HC MEDTRONIC ICD DUAL
|
Facility
|
OP
|
$25,806.00
|
|
Service Code
|
HCPCS C1721
|
Hospital Charge Code |
27800019
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$9,548.22 |
Max. Negotiated Rate |
$23,225.40 |
Rate for Payer: Aetna American Axle |
$16,773.90
|
Rate for Payer: Aetna Commercial |
$21,935.10
|
Rate for Payer: Aetna New Business (MI Preferred) |
$16,773.90
|
Rate for Payer: BCBS Complete |
$10,322.40
|
Rate for Payer: Cash Price |
$20,644.80
|
Rate for Payer: Cofinity Commercial |
$18,064.20
|
Rate for Payer: Cofinity Commercial |
$22,193.16
|
Rate for Payer: Encore Health Key Benefits Commercial |
$20,644.80
|
Rate for Payer: Healthscope Commercial |
$23,225.40
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18,064.20
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$19,354.50
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21,935.10
|
Rate for Payer: PHP Commercial |
$21,935.10
|
Rate for Payer: Priority Health Cigna Priority Health |
$18,064.20
|
Rate for Payer: Priority Health SBD |
$16,257.78
|
Rate for Payer: UMR Bronson Commercial |
$9,548.22
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19,354.50
|
|
HC MEDTRONIC ICD DUAL
|
Facility
|
IP
|
$25,806.00
|
|
Service Code
|
HCPCS C1721
|
Hospital Charge Code |
27800019
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$11,354.64 |
Max. Negotiated Rate |
$23,225.40 |
Rate for Payer: Aetna American Axle |
$16,773.90
|
Rate for Payer: Aetna Commercial |
$21,935.10
|
Rate for Payer: Aetna New Business (MI Preferred) |
$16,773.90
|
Rate for Payer: Cash Price |
$20,644.80
|
Rate for Payer: Cofinity Commercial |
$18,064.20
|
Rate for Payer: Cofinity Commercial |
$22,193.16
|
Rate for Payer: Encore Health Key Benefits Commercial |
$20,644.80
|
Rate for Payer: Healthscope Commercial |
$23,225.40
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18,064.20
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$19,354.50
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21,935.10
|
Rate for Payer: PHP Commercial |
$21,935.10
|
Rate for Payer: Priority Health Cigna Priority Health |
$18,064.20
|
Rate for Payer: Priority Health SBD |
$16,257.78
|
Rate for Payer: UMR Bronson Commercial |
$11,354.64
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19,354.50
|
|
HC MEDTRONIC ICD SINGLE
|
Facility
|
IP
|
$23,358.00
|
|
Service Code
|
HCPCS C1722
|
Hospital Charge Code |
27800020
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$10,277.52 |
Max. Negotiated Rate |
$21,022.20 |
Rate for Payer: Aetna American Axle |
$15,182.70
|
Rate for Payer: Aetna Commercial |
$19,854.30
|
Rate for Payer: Aetna New Business (MI Preferred) |
$15,182.70
|
Rate for Payer: Cash Price |
$18,686.40
|
Rate for Payer: Cofinity Commercial |
$16,350.60
|
Rate for Payer: Cofinity Commercial |
$20,087.88
|
Rate for Payer: Encore Health Key Benefits Commercial |
$18,686.40
|
Rate for Payer: Healthscope Commercial |
$21,022.20
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16,350.60
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$17,518.50
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19,854.30
|
Rate for Payer: PHP Commercial |
$19,854.30
|
Rate for Payer: Priority Health Cigna Priority Health |
$16,350.60
|
Rate for Payer: Priority Health SBD |
$14,715.54
|
Rate for Payer: UMR Bronson Commercial |
$10,277.52
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17,518.50
|
|
HC MEDTRONIC ICD SINGLE
|
Facility
|
OP
|
$23,358.00
|
|
Service Code
|
HCPCS C1722
|
Hospital Charge Code |
27800020
