|
HC DILATION CERVICAL CANAL
|
Facility
|
OP
|
$8,102.32
|
|
|
Service Code
|
CPT 57800
|
| Hospital Charge Code |
36000112
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$48.77 |
| Max. Negotiated Rate |
$10,430.93 |
| Rate for Payer: Aetna American Axle |
$5,266.51
|
| Rate for Payer: Aetna Commercial |
$6,886.97
|
| Rate for Payer: Aetna Medicare |
$3,354.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,266.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,031.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,031.86
|
| Rate for Payer: BCBS Complete |
$1,771.44
|
| Rate for Payer: BCBS MAPPO |
$3,225.49
|
| Rate for Payer: BCBS Trust/PPO |
$48.77
|
| Rate for Payer: BCN Commercial |
$48.77
|
| Rate for Payer: BCN Medicare Advantage |
$3,225.49
|
| Rate for Payer: Cash Price |
$6,481.86
|
| Rate for Payer: Cash Price |
$6,481.86
|
| Rate for Payer: Cash Price |
$6,481.86
|
| Rate for Payer: Cofinity Advantage |
$5,671.62
|
| Rate for Payer: Cofinity Commercial |
$6,968.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,481.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,225.49
|
| Rate for Payer: Healthscope Commercial |
$7,292.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,671.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,076.74
|
| Rate for Payer: Mclaren Medicaid |
$3,225.49
|
| Rate for Payer: Mclaren Medicare |
$3,225.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,386.76
|
| Rate for Payer: Meridian Medicaid |
$3,386.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,709.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,548.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,886.97
|
| Rate for Payer: Nomi Health Commercial |
$9,676.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,076.74
|
| Rate for Payer: PACE Medicare |
$3,064.22
|
| Rate for Payer: PACE SWMI |
$3,225.49
|
| Rate for Payer: PHP Commercial |
$6,886.97
|
| Rate for Payer: PHP Medicare Advantage |
$3,225.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,686.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,430.93
|
| Rate for Payer: Priority Health Medicare |
$3,225.49
|
| Rate for Payer: Priority Health SBD |
$5,104.46
|
| Rate for Payer: Priority Health Tiered Network |
$8,344.74
|
| Rate for Payer: Railroad Medicare Medicare |
$3,225.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,266.51
|
| Rate for Payer: UHC Core |
$4,221.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,225.49
|
| Rate for Payer: UHC Exchange |
$3,184.21
|
| Rate for Payer: UHC Medicaid |
$1,686.93
|
| Rate for Payer: UHCCP Medicaid |
$1,686.93
|
| Rate for Payer: UMR Bronson Commercial |
$2,997.86
|
| Rate for Payer: VA VA |
$3,225.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,076.74
|
|
|
HC DILATION & CURETTAGE DX/THER NONOBSTETRIC
|
Facility
|
OP
|
$9,990.90
|
|
|
Service Code
|
CPT 58120
|
| Hospital Charge Code |
36000136
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,686.93 |
| Max. Negotiated Rate |
$10,430.93 |
| Rate for Payer: Aetna American Axle |
$6,494.09
|
| Rate for Payer: Aetna Commercial |
$8,492.26
|
| Rate for Payer: Aetna Medicare |
$3,354.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,494.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,031.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,031.86
|
| Rate for Payer: BCBS Complete |
$1,771.44
|
| Rate for Payer: BCBS MAPPO |
$3,225.49
|
| Rate for Payer: BCBS Trust/PPO |
$2,956.04
|
| Rate for Payer: BCN Commercial |
$2,956.04
|
| Rate for Payer: BCN Medicare Advantage |
$3,225.49
|
| Rate for Payer: Cash Price |
$7,992.72
|
| Rate for Payer: Cash Price |
$7,992.72
|
| Rate for Payer: Cash Price |
$7,992.72
|
| Rate for Payer: Cofinity Advantage |
$6,993.63
|
| Rate for Payer: Cofinity Commercial |
$8,592.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,992.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,225.49
|
| Rate for Payer: Healthscope Commercial |
$8,991.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,993.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,493.18
|
| Rate for Payer: Mclaren Medicaid |
$3,225.49
|
| Rate for Payer: Mclaren Medicare |
$3,225.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,386.76
|
| Rate for Payer: Meridian Medicaid |
$3,386.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,709.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,548.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,492.26
|
| Rate for Payer: Nomi Health Commercial |
$9,676.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,493.18
|
| Rate for Payer: PACE Medicare |
$3,064.22
|
| Rate for Payer: PACE SWMI |
$3,225.49
|
| Rate for Payer: PHP Commercial |
$8,492.26
|
| Rate for Payer: PHP Medicare Advantage |
