|
HC DEFINITY CONTRAST 1ST ML
|
Facility
|
IP
|
$302.02
|
|
|
Service Code
|
HCPCS Q9957
|
| Hospital Charge Code |
63600002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$132.89 |
| Max. Negotiated Rate |
$271.82 |
| Rate for Payer: Aetna American Axle |
$196.31
|
| Rate for Payer: Aetna Commercial |
$256.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.31
|
| Rate for Payer: Cash Price |
$241.62
|
| Rate for Payer: Cofinity Advantage |
$211.41
|
| Rate for Payer: Cofinity Commercial |
$259.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.62
|
| Rate for Payer: Healthscope Commercial |
$271.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$211.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$226.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$256.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$226.51
|
| Rate for Payer: PHP Commercial |
$256.72
|
| Rate for Payer: Priority Health SBD |
$190.27
|
| Rate for Payer: UMR Bronson Commercial |
$132.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$226.51
|
|
|
HC DEFINITY CONTRAST 1ST ML
|
Facility
|
OP
|
$302.02
|
|
|
Service Code
|
HCPCS Q9957
|
| Hospital Charge Code |
63600002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$66.35 |
| Max. Negotiated Rate |
$271.82 |
| Rate for Payer: Aetna American Axle |
$196.31
|
| Rate for Payer: Aetna Commercial |
$256.72
|
| Rate for Payer: Aetna Medicare |
$151.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.31
|
| Rate for Payer: BCBS Complete |
$120.81
|
| Rate for Payer: BCBS Trust/PPO |
$130.36
|
| Rate for Payer: BCN Commercial |
$130.36
|
| Rate for Payer: Cash Price |
$241.62
|
| Rate for Payer: Cash Price |
$241.62
|
| Rate for Payer: Cofinity Advantage |
$211.41
|
| Rate for Payer: Cofinity Commercial |
$259.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.62
|
| Rate for Payer: Healthscope Commercial |
$271.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$211.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$226.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$241.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$256.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$226.51
|
| Rate for Payer: PHP Commercial |
$256.72
|
| Rate for Payer: Priority Health SBD |
$190.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.35
|
| Rate for Payer: UHC Core |
$66.35
|
| Rate for Payer: UHC Exchange |
$66.35
|
| Rate for Payer: UMR Bronson Commercial |
$111.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$226.51
|
|
|
HC DEFINITY CONTRAST 2ND ML
|
Facility
|
OP
|
$302.02
|
|
|
Service Code
|
HCPCS Q9957
|
| Hospital Charge Code |
63600003
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$66.35 |
| Max. Negotiated Rate |
$271.82 |
| Rate for Payer: Aetna American Axle |
$196.31
|
| Rate for Payer: Aetna Commercial |
$256.72
|
| Rate for Payer: Aetna Medicare |
$151.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.31
|
| Rate for Payer: BCBS Complete |
$120.81
|
| Rate for Payer: BCBS Trust/PPO |
$130.36
|
| Rate for Payer: BCN Commercial |
$130.36
|
| Rate for Payer: Cash Price |
$241.62
|
| Rate for Payer: Cash Price |
$241.62
|
| Rate for Payer: Cofinity Advantage |
$211.41
|
| Rate for Payer: Cofinity Commercial |
$259.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.62
|
| Rate for Payer: Healthscope Commercial |
$271.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$211.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$226.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$241.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$256.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$226.51
|
| Rate for Payer: PHP Commercial |
$256.72
|
| Rate for Payer: Priority Health SBD |
$190.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.35
|
| Rate for Payer: UHC Core |
$66.35
|
| Rate for Payer: UHC Exchange |
$66.35
|
| Rate for Payer: UMR Bronson Commercial |
$111.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$226.51
|
|
|
HC DEFINITY CONTRAST 2ND ML
|
Facility
|
IP
|
$302.02
|
|
|
Service Code
|
HCPCS Q9957
|
| Hospital Charge Code |
63600003
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$132.89 |
| Max. Negotiated Rate |
$271.82 |
| Rate for Payer: Aetna American Axle |
$196.31
|
| Rate for Payer: Aetna Commercial |
$256.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.31
|
| Rate for Payer: Cash Price |
$241.62
|
| Rate for Payer: Cofinity Advantage |
$211.41
|
| Rate for Payer: Cofinity Commercial |
$259.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.62
|
| Rate for Payer: Healthscope Commercial |
$271.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$211.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$226.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$256.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$226.51
|
| Rate for Payer: PHP Commercial |
$256.72
|
| Rate for Payer: Priority Health SBD |
$190.27
|
| Rate for Payer: UMR Bronson Commercial |
$132.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$226.51
|
|
|
HC DEGARELIX INJECTION PER 1MG
|
Facility
|
OP
|
$6.36
|
|
|
Service Code
|
HCPCS J9155
|
| Hospital Charge Code |
63600146