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$8,642.46 |
Max. Negotiated Rate |
$21,022.20 |
Rate for Payer: Aetna American Axle |
$15,182.70
|
Rate for Payer: Aetna Commercial |
$19,854.30
|
Rate for Payer: Aetna New Business (MI Preferred) |
$15,182.70
|
Rate for Payer: BCBS Complete |
$9,343.20
|
Rate for Payer: Cash Price |
$18,686.40
|
Rate for Payer: Cofinity Commercial |
$16,350.60
|
Rate for Payer: Cofinity Commercial |
$20,087.88
|
Rate for Payer: Encore Health Key Benefits Commercial |
$18,686.40
|
Rate for Payer: Healthscope Commercial |
$21,022.20
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16,350.60
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$17,518.50
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19,854.30
|
Rate for Payer: PHP Commercial |
$19,854.30
|
Rate for Payer: Priority Health Cigna Priority Health |
$16,350.60
|
Rate for Payer: Priority Health SBD |
$14,715.54
|
Rate for Payer: UMR Bronson Commercial |
$8,642.46
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17,518.50
|
|
HC MEDTRONIC SINGLE PACEMAKER
|
Facility
|
IP
|
$12,956.99
|
|
Service Code
|
HCPCS C1786
|
Hospital Charge Code |
27500008
|
Hospital Revenue Code
|
275
|
Min. Negotiated Rate |
$5,701.08 |
Max. Negotiated Rate |
$11,661.29 |
Rate for Payer: Aetna American Axle |
$8,422.04
|
Rate for Payer: Aetna Commercial |
$11,013.44
|
Rate for Payer: Aetna New Business (MI Preferred) |
$8,422.04
|
Rate for Payer: Cash Price |
$10,365.59
|
Rate for Payer: Cofinity Commercial |
$11,143.01
|
Rate for Payer: Cofinity Commercial |
$9,069.89
|
Rate for Payer: Encore Health Key Benefits Commercial |
$10,365.59
|
Rate for Payer: Healthscope Commercial |
$11,661.29
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9,069.89
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,717.74
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11,013.44
|
Rate for Payer: PHP Commercial |
$11,013.44
|
Rate for Payer: Priority Health Cigna Priority Health |
$9,069.89
|
Rate for Payer: Priority Health SBD |
$8,162.90
|
Rate for Payer: UMR Bronson Commercial |
$5,701.08
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,717.74
|
|
HC MEDTRONIC SINGLE PACEMAKER
|
Facility
|
OP
|
$12,956.99
|
|
Service Code
|
HCPCS C1786
|
Hospital Charge Code |
27500008
|
Hospital Revenue Code
|
275
|
Min. Negotiated Rate |
$4,794.09 |
Max. Negotiated Rate |
$11,661.29 |
Rate for Payer: Aetna American Axle |
$8,422.04
|
Rate for Payer: Aetna Commercial |
$11,013.44
|
Rate for Payer: Aetna New Business (MI Preferred) |
$8,422.04
|
Rate for Payer: BCBS Complete |
$5,182.80
|
Rate for Payer: Cash Price |
$10,365.59
|
Rate for Payer: Cofinity Commercial |
$11,143.01
|
Rate for Payer: Cofinity Commercial |
$9,069.89
|
Rate for Payer: Encore Health Key Benefits Commercial |
$10,365.59
|
Rate for Payer: Healthscope Commercial |
$11,661.29
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9,069.89
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,717.74
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11,013.44
|
Rate for Payer: PHP Commercial |
$11,013.44
|
Rate for Payer: Priority Health Cigna Priority Health |
$9,069.89
|
Rate for Payer: Priority Health SBD |
$8,162.90
|
Rate for Payer: UMR Bronson Commercial |
$4,794.09
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,717.74
|
|
HC MEDTRONIC TACHY (ICD) LEAD
|
Facility
|
IP
|
$15,291.65
|
|
Service Code
|
HCPCS C1895
|
Hospital Charge Code |
27800021
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$6,728.33 |
Max. Negotiated Rate |
$13,762.48 |
Rate for Payer: Aetna American Axle |