$3,225.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,686.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,430.93
|
| Rate for Payer: Priority Health Medicare |
$3,225.49
|
| Rate for Payer: Priority Health SBD |
$6,294.27
|
| Rate for Payer: Priority Health Tiered Network |
$8,344.74
|
| Rate for Payer: Railroad Medicare Medicare |
$3,225.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,494.09
|
| Rate for Payer: UHC Core |
$5,205.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,225.49
|
| Rate for Payer: UHC Exchange |
$3,926.42
|
| Rate for Payer: UHC Medicaid |
$1,686.93
|
| Rate for Payer: UHCCP Medicaid |
$1,686.93
|
| Rate for Payer: UMR Bronson Commercial |
$3,696.63
|
| Rate for Payer: VA VA |
$3,225.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,493.18
|
|
|
HC DILATION & CURETTAGE DX/THER NONOBSTETRIC
|
Facility
|
IP
|
$9,990.90
|
|
|
Service Code
|
CPT 58120
|
| Hospital Charge Code |
36000136
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$4,396.00 |
| Max. Negotiated Rate |
$8,991.81 |
| Rate for Payer: Aetna American Axle |
$6,494.09
|
| Rate for Payer: Aetna Commercial |
$8,492.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,494.09
|
| Rate for Payer: Cash Price |
$7,992.72
|
| Rate for Payer: Cofinity Advantage |
$6,993.63
|
| Rate for Payer: Cofinity Commercial |
$8,592.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,992.72
|
| Rate for Payer: Healthscope Commercial |
$8,991.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,993.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,493.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,492.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,493.18
|
| Rate for Payer: PHP Commercial |
$8,492.26
|
| Rate for Payer: Priority Health SBD |
$6,294.27
|
| Rate for Payer: UMR Bronson Commercial |
$4,396.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,493.18
|
|
|
HC DILATION URETHRA, INITIAL
|
Facility
|
OP
|
$220.23
|
|
|
Service Code
|
CPT 53660
|
| Hospital Charge Code |
76100266
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$67.05 |
| Max. Negotiated Rate |
$414.63 |
| Rate for Payer: Aetna American Axle |
$143.15
|
| Rate for Payer: Aetna Commercial |
$187.20
|
| Rate for Payer: Aetna Medicare |
$133.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$160.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$160.26
|
| Rate for Payer: BCBS Complete |
$70.41
|
| Rate for Payer: BCBS MAPPO |
$128.21
|
| Rate for Payer: BCBS Trust/PPO |
$70.00
|
| Rate for Payer: BCN Commercial |
$70.00
|
| Rate for Payer: BCN Medicare Advantage |
$128.21
|
| Rate for Payer: Cash Price |
$176.18
|
| Rate for Payer: Cash Price |
$176.18
|
| Rate for Payer: Cash Price |
$176.18
|
| Rate for Payer: Cofinity Advantage |
$154.16
|
| Rate for Payer: Cofinity Commercial |
$189.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$128.21
|
| Rate for Payer: Healthscope Commercial |
$198.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$154.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$165.17
|
| Rate for Payer: Mclaren Medicaid |
$128.21
|
| Rate for Payer: Mclaren Medicare |
$128.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$134.62
|
| Rate for Payer: Meridian Medicaid |
$134.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$147.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$141.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$187.20
|
| Rate for Payer: Nomi Health Commercial |
$384.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$165.17
|
| Rate for Payer: PACE Medicare |
$121.80
|
| Rate for Payer: PACE SWMI |
$128.21
|
| Rate for Payer: PHP Commercial |
$187.20
|
| Rate for Payer: PHP Medicare Advantage |
$128.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$414.63
|
| Rate for Payer: Priority Health Medicare |
$128.21
|
| Rate for Payer: Priority Health SBD |
$138.74
|
| Rate for Payer: Priority Health Tiered Network |
$331.70
|
| Rate for Payer: Railroad Medicare Medicare |
$128.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$143.15
|
| Rate for Payer: UHC Core |
$114.74
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$128.21
|
| Rate for Payer: UHC Exchange |
$86.55
|
| Rate for Payer: UHC Medicaid |
$67.05
|
| Rate for Payer: UHCCP Medicaid |
$67.05
|
| Rate for Payer: UMR Bronson Commercial |
$81.49
|
| Rate for Payer: VA VA |
$128.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$165.17
|
|
|
HC DILATION URETHRA, INITIAL
|
Facility
|
IP
|
$220.23
|
|
|
Service Code
|
CPT 53660
|
| Hospital Charge Code |
76100266
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$96.90 |
| Max. Negotiated Rate |
$198.21 |
| Rate for Payer: Aetna American Axle |
$143.15
|