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.33 |
| Max. Negotiated Rate |
$14.42 |
| Rate for Payer: Aetna American Axle |
$4.13
|
| Rate for Payer: Aetna Commercial |
$5.41
|
| Rate for Payer: Aetna Medicare |
$4.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.58
|
| Rate for Payer: BCBS Complete |
$2.45
|
| Rate for Payer: BCBS MAPPO |
$4.46
|
| Rate for Payer: BCBS Trust/PPO |
$14.42
|
| Rate for Payer: BCN Commercial |
$14.42
|
| Rate for Payer: BCN Medicare Advantage |
$4.46
|
| Rate for Payer: Cash Price |
$5.09
|
| Rate for Payer: Cash Price |
$5.09
|
| Rate for Payer: Cofinity Advantage |
$4.45
|
| Rate for Payer: Cofinity Commercial |
$5.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.46
|
| Rate for Payer: Healthscope Commercial |
$5.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.77
|
| Rate for Payer: Mclaren Medicaid |
$4.46
|
| Rate for Payer: Mclaren Medicare |
$4.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.68
|
| Rate for Payer: Meridian Medicaid |
$4.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.41
|
| Rate for Payer: Nomi Health Commercial |
$13.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.77
|
| Rate for Payer: PACE Medicare |
$4.24
|
| Rate for Payer: PACE SWMI |
$4.46
|
| Rate for Payer: PHP Commercial |
$5.41
|
| Rate for Payer: PHP Medicare Advantage |
$4.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$14.04
|
| Rate for Payer: Priority Health Medicare |
$4.46
|
| Rate for Payer: Priority Health SBD |
$4.01
|
| Rate for Payer: Priority Health Tiered Network |
$11.23
|
| Rate for Payer: Railroad Medicare Medicare |
$4.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.34
|
| Rate for Payer: UHC Core |
$7.34
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4.46
|
| Rate for Payer: UHC Exchange |
$7.34
|
| Rate for Payer: UHC Medicaid |
$2.33
|
| Rate for Payer: UHCCP Medicaid |
$2.33
|
| Rate for Payer: UMR Bronson Commercial |
$2.35
|
| Rate for Payer: VA VA |
$4.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.77
|
|
|
HC DEGARELIX INJECTION PER 1MG
|
Facility
|
IP
|
$6.36
|
|
|
Service Code
|
HCPCS J9155
|
| Hospital Charge Code |
63600146
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$5.72 |
| Rate for Payer: Aetna American Axle |
$4.13
|
| Rate for Payer: Aetna Commercial |
$5.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.13
|
| Rate for Payer: Cash Price |
$5.09
|
| Rate for Payer: Cofinity Advantage |
$4.45
|
| Rate for Payer: Cofinity Commercial |
$5.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.09
|
| Rate for Payer: Healthscope Commercial |
$5.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.77
|
| Rate for Payer: PHP Commercial |
$5.41
|
| Rate for Payer: Priority Health SBD |
$4.01
|
| Rate for Payer: UMR Bronson Commercial |
$2.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.77
|
|
|
HC DEGLYCEROLIZED RED BLOOD CELLS
|
Facility
|
OP
|
$962.94
|
|
|
Service Code
|
HCPCS P9039
|
| Hospital Charge Code |
39000049
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$159.65 |
| Max. Negotiated Rate |
$1,729.34 |
| Rate for Payer: Aetna American Axle |
$625.91
|
| Rate for Payer: Aetna Commercial |
$818.50
|
| Rate for Payer: Aetna Medicare |
$317.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$625.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$381.57
|
| Rate for Payer: Amish Plain Church Group Commercial |
$381.57
|
| Rate for Payer: BCBS Complete |
$167.65
|
| Rate for Payer: BCBS MAPPO |
$305.26
|
| Rate for Payer: BCBS Trust/PPO |
$1,729.34
|
| Rate for Payer: BCN Commercial |
$1,729.34
|
| Rate for Payer: BCN Medicare Advantage |
$305.26
|
| Rate for Payer: Cash Price |
$770.35
|
| Rate for Payer: Cash Price |
$770.35
|
| Rate for Payer: Cofinity Advantage |
$674.06
|
| Rate for Payer: Cofinity Commercial |
$828.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$770.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.26
|
| Rate for Payer: Healthscope Commercial |
$866.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$674.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$722.21
|
| Rate for Payer: Mclaren Medicaid |
$305.26
|
| Rate for Payer: Mclaren Medicare |
$305.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$320.52
|
| Rate for Payer: Meridian Medicaid |
$320.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$351.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$335.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$818.50
|
| Rate for Payer: Nomi Health Commercial |
$915.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$722.21
|
| Rate for Payer: PACE Medicare |
$290.00
|
| Rate for Payer: PACE SWMI |
$305.26
|
| Rate for Payer: PHP Commercial |
$818.50
|
| Rate for Payer: PHP Medicare Advantage |
$305.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$159.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$987.21
|
| Rate for Payer: Priority Health Medicare |
$305.26
|
| Rate for Payer: Priority Health SBD |
$606.65
|
| Rate for Payer: Priority Health Tiered Network |
$789.77
|
| Rate for Payer: Railroad Medicare Medicare |
$305.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$625.91
|