$9,939.57
|
Rate for Payer: Aetna Commercial |
$12,997.90
|
Rate for Payer: Aetna New Business (MI Preferred) |
$9,939.57
|
Rate for Payer: Cash Price |
$12,233.32
|
Rate for Payer: Cofinity Commercial |
$10,704.16
|
Rate for Payer: Cofinity Commercial |
$13,150.82
|
Rate for Payer: Encore Health Key Benefits Commercial |
$12,233.32
|
Rate for Payer: Healthscope Commercial |
$13,762.48
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10,704.16
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$11,468.74
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12,997.90
|
Rate for Payer: PHP Commercial |
$12,997.90
|
Rate for Payer: Priority Health Cigna Priority Health |
$10,704.16
|
Rate for Payer: Priority Health SBD |
$9,633.74
|
Rate for Payer: UMR Bronson Commercial |
$6,728.33
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11,468.74
|
|
HC MEDTRONIC TACHY (ICD) LEAD
|
Facility
|
OP
|
$15,291.65
|
|
Service Code
|
HCPCS C1895
|
Hospital Charge Code |
27800021
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$5,657.91 |
Max. Negotiated Rate |
$13,762.48 |
Rate for Payer: Aetna American Axle |
$9,939.57
|
Rate for Payer: Aetna Commercial |
$12,997.90
|
Rate for Payer: Aetna New Business (MI Preferred) |
$9,939.57
|
Rate for Payer: BCBS Complete |
$6,116.66
|
Rate for Payer: Cash Price |
$12,233.32
|
Rate for Payer: Cofinity Commercial |
$10,704.16
|
Rate for Payer: Cofinity Commercial |
$13,150.82
|
Rate for Payer: Encore Health Key Benefits Commercial |
$12,233.32
|
Rate for Payer: Healthscope Commercial |
$13,762.48
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10,704.16
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$11,468.74
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12,997.90
|
Rate for Payer: PHP Commercial |
$12,997.90
|
Rate for Payer: Priority Health Cigna Priority Health |
$10,704.16
|
Rate for Payer: Priority Health SBD |
$9,633.74
|
Rate for Payer: UMR Bronson Commercial |
$5,657.91
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11,468.74
|
|
HC MENACWY-TT VACCINE IM
|
Facility
|
OP
|
$183.60
|
|
Service Code
|
CPT 90619
|
Hospital Charge Code |
63600210
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$67.93 |
Max. Negotiated Rate |
$533.99 |
Rate for Payer: Aetna American Axle |
$119.34
|
Rate for Payer: Aetna Commercial |
$156.06
|
Rate for Payer: Aetna New Business (MI Preferred) |
$119.34
|
Rate for Payer: BCBS Complete |
$73.44
|
Rate for Payer: BCBS Trust/PPO |
$533.99
|
Rate for Payer: Cash Price |
$146.88
|
Rate for Payer: Cash Price |
$146.88
|
Rate for Payer: Cofinity Commercial |
$157.90
|
Rate for Payer: Cofinity Commercial |
$128.52
|
Rate for Payer: Encore Health Key Benefits Commercial |
$146.88
|
Rate for Payer: Healthscope Commercial |
$165.24
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$128.52
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$137.70
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$156.06
|
Rate for Payer: PHP Commercial |
$156.06
|
Rate for Payer: Priority Health Cigna Priority Health |
$128.52
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$177.82
|
Rate for Payer: Priority Health Narrow Network |
$142.26
|
Rate for Payer: Priority Health SBD |
$115.67
|
Rate for Payer: UMR Bronson Commercial |
$67.93
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$137.70
|
|
HC MENACWY-TT VACCINE IM
|
Facility
|
IP
|
$183.60
|
|
Service Code
|
CPT 90619
|
Hospital Charge Code |
63600210
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$80.78 |
Max. Negotiated Rate |
$165.24 |