| Rate for Payer: Aetna Commercial |
$187.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.15
|
| Rate for Payer: Cash Price |
$176.18
|
| Rate for Payer: Cofinity Advantage |
$154.16
|
| Rate for Payer: Cofinity Commercial |
$189.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.18
|
| Rate for Payer: Healthscope Commercial |
$198.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$154.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$165.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$187.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$165.17
|
| Rate for Payer: PHP Commercial |
$187.20
|
| Rate for Payer: Priority Health SBD |
$138.74
|
| Rate for Payer: UMR Bronson Commercial |
$96.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$165.17
|
|
|
HC DILATION URETHRAL STRICTURE MALE
|
Facility
|
OP
|
$373.92
|
|
|
Service Code
|
CPT 53600
|
| Hospital Charge Code |
76100231
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$59.66 |
| Max. Negotiated Rate |
$805.08 |
| Rate for Payer: Aetna American Axle |
$243.05
|
| Rate for Payer: Aetna Commercial |
$317.83
|
| Rate for Payer: Aetna Medicare |
$258.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$243.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$311.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$311.19
|
| Rate for Payer: BCBS Complete |
$136.72
|
| Rate for Payer: BCBS MAPPO |
$248.95
|
| Rate for Payer: BCBS Trust/PPO |
$59.66
|
| Rate for Payer: BCN Commercial |
$59.66
|
| Rate for Payer: BCN Medicare Advantage |
$248.95
|
| Rate for Payer: Cash Price |
$299.14
|
| Rate for Payer: Cash Price |
$299.14
|
| Rate for Payer: Cash Price |
$299.14
|
| Rate for Payer: Cofinity Advantage |
$261.74
|
| Rate for Payer: Cofinity Commercial |
$321.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$299.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$248.95
|
| Rate for Payer: Healthscope Commercial |
$336.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$261.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$280.44
|
| Rate for Payer: Mclaren Medicaid |
$248.95
|
| Rate for Payer: Mclaren Medicare |
$248.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$261.40
|
| Rate for Payer: Meridian Medicaid |
$261.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$286.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$273.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$317.83
|
| Rate for Payer: Nomi Health Commercial |
$746.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$280.44
|
| Rate for Payer: PACE Medicare |
$236.50
|
| Rate for Payer: PACE SWMI |
$248.95
|
| Rate for Payer: PHP Commercial |
$317.83
|
| Rate for Payer: PHP Medicare Advantage |
$248.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$130.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$805.08
|
| Rate for Payer: Priority Health Medicare |
$248.95
|
| Rate for Payer: Priority Health SBD |
$235.57
|
| Rate for Payer: Priority Health Tiered Network |
$644.06
|
| Rate for Payer: Railroad Medicare Medicare |
$248.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$243.05
|
| Rate for Payer: UHC Core |
$194.81
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$248.95
|
| Rate for Payer: UHC Exchange |
$146.95
|
| Rate for Payer: UHC Medicaid |
$130.20
|
| Rate for Payer: UHCCP Medicaid |
$130.20
|
| Rate for Payer: UMR Bronson Commercial |
$138.35
|
| Rate for Payer: VA VA |
$248.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$280.44
|
|
|
HC DILATION URETHRAL STRICTURE MALE
|
Facility
|
IP
|
$373.92
|
|
|
Service Code
|
CPT 53600
|
| Hospital Charge Code |
76100231
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$164.52 |
| Max. Negotiated Rate |
$336.53 |
| Rate for Payer: Aetna American Axle |
$243.05
|
| Rate for Payer: Aetna Commercial |
$317.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$243.05
|
| Rate for Payer: Cash Price |
$299.14
|
| Rate for Payer: Cofinity Advantage |
$261.74
|
| Rate for Payer: Cofinity Commercial |
$321.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$299.14
|
| Rate for Payer: Healthscope Commercial |
$336.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$261.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$280.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$317.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$280.44
|
| Rate for Payer: PHP Commercial |
$317.83
|
| Rate for Payer: Priority Health SBD |
$235.57
|
| Rate for Payer: UMR Bronson Commercial |
$164.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$280.44
|
|
|
HC DILATOR SIZE 12
|
Facility
|
IP
|
$35.26
|
|
| Hospital Charge Code |
27000055
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.51 |
| Max. Negotiated Rate |