| Rate for Payer: UHC Core |
$501.69
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$305.26
|
| Rate for Payer: UHC Exchange |
$378.44
|
| Rate for Payer: UHC Medicaid |
$159.65
|
| Rate for Payer: UHCCP Medicaid |
$159.65
|
| Rate for Payer: UMR Bronson Commercial |
$356.29
|
| Rate for Payer: VA VA |
$305.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$722.21
|
|
|
HC DEGLYCEROLIZED RED BLOOD CELLS
|
Facility
|
IP
|
$962.94
|
|
|
Service Code
|
HCPCS P9039
|
| Hospital Charge Code |
39000049
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$423.69 |
| Max. Negotiated Rate |
$866.65 |
| Rate for Payer: Aetna American Axle |
$625.91
|
| Rate for Payer: Aetna Commercial |
$818.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$625.91
|
| Rate for Payer: Cash Price |
$770.35
|
| Rate for Payer: Cofinity Advantage |
$674.06
|
| Rate for Payer: Cofinity Commercial |
$828.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$770.35
|
| Rate for Payer: Healthscope Commercial |
$866.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$674.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$722.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$818.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$722.21
|
| Rate for Payer: PHP Commercial |
$818.50
|
| Rate for Payer: Priority Health SBD |
$606.65
|
| Rate for Payer: UMR Bronson Commercial |
$423.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$722.21
|
|
|
HC DELAY FLAP/SCTJ FLAP EYELIDS NOSE EARS/LIPS
|
Facility
|
IP
|
$5,309.16
|
|
|
Service Code
|
CPT 15630
|
| Hospital Charge Code |
76100415
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,336.03 |
| Max. Negotiated Rate |
$4,778.24 |
| Rate for Payer: Aetna American Axle |
$3,450.95
|
| Rate for Payer: Aetna Commercial |
$4,512.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,450.95
|
| Rate for Payer: Cash Price |
$4,247.33
|
| Rate for Payer: Cofinity Advantage |
$3,716.41
|
| Rate for Payer: Cofinity Commercial |
$4,565.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,247.33
|
| Rate for Payer: Healthscope Commercial |
$4,778.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,716.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,981.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,512.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,981.87
|
| Rate for Payer: PHP Commercial |
$4,512.79
|
| Rate for Payer: Priority Health SBD |
$3,344.77
|
| Rate for Payer: UMR Bronson Commercial |
$2,336.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,981.87
|
|
|
HC DELAY FLAP/SCTJ FLAP EYELIDS NOSE EARS/LIPS
|
Facility
|
OP
|
$5,309.16
|
|
|
Service Code
|
CPT 15630
|
| Hospital Charge Code |
76100415
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,075.21 |
| Max. Negotiated Rate |
$6,648.46 |
| Rate for Payer: Aetna American Axle |
$3,450.95
|
| Rate for Payer: Aetna Commercial |
$4,512.79
|
| Rate for Payer: Aetna Medicare |
$2,138.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,450.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,569.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,569.82
|
| Rate for Payer: BCBS Complete |
$1,129.08
|
| Rate for Payer: BCBS MAPPO |
$2,055.86
|
| Rate for Payer: BCBS Trust/PPO |
$1,693.74
|
| Rate for Payer: BCN Commercial |
$1,693.74
|
| Rate for Payer: BCN Medicare Advantage |
$2,055.86
|
| Rate for Payer: Cash Price |
$4,247.33
|
| Rate for Payer: Cash Price |
$4,247.33
|
| Rate for Payer: Cash Price |
$4,247.33
|
| Rate for Payer: Cofinity Advantage |
$3,716.41
|
| Rate for Payer: Cofinity Commercial |
$4,565.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,247.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,055.86
|
| Rate for Payer: Healthscope Commercial |
$4,778.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,716.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,981.87
|
| Rate for Payer: Mclaren Medicaid |
$2,055.86
|
| Rate for Payer: Mclaren Medicare |
$2,055.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,158.65
|
| Rate for Payer: Meridian Medicaid |
$2,158.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,364.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,261.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,512.79
|
| Rate for Payer: Nomi Health Commercial |
$6,167.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,981.87
|
| Rate for Payer: PACE Medicare |
$1,953.07
|
| Rate for Payer: PACE SWMI |
$2,055.86
|
| Rate for Payer: PHP Commercial |
$4,512.79
|
| Rate for Payer: PHP Medicare Advantage |
$2,055.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,075.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,648.46
|
| Rate for Payer: Priority Health Medicare |
$2,055.86
|
| Rate for Payer: Priority Health SBD |
$3,344.77
|
| Rate for Payer: Priority Health Tiered Network |
$5,318.77
|
| Rate for Payer: Railroad Medicare Medicare |
$2,055.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,450.95
|
| Rate for Payer: UHC Core |
$2,766.07
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,055.86
|
| Rate for Payer: UHC Exchange |
$2,086.50
|
| Rate for Payer: UHC Medicaid |
$1,075.21
|
| Rate for Payer: UHCCP Medicaid |