Rate for Payer: Aetna American Axle |
$119.34
|
Rate for Payer: Aetna Commercial |
$156.06
|
Rate for Payer: Aetna New Business (MI Preferred) |
$119.34
|
Rate for Payer: Cash Price |
$146.88
|
Rate for Payer: Cofinity Commercial |
$128.52
|
Rate for Payer: Cofinity Commercial |
$157.90
|
Rate for Payer: Encore Health Key Benefits Commercial |
$146.88
|
Rate for Payer: Healthscope Commercial |
$165.24
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$128.52
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$137.70
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$156.06
|
Rate for Payer: PHP Commercial |
$156.06
|
Rate for Payer: Priority Health Cigna Priority Health |
$128.52
|
Rate for Payer: Priority Health SBD |
$115.67
|
Rate for Payer: UMR Bronson Commercial |
$80.78
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$137.70
|
|
HC MENB-FHBP VACC 2/3 DOSE IM
|
Facility
|
IP
|
$516.58
|
|
Service Code
|
CPT 90621
|
Hospital Charge Code |
63600187
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$227.30 |
Max. Negotiated Rate |
$464.92 |
Rate for Payer: Aetna American Axle |
$335.78
|
Rate for Payer: Aetna Commercial |
$439.09
|
Rate for Payer: Aetna New Business (MI Preferred) |
$335.78
|
Rate for Payer: Cash Price |
$413.26
|
Rate for Payer: Cofinity Commercial |
$361.61
|
Rate for Payer: Cofinity Commercial |
$444.26
|
Rate for Payer: Encore Health Key Benefits Commercial |
$413.26
|
Rate for Payer: Healthscope Commercial |
$464.92
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$361.61
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$387.44
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$439.09
|
Rate for Payer: PHP Commercial |
$439.09
|
Rate for Payer: Priority Health Cigna Priority Health |
$361.61
|
Rate for Payer: Priority Health SBD |
$325.45
|
Rate for Payer: UMR Bronson Commercial |
$227.30
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$387.44
|
|
HC MENB-FHBP VACC 2/3 DOSE IM
|
Facility
|
OP
|
$516.58
|
|
Service Code
|
CPT 90621
|
Hospital Charge Code |
63600187
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$163.78 |
Max. Negotiated Rate |
$525.99 |
Rate for Payer: Aetna American Axle |
$335.78
|
Rate for Payer: Aetna Commercial |
$439.09
|
Rate for Payer: Aetna New Business (MI Preferred) |
$335.78
|
Rate for Payer: BCBS Complete |
$206.63
|
Rate for Payer: BCBS Trust/PPO |
$525.99
|
Rate for Payer: Cash Price |
$413.26
|
Rate for Payer: Cash Price |
$413.26
|
Rate for Payer: Cofinity Commercial |
$361.61
|
Rate for Payer: Cofinity Commercial |
$444.26
|
Rate for Payer: Encore Health Key Benefits Commercial |
$413.26
|
Rate for Payer: Healthscope Commercial |
$464.92
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$361.61
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$387.44
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$439.09
|
Rate for Payer: PHP Commercial |
$439.09
|
Rate for Payer: Priority Health Cigna Priority Health |
$361.61
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$204.72
|
Rate for Payer: Priority Health Narrow Network |
$163.78
|
Rate for Payer: Priority Health SBD |
$325.45
|
Rate for Payer: UMR Bronson Commercial |
$191.13
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$387.44
|
|
HC MENB RECOMB PROT W/OUT MEMBR VESIC VACC IM
|
Facility
|
OP
|
$236.64
|
|
Service Code
|
CPT 90620
|
Hospital Charge Code |
63600122
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$87.56 |
Max. Negotiated Rate |
$629.74 |
Rate for Payer: Aetna American Axle |
$153.82
|
Rate for Payer: Aetna Commercial |
$201.14
|