$31.73 |
| Rate for Payer: Aetna American Axle |
$22.92
|
| Rate for Payer: Aetna Commercial |
$29.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.92
|
| Rate for Payer: Cash Price |
$28.21
|
| Rate for Payer: Cofinity Advantage |
$24.68
|
| Rate for Payer: Cofinity Commercial |
$30.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.21
|
| Rate for Payer: Healthscope Commercial |
$31.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.45
|
| Rate for Payer: PHP Commercial |
$29.97
|
| Rate for Payer: Priority Health SBD |
$22.21
|
| Rate for Payer: UMR Bronson Commercial |
$15.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.45
|
|
|
HC DILATOR SIZE 12
|
Facility
|
OP
|
$35.26
|
|
| Hospital Charge Code |
27000055
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.05 |
| Max. Negotiated Rate |
$31.73 |
| Rate for Payer: Aetna American Axle |
$22.92
|
| Rate for Payer: Aetna Commercial |
$29.97
|
| Rate for Payer: Aetna Medicare |
$17.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.92
|
| Rate for Payer: BCBS Complete |
$14.10
|
| Rate for Payer: Cash Price |
$28.21
|
| Rate for Payer: Cofinity Advantage |
$24.68
|
| Rate for Payer: Cofinity Commercial |
$30.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.21
|
| Rate for Payer: Healthscope Commercial |
$31.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.45
|
| Rate for Payer: PHP Commercial |
$29.97
|
| Rate for Payer: Priority Health SBD |
$22.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.92
|
| Rate for Payer: UHC Core |
$18.37
|
| Rate for Payer: UHC Exchange |
$13.86
|
| Rate for Payer: UMR Bronson Commercial |
$13.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.45
|
|
|
HC DILATOR SIZE 7
|
Facility
|
OP
|
$25.81
|
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.55 |
| Max. Negotiated Rate |
$23.23 |
| Rate for Payer: Aetna American Axle |
$16.78
|
| Rate for Payer: Aetna Commercial |
$21.94
|
| Rate for Payer: Aetna Medicare |
$12.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.78
|
| Rate for Payer: BCBS Complete |
$10.32
|
| Rate for Payer: Cash Price |
$20.65
|
| Rate for Payer: Cofinity Advantage |
$18.07
|
| Rate for Payer: Cofinity Commercial |
$22.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.65
|
| Rate for Payer: Healthscope Commercial |
$23.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.36
|
| Rate for Payer: PHP Commercial |
$21.94
|
| Rate for Payer: Priority Health SBD |
$16.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.78
|
| Rate for Payer: UHC Core |
$13.45
|
| Rate for Payer: UHC Exchange |
$10.14
|
| Rate for Payer: UMR Bronson Commercial |
$9.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.36
|
|
|
HC DILATOR SIZE 7
|
Facility
|
IP
|
$25.81
|
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.36 |
| Max. Negotiated Rate |
$23.23 |
| Rate for Payer: Aetna American Axle |
$16.78
|
| Rate for Payer: Aetna Commercial |
$21.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.78
|
| Rate for Payer: Cash Price |
$20.65
|
| Rate for Payer: Cofinity Advantage |
$18.07
|
| Rate for Payer: Cofinity Commercial |
$22.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.65
|
| Rate for Payer: Healthscope Commercial |
$23.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.36
|
| Rate for Payer: PHP Commercial |
$21.94
|
| Rate for Payer: Priority Health SBD |
$16.26
|
| Rate for Payer: UMR Bronson Commercial |
$11.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.36
|
|
|
HC DILATOR SIZE 9
|
Facility
|
IP
|
$25.81
|
|
| Hospital Charge Code |
27000057
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.36 |
| Max. Negotiated Rate |
$23.23 |
| Rate for Payer: Aetna American Axle |
$16.78
|
| Rate for Payer: Aetna Commercial |
$21.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.78
|
| Rate for Payer: Cash Price |
$20.65
|
| Rate for Payer: Cofinity Advantage |
$18.07
|
| Rate for Payer: Cofinity Commercial |
$22.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.65
|
| Rate for Payer: Healthscope Commercial |
$23.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.36
|
| Rate for Payer: PHP Commercial |
$21.94
|
| Rate for Payer: Priority Health SBD |
$16.26
|
| Rate for Payer: UMR Bronson Commercial |
$11.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.36
|
|
|
HC DILATOR SIZE 9
|
Facility
|
OP
|
$25.81
|
|
| Hospital Charge Code |
27000057
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.55 |
| Max. Negotiated Rate |
$23.23 |
| Rate for Payer: Aetna American Axle |
$16.78
|
| Rate for Payer: Aetna Commercial |
$21.94
|
| Rate for Payer: Aetna Medicare |
$12.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.78
|
| Rate for Payer: BCBS Complete |
$10.32
|
| Rate for Payer: Cash Price |