$1,075.21
|
| Rate for Payer: UMR Bronson Commercial |
$1,964.39
|
| Rate for Payer: VA VA |
$2,055.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,981.87
|
|
|
HC DELIVERY/BIRTH RM RESUSCITATION
|
Facility
|
IP
|
$853.94
|
|
|
Service Code
|
CPT 99465
|
| Hospital Charge Code |
72000011
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$375.73 |
| Max. Negotiated Rate |
$768.55 |
| Rate for Payer: Aetna American Axle |
$555.06
|
| Rate for Payer: Aetna Commercial |
$725.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$555.06
|
| Rate for Payer: Cash Price |
$683.15
|
| Rate for Payer: Cofinity Advantage |
$597.76
|
| Rate for Payer: Cofinity Commercial |
$734.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$683.15
|
| Rate for Payer: Healthscope Commercial |
$768.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$597.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$640.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$725.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$640.46
|
| Rate for Payer: PHP Commercial |
$725.85
|
| Rate for Payer: Priority Health SBD |
$537.98
|
| Rate for Payer: UMR Bronson Commercial |
$375.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$640.46
|
|
|
HC DELIVERY/BIRTH RM RESUSCITATION
|
Facility
|
OP
|
$853.94
|
|
|
Service Code
|
CPT 99465
|
| Hospital Charge Code |
72000011
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$315.96 |
| Max. Negotiated Rate |
$2,129.73 |
| Rate for Payer: Aetna American Axle |
$555.06
|
| Rate for Payer: Aetna Commercial |
$725.85
|
| Rate for Payer: Aetna Medicare |
$684.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$555.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$823.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$823.21
|
| Rate for Payer: BCBS Complete |
$361.69
|
| Rate for Payer: BCBS MAPPO |
$658.57
|
| Rate for Payer: BCN Medicare Advantage |
$658.57
|
| Rate for Payer: Cash Price |
$683.15
|
| Rate for Payer: Cash Price |
$683.15
|
| Rate for Payer: Cofinity Advantage |
$597.76
|
| Rate for Payer: Cofinity Commercial |
$734.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$683.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$658.57
|
| Rate for Payer: Healthscope Commercial |
$768.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$597.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$640.46
|
| Rate for Payer: Mclaren Medicaid |
$658.57
|
| Rate for Payer: Mclaren Medicare |
$658.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$691.50
|
| Rate for Payer: Meridian Medicaid |
$691.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$757.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$724.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$725.85
|
| Rate for Payer: Nomi Health Commercial |
$1,975.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$640.46
|
| Rate for Payer: PACE Medicare |
$625.64
|
| Rate for Payer: PACE SWMI |
$658.57
|
| Rate for Payer: PHP Commercial |
$725.85
|
| Rate for Payer: PHP Medicare Advantage |
$658.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$344.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,129.73
|
| Rate for Payer: Priority Health Medicare |
$658.57
|
| Rate for Payer: Priority Health SBD |
$537.98
|
| Rate for Payer: Priority Health Tiered Network |
$1,703.78
|
| Rate for Payer: Railroad Medicare Medicare |
$658.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$555.06
|
| Rate for Payer: UHC Core |
$444.90
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$658.57
|
| Rate for Payer: UHC Exchange |
$335.60
|
| Rate for Payer: UHC Medicaid |
$344.43
|
| Rate for Payer: UHCCP Medicaid |
$344.43
|
| Rate for Payer: UMR Bronson Commercial |
$315.96
|
| Rate for Payer: VA VA |
$658.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$640.46
|
|
|
HC DEMO EVAL NEB MDI IPPB
|
Facility
|
IP
|
$249.83
|
|
|
Service Code
|
CPT 94664
|
| Hospital Charge Code |
41000009
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$109.93 |
| Max. Negotiated Rate |
$224.85 |
| Rate for Payer: Aetna American Axle |
$162.39
|
| Rate for Payer: Aetna Commercial |
$212.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.39
|
| Rate for Payer: Cash Price |
$199.86
|
| Rate for Payer: Cofinity Advantage |
$174.88
|
| Rate for Payer: Cofinity Commercial |
$214.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.86
|
| Rate for Payer: Healthscope Commercial |
$224.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$174.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$187.37
|
| Rate for Payer: PHP Commercial |
$212.36
|
| Rate for Payer: Priority Health SBD |
$157.39
|
| Rate for Payer: UMR Bronson Commercial |
$109.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.37
|
|
|
HC DEMO EVAL NEB MDI IPPB
|
Facility
|
OP
|
$249.83
|
|
|
Service Code
|
CPT 94664
|
| Hospital Charge Code |
41000009
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$73.27 |
| Max. Negotiated Rate |
$705.61 |
| Rate for Payer: Aetna American Axle |
$162.39
|
| Rate for Payer: Aetna Commercial |
$212.36
|
| Rate for Payer: Aetna Medicare |
$226.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$272.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$272.74