Rate for Payer: Aetna New Business (MI Preferred) |
$153.82
|
Rate for Payer: BCBS Complete |
$94.66
|
Rate for Payer: BCBS Trust/PPO |
$629.74
|
Rate for Payer: Cash Price |
$189.31
|
Rate for Payer: Cash Price |
$189.31
|
Rate for Payer: Cofinity Commercial |
$203.51
|
Rate for Payer: Cofinity Commercial |
$165.65
|
Rate for Payer: Encore Health Key Benefits Commercial |
$189.31
|
Rate for Payer: Healthscope Commercial |
$212.98
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$165.65
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$177.48
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$201.14
|
Rate for Payer: PHP Commercial |
$201.14
|
Rate for Payer: Priority Health Cigna Priority Health |
$165.65
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$240.77
|
Rate for Payer: Priority Health Narrow Network |
$192.62
|
Rate for Payer: Priority Health SBD |
$149.08
|
Rate for Payer: UMR Bronson Commercial |
$87.56
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$177.48
|
|
HC MENB RECOMB PROT W/OUT MEMBR VESIC VACC IM
|
Facility
|
IP
|
$236.64
|
|
Service Code
|
CPT 90620
|
Hospital Charge Code |
63600122
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$104.12 |
Max. Negotiated Rate |
$212.98 |
Rate for Payer: Aetna American Axle |
$153.82
|
Rate for Payer: Aetna Commercial |
$201.14
|
Rate for Payer: Aetna New Business (MI Preferred) |
$153.82
|
Rate for Payer: Cash Price |
$189.31
|
Rate for Payer: Cofinity Commercial |
$165.65
|
Rate for Payer: Cofinity Commercial |
$203.51
|
Rate for Payer: Encore Health Key Benefits Commercial |
$189.31
|
Rate for Payer: Healthscope Commercial |
$212.98
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$165.65
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$177.48
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$201.14
|
Rate for Payer: PHP Commercial |
$201.14
|
Rate for Payer: Priority Health Cigna Priority Health |
$165.65
|
Rate for Payer: Priority Health SBD |
$149.08
|
Rate for Payer: UMR Bronson Commercial |
$104.12
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$177.48
|
|
HC MENENCEPH CMPT 10
|
Facility
|
OP
|
$13.87
|
|
Service Code
|
CPT 86735
|
Hospital Charge Code |
30200307
|
Hospital Revenue Code
|
302
|
Min. Negotiated Rate |
$5.13 |
Max. Negotiated Rate |
$21.53 |
Rate for Payer: Aetna American Axle |
$9.02
|
Rate for Payer: Aetna Commercial |
$11.79
|
Rate for Payer: Aetna Medicare |
$13.57
|
Rate for Payer: Aetna New Business (MI Preferred) |
$9.02
|
Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.31
|
Rate for Payer: Amish Plain Church Group Commercial |
$16.31
|
Rate for Payer: BCBS Complete |
$7.50
|
Rate for Payer: BCBS MAPPO |
$13.05
|
Rate for Payer: BCBS Trust/PPO |
$11.74
|
Rate for Payer: BCN Medicare Advantage |
$13.05
|
Rate for Payer: Cash Price |
$11.10
|
Rate for Payer: Cash Price |
$11.10
|
Rate for Payer: Cofinity Commercial |
$9.71
|
Rate for Payer: Cofinity Commercial |
$11.93
|
Rate for Payer: Encore Health Key Benefits Commercial |
$11.10
|
Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.05
|
Rate for Payer: Healthscope Commercial |
$12.48
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.71
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.40
|
Rate for Payer: Mclaren Medicaid |
$7.14
|
Rate for Payer: Mclaren Medicare |
$13.05
|
Rate for Payer: Meridian Medicaid |
$7.50
|
Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.70
|
Rate for Payer: MI Amish Medical Board Commercial |
$15.01
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.79
|