$20.65
|
| Rate for Payer: Cofinity Advantage |
$18.07
|
| Rate for Payer: Cofinity Commercial |
$22.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.65
|
| Rate for Payer: Healthscope Commercial |
$23.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.36
|
| Rate for Payer: PHP Commercial |
$21.94
|
| Rate for Payer: Priority Health SBD |
$16.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.78
|
| Rate for Payer: UHC Core |
$13.45
|
| Rate for Payer: UHC Exchange |
$10.14
|
| Rate for Payer: UMR Bronson Commercial |
$9.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.36
|
|
|
HC DIL PERC EXISTING TRACT INCLUDE NEW ACCESS
|
Facility
|
IP
|
$4,658.71
|
|
|
Service Code
|
CPT 50437
|
| Hospital Charge Code |
32000329
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,049.83 |
| Max. Negotiated Rate |
$4,192.84 |
| Rate for Payer: Aetna American Axle |
$3,028.16
|
| Rate for Payer: Aetna Commercial |
$3,959.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,028.16
|
| Rate for Payer: Cash Price |
$3,726.97
|
| Rate for Payer: Cofinity Advantage |
$3,261.10
|
| Rate for Payer: Cofinity Commercial |
$4,006.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,726.97
|
| Rate for Payer: Healthscope Commercial |
$4,192.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,261.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,494.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,959.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,494.03
|
| Rate for Payer: PHP Commercial |
$3,959.90
|
| Rate for Payer: Priority Health SBD |
$2,934.99
|
| Rate for Payer: UMR Bronson Commercial |
$2,049.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,494.03
|
|
|
HC DIL PERC EXISTING TRACT INCLUDE NEW ACCESS
|
Facility
|
OP
|
$4,658.71
|
|
|
Service Code
|
CPT 50437
|
| Hospital Charge Code |
32000329
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,723.72 |
| Max. Negotiated Rate |
$11,358.48 |
| Rate for Payer: Aetna American Axle |
$3,028.16
|
| Rate for Payer: Aetna Commercial |
$3,959.90
|
| Rate for Payer: Aetna Medicare |
$3,652.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,028.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,390.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,390.39
|
| Rate for Payer: BCBS Complete |
$1,928.96
|
| Rate for Payer: BCBS MAPPO |
$3,512.31
|
| Rate for Payer: BCBS Trust/PPO |
$2,941.33
|
| Rate for Payer: BCN Commercial |
$2,941.33
|
| Rate for Payer: BCN Medicare Advantage |
$3,512.31
|
| Rate for Payer: Cash Price |
$3,726.97
|
| Rate for Payer: Cash Price |
$3,726.97
|
| Rate for Payer: Cash Price |
$3,726.97
|
| Rate for Payer: Cofinity Advantage |
$3,261.10
|
| Rate for Payer: Cofinity Commercial |
$4,006.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,726.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,512.31
|
| Rate for Payer: Healthscope Commercial |
$4,192.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,261.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,494.03
|
| Rate for Payer: Mclaren Medicaid |
$3,512.31
|
| Rate for Payer: Mclaren Medicare |
$3,512.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,687.93
|
| Rate for Payer: Meridian Medicaid |
$3,687.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,039.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,863.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,959.90
|
| Rate for Payer: Nomi Health Commercial |
$10,536.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,494.03
|
| Rate for Payer: PACE Medicare |
$3,336.69
|
| Rate for Payer: PACE SWMI |
$3,512.31
|
| Rate for Payer: PHP Commercial |
$3,959.90
|
| Rate for Payer: PHP Medicare Advantage |
$3,512.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,836.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11,358.48
|
| Rate for Payer: Priority Health Medicare |
$3,512.31
|
| Rate for Payer: Priority Health SBD |
$2,934.99
|
| Rate for Payer: Priority Health Tiered Network |
$9,086.78
|
| Rate for Payer: Railroad Medicare Medicare |
$3,512.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,028.16
|
| Rate for Payer: UHC Core |
$2,427.19
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,512.31
|
| Rate for Payer: UHC Exchange |
$1,830.87
|
| Rate for Payer: UHC Medicaid |
$1,836.94
|
| Rate for Payer: UHCCP Medicaid |
$1,836.94
|
| Rate for Payer: UMR Bronson Commercial |
$1,723.72
|
| Rate for Payer: VA VA |
$3,512.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,494.03
|
|
|
HC DIPHTHERIA/TETANUS AB PANEL, S
|
Facility
|
IP
|
$46.30
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
30200506
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.37 |
| Max. Negotiated Rate |
$41.67 |
