
|
| Rate for Payer: Priority Health SBD |
$191.32
|
| Rate for Payer: UMR Bronson Commercial |
$133.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$227.76
|
|
|
HC INTMD RPR WND FACE/MM 5.1-7.5 CM
|
Facility
|
IP
|
$881.89
|
|
|
Service Code
|
CPT 12053
|
| Hospital Charge Code |
76100315
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$388.03 |
| Max. Negotiated Rate |
$793.70 |
| Rate for Payer: Aetna American Axle |
$573.23
|
| Rate for Payer: Aetna Commercial |
$749.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$573.23
|
| Rate for Payer: Cash Price |
$705.51
|
| Rate for Payer: Cofinity Commercial |
$617.32
|
| Rate for Payer: Cofinity Commercial |
$758.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$705.51
|
| Rate for Payer: Healthscope Commercial |
$793.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$617.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$661.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$749.61
|
| Rate for Payer: PHP Commercial |
$749.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$617.32
|
| Rate for Payer: Priority Health SBD |
$555.59
|
| Rate for Payer: UMR Bronson Commercial |
$388.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$661.42
|
|