|
| Rate for Payer: BCBS Complete |
$119.83
|
| Rate for Payer: BCBS MAPPO |
$218.19
|
| Rate for Payer: BCBS Trust/PPO |
$73.27
|
| Rate for Payer: BCN Commercial |
$73.27
|
| Rate for Payer: BCN Medicare Advantage |
$218.19
|
| Rate for Payer: Cash Price |
$199.86
|
| Rate for Payer: Cash Price |
$199.86
|
| Rate for Payer: Cofinity Advantage |
$174.88
|
| Rate for Payer: Cofinity Commercial |
$214.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$218.19
|
| Rate for Payer: Healthscope Commercial |
$224.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$174.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.37
|
| Rate for Payer: Mclaren Medicaid |
$218.19
|
| Rate for Payer: Mclaren Medicare |
$218.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$229.10
|
| Rate for Payer: Meridian Medicaid |
$229.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$250.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$240.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.36
|
| Rate for Payer: Nomi Health Commercial |
$654.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$187.37
|
| Rate for Payer: PACE Medicare |
$207.28
|
| Rate for Payer: PACE SWMI |
$218.19
|
| Rate for Payer: PHP Commercial |
$212.36
|
| Rate for Payer: PHP Medicare Advantage |
$218.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$114.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$705.61
|
| Rate for Payer: Priority Health Medicare |
$218.19
|
| Rate for Payer: Priority Health SBD |
$157.39
|
| Rate for Payer: Priority Health Tiered Network |
$564.49
|
| Rate for Payer: Railroad Medicare Medicare |
$218.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$162.39
|
| Rate for Payer: UHC Core |
$130.16
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$218.19
|
| Rate for Payer: UHC Exchange |
$98.18
|
| Rate for Payer: UHC Medicaid |
$114.11
|
| Rate for Payer: UHCCP Medicaid |
$114.11
|
| Rate for Payer: UMR Bronson Commercial |
$92.44
|
| Rate for Payer: VA VA |
$218.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.37
|
|
|
HC DEMO HOME USE INR MONITOR
|
Facility
|
IP
|
$598.12
|
|
|
Service Code
|
HCPCS G0248
|
| Hospital Charge Code |
51000042
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$263.17 |
| Max. Negotiated Rate |
$538.31 |
| Rate for Payer: Aetna American Axle |
$388.78
|
| Rate for Payer: Aetna Commercial |
$508.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$388.78
|
| Rate for Payer: Cash Price |
$478.50
|
| Rate for Payer: Cofinity Advantage |
$418.68
|
| Rate for Payer: Cofinity Commercial |
$514.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$478.50
|
| Rate for Payer: Healthscope Commercial |
$538.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$418.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$448.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$508.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$448.59
|
| Rate for Payer: PHP Commercial |
$508.40
|
| Rate for Payer: Priority Health SBD |
$376.82
|
| Rate for Payer: UMR Bronson Commercial |
$263.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$448.59
|
|
|
HC DEMO HOME USE INR MONITOR
|
Facility
|
OP
|
$598.12
|
|
|
Service Code
|
HCPCS G0248
|
| Hospital Charge Code |
51000042
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$69.38 |
| Max. Negotiated Rate |
$538.31 |
| Rate for Payer: Aetna American Axle |
$388.78
|
| Rate for Payer: Aetna Commercial |
$508.40
|
| Rate for Payer: Aetna Medicare |
$137.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$388.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$165.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$165.82
|
| Rate for Payer: BCBS Complete |
$72.86
|
| Rate for Payer: BCBS MAPPO |
$132.66
|
| Rate for Payer: BCBS Trust/PPO |
$212.90
|
| Rate for Payer: BCN Commercial |
$212.90
|
| Rate for Payer: BCN Medicare Advantage |
$132.66
|
| Rate for Payer: Cash Price |
$478.50
|
| Rate for Payer: Cash Price |
$478.50
|
| Rate for Payer: Cash Price |
$478.50
|
| Rate for Payer: Cofinity Advantage |
$418.68
|
| Rate for Payer: Cofinity Commercial |
$514.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$478.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.66
|
| Rate for Payer: Healthscope Commercial |
$538.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$418.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$448.59
|
| Rate for Payer: Mclaren Medicaid |
$132.66
|
| Rate for Payer: Mclaren Medicare |
$132.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$139.29
|
| Rate for Payer: Meridian Medicaid |
$139.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.56
|
| Rate for Payer: Molina Medicare/Medicaid |
$145.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$508.40
|
| Rate for Payer: Nomi Health Commercial |
$397.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$448.59
|
| Rate for Payer: PACE Medicare |
$126.03
|
| Rate for Payer: PACE SWMI |
$132.66
|
| Rate for Payer: PHP Commercial |
$508.40
|
| Rate for Payer: PHP Medicare Advantage |
$132.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$428.99
|