| Rate for Payer: Aetna American Axle |
$30.09
|
| Rate for Payer: Aetna Commercial |
$39.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.09
|
| Rate for Payer: Cash Price |
$37.04
|
| Rate for Payer: Cofinity Advantage |
$32.41
|
| Rate for Payer: Cofinity Commercial |
$39.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.04
|
| Rate for Payer: Healthscope Commercial |
$41.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.73
|
| Rate for Payer: PHP Commercial |
$39.35
|
| Rate for Payer: Priority Health SBD |
$29.17
|
| Rate for Payer: UMR Bronson Commercial |
$20.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.73
|
|
|
HC DIPHTHERIA/TETANUS AB PANEL, S
|
Facility
|
OP
|
$46.30
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
30200506
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.84 |
| Max. Negotiated Rate |
$41.67 |
| Rate for Payer: Aetna American Axle |
$30.09
|
| Rate for Payer: Aetna Commercial |
$39.35
|
| Rate for Payer: Aetna Medicare |
$15.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.74
|
| Rate for Payer: BCBS Complete |
$8.23
|
| Rate for Payer: BCBS MAPPO |
$14.99
|
| Rate for Payer: BCBS Trust/PPO |
$17.32
|
| Rate for Payer: BCN Commercial |
$17.32
|
| Rate for Payer: BCN Medicare Advantage |
$14.99
|
| Rate for Payer: Cash Price |
$37.04
|
| Rate for Payer: Cash Price |
$37.04
|
| Rate for Payer: Cofinity Advantage |
$32.41
|
| Rate for Payer: Cofinity Commercial |
$39.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.99
|
| Rate for Payer: Healthscope Commercial |
$41.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.73
|
| Rate for Payer: Mclaren Medicaid |
$14.99
|
| Rate for Payer: Mclaren Medicare |
$14.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.74
|
| Rate for Payer: Meridian Medicaid |
$15.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$16.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.35
|
| Rate for Payer: Nomi Health Commercial |
$22.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.73
|
| Rate for Payer: PACE Medicare |
$14.24
|
| Rate for Payer: PACE SWMI |
$14.99
|
| Rate for Payer: PHP Commercial |
$39.35
|
| Rate for Payer: PHP Medicare Advantage |
$14.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$14.99
|
| Rate for Payer: Priority Health Medicare |
$14.99
|
| Rate for Payer: Priority Health SBD |
$29.17
|
| Rate for Payer: Priority Health Tiered Network |
$11.99
|
| Rate for Payer: Railroad Medicare Medicare |
$14.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.49
|
| Rate for Payer: UHC Core |
$22.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14.99
|
| Rate for Payer: UHC Exchange |
$22.49
|
| Rate for Payer: UHC Medicaid |
$7.84
|
| Rate for Payer: UHCCP Medicaid |
$7.84
|
| Rate for Payer: UMR Bronson Commercial |
$17.13
|
| Rate for Payer: VA VA |
$14.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.73
|
|
|
HC DIP, TET TOX, HAEMO INFLU TYPE B, INACTIV POLIO VAC, (DTAP-IPV/HIB) IM
|
Facility
|
IP
|
$126.07
|
|
|
Service Code
|
CPT 90698
|
| Hospital Charge Code |
63600080
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$55.47 |
| Max. Negotiated Rate |
$113.46 |
| Rate for Payer: Aetna American Axle |
$81.95
|
| Rate for Payer: Aetna Commercial |
$107.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.95
|
| Rate for Payer: Cash Price |
$100.86
|
| Rate for Payer: Cofinity Advantage |
$88.25
|
| Rate for Payer: Cofinity Commercial |
$108.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.86
|
| Rate for Payer: Healthscope Commercial |
$113.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$88.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$94.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$94.55
|
| Rate for Payer: PHP Commercial |
$107.16
|
| Rate for Payer: Priority Health SBD |
$79.42
|
| Rate for Payer: UMR Bronson Commercial |
$55.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$94.55
|
|
|
HC DIP, TET TOX, HAEMO INFLU TYPE B, INACTIV POLIO VAC, (DTAP-IPV/HIB) IM
|
Facility
|
OP
|
$126.07
|
|
|
Service Code
|
CPT 90698
|
| Hospital Charge Code |
63600080
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$46.65 |
| Max. Negotiated Rate |
$415.42 |
| Rate for Payer: Aetna American Axle |
$81.95
|
| Rate for Payer: Aetna Commercial |
$107.16
|
| Rate for Payer: Aetna Medicare |
$63.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.95
|
| Rate for Payer: BCBS Complete |
$50.43
|
| Rate for Payer: BCBS Trust/PPO |
$415.42
|
| Rate for Payer: BCN Commercial |
$415.42
|
| Rate for Payer: Cash Price |
$100.86
|
| Rate for Payer: Cash Price |
$100.86
|
| Rate for Payer: Cofinity Advantage |
$88.25
|
| Rate for Payer: Cofinity Commercial |
$108.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.86