Rate for Payer: PACE Medicare |
$12.40
|
Rate for Payer: PACE SWMI |
$13.05
|
Rate for Payer: PHP Commercial |
$11.79
|
Rate for Payer: PHP Medicare Advantage |
$13.05
|
Rate for Payer: Priority Health Choice Medicaid |
$7.14
|
Rate for Payer: Priority Health Cigna Priority Health |
$9.71
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.90
|
Rate for Payer: Priority Health Medicare |
$13.05
|
Rate for Payer: Priority Health Narrow Network |
$14.32
|
Rate for Payer: Priority Health SBD |
$8.74
|
Rate for Payer: Railroad Medicare Medicare |
$13.05
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$15.66
|
Rate for Payer: UHC Core |
$21.53
|
Rate for Payer: UHC Dual Complete DSNP |
$13.05
|
Rate for Payer: UHC Exchange |
$13.05
|
Rate for Payer: UHC Medicare Advantage |
$13.44
|
Rate for Payer: UMR Bronson Commercial |
$5.13
|
Rate for Payer: VA VA |
$13.05
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.40
|
|
HC MENENCEPH CMPT 10
|
Facility
|
IP
|
$13.87
|
|
Service Code
|
CPT 86735
|
Hospital Charge Code |
30200307
|
Hospital Revenue Code
|
302
|
Min. Negotiated Rate |
$6.10 |
Max. Negotiated Rate |
$12.48 |
Rate for Payer: Aetna American Axle |
$9.02
|
Rate for Payer: Aetna Commercial |
$11.79
|
Rate for Payer: Aetna New Business (MI Preferred) |
$9.02
|
Rate for Payer: Cash Price |
$11.10
|
Rate for Payer: Cofinity Commercial |
$11.93
|
Rate for Payer: Cofinity Commercial |
$9.71
|
Rate for Payer: Encore Health Key Benefits Commercial |
$11.10
|
Rate for Payer: Healthscope Commercial |
$12.48
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.71
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.40
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.79
|
Rate for Payer: PHP Commercial |
$11.79
|
Rate for Payer: Priority Health Cigna Priority Health |
$9.71
|
Rate for Payer: Priority Health SBD |
$8.74
|
Rate for Payer: UMR Bronson Commercial |
$6.10
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.40
|
|
HC MENENCEPH CMPT 11
|
Facility
|
OP
|
$13.87
|
|
Service Code
|
CPT 86653
|
Hospital Charge Code |
30200258
|
Hospital Revenue Code
|
302
|
Min. Negotiated Rate |
$5.13 |
Max. Negotiated Rate |
$21.76 |
Rate for Payer: Aetna American Axle |
$9.02
|
Rate for Payer: Aetna Commercial |
$11.79
|
Rate for Payer: Aetna Medicare |
$13.72
|
Rate for Payer: Aetna New Business (MI Preferred) |
$9.02
|
Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.49
|
Rate for Payer: Amish Plain Church Group Commercial |
$16.49
|
Rate for Payer: BCBS Complete |
$7.58
|
Rate for Payer: BCBS MAPPO |
$13.19
|
Rate for Payer: BCBS Trust/PPO |
$11.86
|
Rate for Payer: BCN Medicare Advantage |
$13.19
|
Rate for Payer: Cash Price |
$11.10
|
Rate for Payer: Cash Price |
$11.10
|
Rate for Payer: Cofinity Commercial |
$11.93
|
Rate for Payer: Cofinity Commercial |
$9.71
|
Rate for Payer: Encore Health Key Benefits Commercial |
$11.10
|
Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.19
|
Rate for Payer: Healthscope Commercial |
$12.48
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.71
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.40
|
Rate for Payer: Mclaren Medicaid |
$7.21
|
Rate for Payer: Mclaren Medicare |
$13.19
|
Rate for Payer: Meridian Medicaid |
$7.58
|
Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.85
|
Rate for Payer: MI Amish Medical Board Commercial |
$15.17
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.79
|
Rate for Payer: PACE Medicare |
$12.53
|
Rate for Payer: PACE SWMI |
$13.19
|
Rate for Payer: PHP Commercial |
$11.79
|
Rate for Payer: PHP Medicare Advantage |