| Rate for Payer: Priority Health Medicare |
$132.66
|
| Rate for Payer: Priority Health SBD |
$376.82
|
| Rate for Payer: Priority Health Tiered Network |
$343.19
|
| Rate for Payer: Railroad Medicare Medicare |
$132.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$388.78
|
| Rate for Payer: UHC Core |
$311.62
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$132.66
|
| Rate for Payer: UHC Exchange |
$235.06
|
| Rate for Payer: UHC Medicaid |
$69.38
|
| Rate for Payer: UHCCP Medicaid |
$69.38
|
| Rate for Payer: UMR Bronson Commercial |
$221.30
|
| Rate for Payer: VA VA |
$132.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$448.59
|
|
|
HC DENTAL NERVE BLOCK TRIGEMINAL
|
Facility
|
OP
|
$573.10
|
|
|
Service Code
|
CPT 64400
|
| Hospital Charge Code |
45000014
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$159.96 |
| Max. Negotiated Rate |
$989.08 |
| Rate for Payer: Aetna American Axle |
$372.51
|
| Rate for Payer: Aetna Commercial |
$487.13
|
| Rate for Payer: Aetna Medicare |
$318.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$372.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$382.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$382.31
|
| Rate for Payer: BCBS Complete |
$167.97
|
| Rate for Payer: BCBS MAPPO |
$305.85
|
| Rate for Payer: BCBS Trust/PPO |
$368.41
|
| Rate for Payer: BCN Commercial |
$368.41
|
| Rate for Payer: BCN Medicare Advantage |
$305.85
|
| Rate for Payer: Cash Price |
$458.48
|
| Rate for Payer: Cash Price |
$458.48
|
| Rate for Payer: Cash Price |
$458.48
|
| Rate for Payer: Cofinity Advantage |
$401.17
|
| Rate for Payer: Cofinity Commercial |
$492.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$458.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.85
|
| Rate for Payer: Healthscope Commercial |
$515.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$401.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$429.82
|
| Rate for Payer: Mclaren Medicaid |
$305.85
|
| Rate for Payer: Mclaren Medicare |
$305.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$321.14
|
| Rate for Payer: Meridian Medicaid |
$321.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$351.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$336.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$487.13
|
| Rate for Payer: Nomi Health Commercial |
$917.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$429.82
|
| Rate for Payer: PACE Medicare |
$290.56
|
| Rate for Payer: PACE SWMI |
$305.85
|
| Rate for Payer: PHP Commercial |
$487.13
|
| Rate for Payer: PHP Medicare Advantage |
$305.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$159.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$989.08
|
| Rate for Payer: Priority Health Medicare |
$305.85
|
| Rate for Payer: Priority Health SBD |
$361.05
|
| Rate for Payer: Priority Health Tiered Network |
$791.26
|
| Rate for Payer: Railroad Medicare Medicare |
$305.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$372.51
|
| Rate for Payer: UHC Core |
$298.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$305.85
|
| Rate for Payer: UHC Exchange |
$225.23
|
| Rate for Payer: UHC Medicaid |
$159.96
|
| Rate for Payer: UHCCP Medicaid |
$159.96
|
| Rate for Payer: UMR Bronson Commercial |
$212.05
|
| Rate for Payer: VA VA |
$305.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$429.82
|
|
|
HC DENTAL NERVE BLOCK TRIGEMINAL
|
Facility
|
IP
|
$573.10
|
|
|
Service Code
|
CPT 64400
|
| Hospital Charge Code |
45000014
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$252.16 |
| Max. Negotiated Rate |
$515.79 |
| Rate for Payer: Aetna American Axle |
$372.51
|
| Rate for Payer: Aetna Commercial |
$487.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$372.51
|
| Rate for Payer: Cash Price |
$458.48
|
| Rate for Payer: Cofinity Advantage |
$401.17
|
| Rate for Payer: Cofinity Commercial |
$492.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$458.48
|
| Rate for Payer: Healthscope Commercial |
$515.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$401.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$429.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$487.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$429.82
|
| Rate for Payer: PHP Commercial |
$487.13
|
| Rate for Payer: Priority Health SBD |
$361.05
|
| Rate for Payer: UMR Bronson Commercial |
$252.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$429.82
|
|
|
HC DERMAGRAFT PER SQ CM
|
Facility
|
OP
|
$87.27
|
|
|
Service Code
|
HCPCS Q4106
|
| Hospital Charge Code |
63600004
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.29 |
| Max. Negotiated Rate |
$4,940.76 |
| Rate for Payer: Aetna American Axle |
$56.73
|
| Rate for Payer: Aetna Commercial |
$74.18
|
| Rate for Payer: Aetna Medicare |
$43.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.73
|
| Rate for Payer: BCBS Complete |
$34.91
|
| Rate for Payer: BCBS Trust/PPO |
$4,940.76
|
| Rate for Payer: BCN Commercial |
$4,940.76
|
| Rate for Payer: Cash Price |
$69.82
|
| Rate for Payer: Cash Price |
$69.82
|
| Rate for Payer: Cash Price |
$69.82
|
| Rate for Payer: Cofinity Advantage |
$61.09
|
| Rate for Payer: Cofinity Commercial |