|
| Rate for Payer: Healthscope Commercial |
$113.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$88.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$94.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$100.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$94.55
|
| Rate for Payer: PHP Commercial |
$107.16
|
| Rate for Payer: Priority Health SBD |
$79.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$233.10
|
| Rate for Payer: UHC Core |
$233.10
|
| Rate for Payer: UHC Exchange |
$233.10
|
| Rate for Payer: UMR Bronson Commercial |
$46.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$94.55
|
|
|
HC DIPTH, TET TOX, AND ACELLUEAR PERTUSSIS VAC (DTAP), LESS THAN 7 YRS IM
|
Facility
|
OP
|
$54.86
|
|
|
Service Code
|
CPT 90700
|
| Hospital Charge Code |
63600081
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.30 |
| Max. Negotiated Rate |
$94.17 |
| Rate for Payer: Aetna American Axle |
$35.66
|
| Rate for Payer: Aetna Commercial |
$46.63
|
| Rate for Payer: Aetna Medicare |
$27.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.66
|
| Rate for Payer: BCBS Complete |
$21.94
|
| Rate for Payer: BCBS Trust/PPO |
$94.17
|
| Rate for Payer: BCN Commercial |
$94.17
|
| Rate for Payer: Cash Price |
$43.89
|
| Rate for Payer: Cash Price |
$43.89
|
| Rate for Payer: Cofinity Advantage |
$38.40
|
| Rate for Payer: Cofinity Commercial |
$47.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.89
|
| Rate for Payer: Healthscope Commercial |
$49.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$38.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.15
|
| Rate for Payer: PHP Commercial |
$46.63
|
| Rate for Payer: Priority Health SBD |
$34.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.12
|
| Rate for Payer: UHC Core |
$61.12
|
| Rate for Payer: UHC Exchange |
$61.12
|
| Rate for Payer: UMR Bronson Commercial |
$20.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.15
|
|
|
HC DIPTH, TET TOX, AND ACELLUEAR PERTUSSIS VAC (DTAP), LESS THAN 7 YRS IM
|
Facility
|
IP
|
$54.86
|
|
|
Service Code
|
CPT 90700
|
| Hospital Charge Code |
63600081
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.14 |
| Max. Negotiated Rate |
$49.37 |
| Rate for Payer: Aetna American Axle |
$35.66
|
| Rate for Payer: Aetna Commercial |
$46.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.66
|
| Rate for Payer: Cash Price |
$43.89
|
| Rate for Payer: Cofinity Advantage |
$38.40
|
| Rate for Payer: Cofinity Commercial |
$47.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.89
|
| Rate for Payer: Healthscope Commercial |
$49.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$38.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.15
|
| Rate for Payer: PHP Commercial |
$46.63
|
| Rate for Payer: Priority Health SBD |
$34.56
|
| Rate for Payer: UMR Bronson Commercial |
$24.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.15
|
|
|
HC DIRECT ADMIT TO OBS
|
Facility
|
IP
|
$157.93
|
|
|
Service Code
|
HCPCS G0379
|
| Hospital Charge Code |
76200001
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$69.49 |
| Max. Negotiated Rate |
$142.14 |
| Rate for Payer: Aetna American Axle |
$102.65
|
| Rate for Payer: Aetna Commercial |
$134.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.65
|
| Rate for Payer: Cash Price |
$126.34
|
| Rate for Payer: Cofinity Advantage |
$110.55
|
| Rate for Payer: Cofinity Commercial |
$135.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.34
|
| Rate for Payer: Healthscope Commercial |
$142.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$110.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$118.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$118.45
|
| Rate for Payer: PHP Commercial |
$134.24
|
| Rate for Payer: Priority Health SBD |
$99.50
|
| Rate for Payer: UMR Bronson Commercial |
$69.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$118.45
|
|
|
HC DIRECT ADMIT TO OBS
|
Facility
|
OP
|
$157.93
|
|
|
Service Code
|
HCPCS G0379
|
| Hospital Charge Code |
76200001
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$58.43 |
| Max. Negotiated Rate |
$1,918.97 |
| Rate for Payer: Aetna American Axle |
$102.65
|
| Rate for Payer: Aetna Commercial |
$134.24
|
| Rate for Payer: Aetna Medicare |
$617.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$741.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$741.74
|
| Rate for Payer: BCBS Complete |
$325.89
|
| Rate for Payer: BCBS MAPPO |
$593.39
|
| Rate for Payer: BCBS Trust/PPO |
$107.13
|
| Rate for Payer: BCN Commercial |
$107.13
|
| Rate for Payer: BCN Medicare Advantage |
$593.39
|
| Rate for Payer: Cash Price |
$126.34
|
| Rate for Payer: Cash Price |
$126.34
|
| Rate for Payer: Cash Price |
$126.34
|