$13.19
|
Rate for Payer: Priority Health Choice Medicaid |
$7.21
|
Rate for Payer: Priority Health Cigna Priority Health |
$9.71
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.09
|
Rate for Payer: Priority Health Medicare |
$13.19
|
Rate for Payer: Priority Health Narrow Network |
$14.47
|
Rate for Payer: Priority Health SBD |
$8.74
|
Rate for Payer: Railroad Medicare Medicare |
$13.19
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$15.83
|
Rate for Payer: UHC Core |
$21.76
|
Rate for Payer: UHC Dual Complete DSNP |
$13.19
|
Rate for Payer: UHC Exchange |
$13.19
|
Rate for Payer: UHC Medicare Advantage |
$13.59
|
Rate for Payer: UMR Bronson Commercial |
$5.13
|
Rate for Payer: VA VA |
$13.19
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.40
|
|
HC MENENCEPH CMPT 11
|
Facility
|
IP
|
$13.87
|
|
Service Code
|
CPT 86653
|
Hospital Charge Code |
30200258
|
Hospital Revenue Code
|
302
|
Min. Negotiated Rate |
$6.10 |
Max. Negotiated Rate |
$12.48 |
Rate for Payer: Aetna American Axle |
$9.02
|
Rate for Payer: Aetna Commercial |
$11.79
|
Rate for Payer: Aetna New Business (MI Preferred) |
$9.02
|
Rate for Payer: Cash Price |
$11.10
|
Rate for Payer: Cofinity Commercial |
$11.93
|
Rate for Payer: Cofinity Commercial |
$9.71
|
Rate for Payer: Encore Health Key Benefits Commercial |
$11.10
|
Rate for Payer: Healthscope Commercial |
$12.48
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.71
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.40
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.79
|
Rate for Payer: PHP Commercial |
$11.79
|
Rate for Payer: Priority Health Cigna Priority Health |
$9.71
|
Rate for Payer: Priority Health SBD |
$8.74
|
Rate for Payer: UMR Bronson Commercial |
$6.10
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.40
|
|
HC MENENCEPH CMPT 12
|
Facility
|
IP
|
$13.87
|
|
Service Code
|
CPT 86787
|
Hospital Charge Code |
30200328
|
Hospital Revenue Code
|
302
|
Min. Negotiated Rate |
$6.10 |
Max. Negotiated Rate |
$12.48 |
Rate for Payer: Aetna American Axle |
$9.02
|
Rate for Payer: Aetna Commercial |
$11.79
|
Rate for Payer: Aetna New Business (MI Preferred) |
$9.02
|
Rate for Payer: Cash Price |
$11.10
|
Rate for Payer: Cofinity Commercial |
$11.93
|
Rate for Payer: Cofinity Commercial |
$9.71
|
Rate for Payer: Encore Health Key Benefits Commercial |
$11.10
|
Rate for Payer: Healthscope Commercial |
$12.48
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.71
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.40
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.79
|
Rate for Payer: PHP Commercial |
$11.79
|
Rate for Payer: Priority Health Cigna Priority Health |
$9.71
|
Rate for Payer: Priority Health SBD |
$8.74
|
Rate for Payer: UMR Bronson Commercial |
$6.10
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.40
|
|
HC MENENCEPH CMPT 12
|
Facility
|
OP
|
$13.87
|
|
Service Code
|
CPT 86787
|
Hospital Charge Code |
30200328
|
Hospital Revenue Code
|
302
|
Min. Negotiated Rate |
$5.13 |
Max. Negotiated Rate |
$21.25 |
Rate for Payer: Aetna American Axle |
$9.02
|
Rate for Payer: Aetna Commercial |
$11.79
|
Rate for Payer: Aetna Medicare |
$13.40
|
Rate for Payer: Aetna New Business (MI Preferred) |
$9.02
|
Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.10
|
Rate for Payer: Amish Plain Church Group Commercial |
$16.10
|
Rate for Payer: BCBS Complete |
$7.40
|
Rate for Payer: BCBS MAPPO |
$12.88
|
Rate for Payer: BCBS Trust/PPO |
$11.58
|
Rate for Payer: BCN Medicare Advantage |
$12.88
|
Rate for Payer: Cash Price |
$11.10
|