$75.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.82
|
| Rate for Payer: Healthscope Commercial |
$78.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$61.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$69.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.45
|
| Rate for Payer: PHP Commercial |
$74.18
|
| Rate for Payer: Priority Health SBD |
$54.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.63
|
| Rate for Payer: UHC Core |
$43.63
|
| Rate for Payer: UHC Exchange |
$43.63
|
| Rate for Payer: UMR Bronson Commercial |
$32.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.45
|
|
|
HC DERMAGRAFT PER SQ CM
|
Facility
|
IP
|
$87.27
|
|
|
Service Code
|
HCPCS Q4106
|
| Hospital Charge Code |
63600004
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.40 |
| Max. Negotiated Rate |
$78.54 |
| Rate for Payer: Aetna American Axle |
$56.73
|
| Rate for Payer: Aetna Commercial |
$74.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.73
|
| Rate for Payer: Cash Price |
$69.82
|
| Rate for Payer: Cofinity Advantage |
$61.09
|
| Rate for Payer: Cofinity Commercial |
$75.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.82
|
| Rate for Payer: Healthscope Commercial |
$78.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$61.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.45
|
| Rate for Payer: PHP Commercial |
$74.18
|
| Rate for Payer: Priority Health SBD |
$54.98
|
| Rate for Payer: UMR Bronson Commercial |
$38.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.45
|
|
|
HC DES ADD.BRANCH
|
Facility
|
IP
|
$17,350.78
|
|
|
Service Code
|
CPT C9601
|
| Hospital Charge Code |
48100076
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$7,634.34 |
| Max. Negotiated Rate |
$15,615.70 |
| Rate for Payer: Aetna American Axle |
$11,278.01
|
| Rate for Payer: Aetna Commercial |
$14,748.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,278.01
|
| Rate for Payer: Cash Price |
$13,880.62
|
| Rate for Payer: Cofinity Advantage |
$12,145.55
|
| Rate for Payer: Cofinity Commercial |
$14,921.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,880.62
|
| Rate for Payer: Healthscope Commercial |
$15,615.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12,145.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13,013.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,748.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13,013.08
|
| Rate for Payer: PHP Commercial |
$14,748.16
|
| Rate for Payer: Priority Health SBD |
$10,930.99
|
| Rate for Payer: UMR Bronson Commercial |
$7,634.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13,013.08
|
|
|
HC DES ADD.BRANCH
|
Facility
|
OP
|
$17,350.78
|
|
|
Service Code
|
CPT C9601
|
| Hospital Charge Code |
48100076
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$15,615.70 |
| Rate for Payer: Aetna American Axle |
$11,278.01
|
| Rate for Payer: Aetna Commercial |
$14,748.16
|
| Rate for Payer: Aetna Medicare |
$8,675.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,278.01
|
| Rate for Payer: BCBS Complete |
$6,940.31
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$13,880.62
|
| Rate for Payer: Cash Price |
$13,880.62
|
| Rate for Payer: Cash Price |
$13,880.62
|
| Rate for Payer: Cofinity Advantage |
$12,145.55
|
| Rate for Payer: Cofinity Commercial |
$14,921.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,880.62
|
| Rate for Payer: Healthscope Commercial |
$15,615.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12,145.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13,013.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,880.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,748.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13,013.08
|
| Rate for Payer: PHP Commercial |
$14,748.16
|
| Rate for Payer: Priority Health SBD |
$10,930.99
|
| Rate for Payer: UMR Bronson Commercial |
$6,419.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13,013.08
|
|
|
HC DESTR LESION ROOF OF MOUTH
|
Facility
|
IP
|
$8,271.18
|
|
|
Service Code
|
CPT 42160
|
| Hospital Charge Code |
76100393
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,639.32 |
| Max. Negotiated Rate |
$7,444.06 |
| Rate for Payer: Aetna American Axle |
$5,376.27
|
| Rate for Payer: Aetna Commercial |
$7,030.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,376.27
|
| Rate for Payer: Cash Price |
$6,616.94
|
| Rate for Payer: Cofinity Advantage |
$5,789.83
|
| Rate for Payer: Cofinity Commercial |
$7,113.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,616.94
|
| Rate for Payer: Healthscope Commercial |
$7,444.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,789.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,203.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,030.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,203.39
|
| Rate for Payer: PHP Commercial |
$7,030.50
|
| Rate for Payer: Priority Health SBD |
$5,210.84
|
| Rate for Payer: UMR Bronson Commercial |
$3,639.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,203.39
|
|
|
HC DESTR LESION ROOF OF MOUTH
|
Facility
|
OP
|
$8,271.18
|
|
|
Service Code
|
CPT 42160
|
| Hospital Charge Code |
76100393
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$262.17 |