| Rate for Payer: Cash Price |
$126.34
|
| Rate for Payer: Cofinity Advantage |
$110.55
|
| Rate for Payer: Cofinity Commercial |
$135.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$593.39
|
| Rate for Payer: Healthscope Commercial |
$142.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$110.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$118.45
|
| Rate for Payer: Mclaren Medicaid |
$593.39
|
| Rate for Payer: Mclaren Medicare |
$593.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$623.06
|
| Rate for Payer: Meridian Medicaid |
$623.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$682.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$652.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.24
|
| Rate for Payer: Nomi Health Commercial |
$1,780.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$118.45
|
| Rate for Payer: PACE Medicare |
$563.72
|
| Rate for Payer: PACE SWMI |
$593.39
|
| Rate for Payer: PHP Commercial |
$134.24
|
| Rate for Payer: PHP Medicare Advantage |
$593.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$310.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,918.97
|
| Rate for Payer: Priority Health Medicare |
$593.39
|
| Rate for Payer: Priority Health SBD |
$99.50
|
| Rate for Payer: Priority Health Tiered Network |
$1,535.18
|
| Rate for Payer: Railroad Medicare Medicare |
$593.39
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$593.39
|
| Rate for Payer: UHC Medicaid |
$1,608.00
|
| Rate for Payer: UHCCP Medicaid |
$850.00
|
| Rate for Payer: UMR Bronson Commercial |
$58.43
|
| Rate for Payer: VA VA |
$593.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$118.45
|
|
|
HC DIRECT COOMBS
|
Facility
|
IP
|
$66.96
|
|
|
Service Code
|
CPT 86880
|
| Hospital Charge Code |
30200343
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$29.46 |
| Max. Negotiated Rate |
$60.26 |
| Rate for Payer: Aetna American Axle |
$43.52
|
| Rate for Payer: Aetna Commercial |
$56.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.52
|
| Rate for Payer: Cash Price |
$53.57
|
| Rate for Payer: Cofinity Advantage |
$46.87
|
| Rate for Payer: Cofinity Commercial |
$57.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.57
|
| Rate for Payer: Healthscope Commercial |
$60.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.22
|
| Rate for Payer: PHP Commercial |
$56.92
|
| Rate for Payer: Priority Health SBD |
$42.18
|
| Rate for Payer: UMR Bronson Commercial |
$29.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.22
|
|
|
HC DIRECT COOMBS
|
Facility
|
OP
|
$66.96
|
|
|
Service Code
|
CPT 86880
|
| Hospital Charge Code |
30200343
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.82 |
| Max. Negotiated Rate |
$190.09 |
| Rate for Payer: Aetna American Axle |
$43.52
|
| Rate for Payer: Aetna Commercial |
$56.92
|
| Rate for Payer: Aetna Medicare |
$5.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.74
|
| Rate for Payer: BCBS Complete |
$2.96
|
| Rate for Payer: BCBS MAPPO |
$5.39
|
| Rate for Payer: BCBS Trust/PPO |
$6.23
|
| Rate for Payer: BCN Commercial |
$6.23
|
| Rate for Payer: BCN Medicare Advantage |
$5.39
|
| Rate for Payer: Cash Price |
$53.57
|
| Rate for Payer: Cash Price |
$53.57
|
| Rate for Payer: Cofinity Advantage |
$46.87
|
| Rate for Payer: Cofinity Commercial |
$57.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.39
|
| Rate for Payer: Healthscope Commercial |
$60.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.22
|
| Rate for Payer: Mclaren Medicaid |
$5.39
|
| Rate for Payer: Mclaren Medicare |
$5.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.66
|
| Rate for Payer: Meridian Medicaid |
$5.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.20
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.92
|
| Rate for Payer: Nomi Health Commercial |
$16.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.22
|
| Rate for Payer: PACE Medicare |
$5.12
|
| Rate for Payer: PACE SWMI |
$5.39
|
| Rate for Payer: PHP Commercial |
$56.92
|
| Rate for Payer: PHP Medicare Advantage |
$5.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$190.09
|
| Rate for Payer: Priority Health Medicare |
$5.39
|
| Rate for Payer: Priority Health SBD |
$42.18
|
| Rate for Payer: Priority Health Tiered Network |
$152.07
|
| Rate for Payer: Railroad Medicare Medicare |
$5.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.09
|
| Rate for Payer: UHC Core |
$8.09
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.39
|
| Rate for Payer: UHC Exchange |
$8.09
|
| Rate for Payer: UHC Medicaid |
$2.82
|
| Rate for Payer: UHCCP Medicaid |
$2.82
|
| Rate for Payer: UMR Bronson Commercial |
$24.78
|
| Rate for Payer: VA VA |
$5.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.22
|
|