| Max. Negotiated Rate |
$10,683.35 |
| Rate for Payer: Aetna American Axle |
$5,376.27
|
| Rate for Payer: Aetna Commercial |
$7,030.50
|
| Rate for Payer: Aetna Medicare |
$3,435.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,376.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,129.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,129.43
|
| Rate for Payer: BCBS Complete |
$1,814.30
|
| Rate for Payer: BCBS MAPPO |
$3,303.54
|
| Rate for Payer: BCBS Trust/PPO |
$262.17
|
| Rate for Payer: BCN Commercial |
$262.17
|
| Rate for Payer: BCN Medicare Advantage |
$3,303.54
|
| Rate for Payer: Cash Price |
$6,616.94
|
| Rate for Payer: Cash Price |
$6,616.94
|
| Rate for Payer: Cash Price |
$6,616.94
|
| Rate for Payer: Cofinity Advantage |
$5,789.83
|
| Rate for Payer: Cofinity Commercial |
$7,113.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,616.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,303.54
|
| Rate for Payer: Healthscope Commercial |
$7,444.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,789.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,203.39
|
| Rate for Payer: Mclaren Medicaid |
$3,303.54
|
| Rate for Payer: Mclaren Medicare |
$3,303.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,468.72
|
| Rate for Payer: Meridian Medicaid |
$3,468.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,799.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,633.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,030.50
|
| Rate for Payer: Nomi Health Commercial |
$9,910.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,203.39
|
| Rate for Payer: PACE Medicare |
$3,138.36
|
| Rate for Payer: PACE SWMI |
$3,303.54
|
| Rate for Payer: PHP Commercial |
$7,030.50
|
| Rate for Payer: PHP Medicare Advantage |
$3,303.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,727.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,683.35
|
| Rate for Payer: Priority Health Medicare |
$3,303.54
|
| Rate for Payer: Priority Health SBD |
$5,210.84
|
| Rate for Payer: Priority Health Tiered Network |
$8,546.68
|
| Rate for Payer: Railroad Medicare Medicare |
$3,303.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,376.27
|
| Rate for Payer: UHC Core |
$4,309.28
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,303.54
|
| Rate for Payer: UHC Exchange |
$3,250.57
|
| Rate for Payer: UHC Medicaid |
$1,727.75
|
| Rate for Payer: UHCCP Medicaid |
$1,727.75
|
| Rate for Payer: UMR Bronson Commercial |
$3,060.34
|
| Rate for Payer: VA VA |
$3,303.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,203.39
|
|
|
HC DESTR MALIG LESION FACE,EAR,EYELID,NOSE,LIP,MUC MEM <0.6 CM
|
Facility
|
OP
|
$247.47
|
|
|
Service Code
|
CPT 17280
|
| Hospital Charge Code |
76100155
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$91.56 |
| Max. Negotiated Rate |
$646.50 |
| Rate for Payer: Aetna American Axle |
$160.86
|
| Rate for Payer: Aetna Commercial |
$210.35
|
| Rate for Payer: Aetna Medicare |
$207.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$249.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$249.89
|
| Rate for Payer: BCBS Complete |
$109.79
|
| Rate for Payer: BCBS MAPPO |
$199.91
|
| Rate for Payer: BCBS Trust/PPO |
$172.78
|
| Rate for Payer: BCN Commercial |
$172.78
|
| Rate for Payer: BCN Medicare Advantage |
$199.91
|
| Rate for Payer: Cash Price |
$197.98
|
| Rate for Payer: Cash Price |
$197.98
|
| Rate for Payer: Cash Price |
$197.98
|
| Rate for Payer: Cofinity Advantage |
$173.23
|
| Rate for Payer: Cofinity Commercial |
$212.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.91
|
| Rate for Payer: Healthscope Commercial |
$222.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$173.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$185.60
|
| Rate for Payer: Mclaren Medicaid |
$199.91
|
| Rate for Payer: Mclaren Medicare |
$199.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$209.91
|
| Rate for Payer: Meridian Medicaid |
$209.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$229.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$219.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$210.35
|
| Rate for Payer: Nomi Health Commercial |
$599.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$185.60
|
| Rate for Payer: PACE Medicare |
$189.91
|
| Rate for Payer: PACE SWMI |
$199.91
|
| Rate for Payer: PHP Commercial |
$210.35
|
| Rate for Payer: PHP Medicare Advantage |
$199.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$646.50
|
| Rate for Payer: Priority Health Medicare |
$199.91
|
| Rate for Payer: Priority Health SBD |
$155.91
|
| Rate for Payer: Priority Health Tiered Network |
$517.20
|
| Rate for Payer: Railroad Medicare Medicare |
$199.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$160.86
|
| Rate for Payer: UHC Core |
$128.93
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$199.91
|
| Rate for Payer: UHC Exchange |
$97.26
|
| Rate for Payer: UHC Medicaid |
$104.55
|
| Rate for Payer: UHCCP Medicaid |
$104.55
|
| Rate for Payer: UMR Bronson Commercial |
$91.56
|
| Rate for Payer: VA VA |
$199.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$185.60
|
|