Rate for Payer: Cash Price |
$11.10
|
Rate for Payer: Cofinity Commercial |
$11.93
|
Rate for Payer: Cofinity Commercial |
$9.71
|
Rate for Payer: Encore Health Key Benefits Commercial |
$11.10
|
Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.88
|
Rate for Payer: Healthscope Commercial |
$12.48
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.71
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.40
|
Rate for Payer: Mclaren Medicaid |
$7.05
|
Rate for Payer: Mclaren Medicare |
$12.88
|
Rate for Payer: Meridian Medicaid |
$7.40
|
Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.52
|
Rate for Payer: MI Amish Medical Board Commercial |
$14.81
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.79
|
Rate for Payer: PACE Medicare |
$12.24
|
Rate for Payer: PACE SWMI |
$12.88
|
Rate for Payer: PHP Commercial |
$11.79
|
Rate for Payer: PHP Medicare Advantage |
$12.88
|
Rate for Payer: Priority Health Choice Medicaid |
$7.05
|
Rate for Payer: Priority Health Cigna Priority Health |
$9.71
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.67
|
Rate for Payer: Priority Health Medicare |
$12.88
|
Rate for Payer: Priority Health Narrow Network |
$14.14
|
Rate for Payer: Priority Health SBD |
$8.74
|
Rate for Payer: Railroad Medicare Medicare |
$12.88
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$15.46
|
Rate for Payer: UHC Core |
$21.25
|
Rate for Payer: UHC Dual Complete DSNP |
$12.88
|
Rate for Payer: UHC Exchange |
$12.88
|
Rate for Payer: UHC Medicare Advantage |
$13.27
|
Rate for Payer: UMR Bronson Commercial |
$5.13
|
Rate for Payer: VA VA |
$12.88
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.40
|
|
HC MENENCEPH CMPT 13
|
Facility
|
OP
|
$13.87
|
|
Service Code
|
CPT 86654
|
Hospital Charge Code |
30200259
|
Hospital Revenue Code
|
302
|
Min. Negotiated Rate |
$5.13 |
Max. Negotiated Rate |
$21.76 |
Rate for Payer: Aetna American Axle |
$9.02
|
Rate for Payer: Aetna Commercial |
$11.79
|
Rate for Payer: Aetna Medicare |
$13.72
|
Rate for Payer: Aetna New Business (MI Preferred) |
$9.02
|
Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.49
|
Rate for Payer: Amish Plain Church Group Commercial |
$16.49
|
Rate for Payer: BCBS Complete |
$7.58
|
Rate for Payer: BCBS MAPPO |
$13.19
|
Rate for Payer: BCBS Trust/PPO |
$11.86
|
Rate for Payer: BCN Medicare Advantage |
$13.19
|
Rate for Payer: Cash Price |
$11.10
|
Rate for Payer: Cash Price |
$11.10
|
Rate for Payer: Cofinity Commercial |
$9.71
|
Rate for Payer: Cofinity Commercial |
$11.93
|
Rate for Payer: Encore Health Key Benefits Commercial |
$11.10
|
Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.19
|
Rate for Payer: Healthscope Commercial |
$12.48
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.71
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.40
|
Rate for Payer: Mclaren Medicaid |
$7.21
|
Rate for Payer: Mclaren Medicare |
$13.19
|
Rate for Payer: Meridian Medicaid |
$7.58
|
Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.85
|
Rate for Payer: MI Amish Medical Board Commercial |
$15.17
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.79
|
Rate for Payer: PACE Medicare |
$12.53
|
Rate for Payer: PACE SWMI |
$13.19
|
Rate for Payer: PHP Commercial |
$11.79
|
Rate for Payer: PHP Medicare Advantage |
$13.19
|
Rate for Payer: Priority Health Choice Medicaid |
$7.21
|
Rate for Payer: Priority Health Cigna Priority Health |
$9.71
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.09
|
Rate for Payer: Priority Health Medicare |
$13.19
|
Rate for Payer: Priority Health Narrow Network |
$14.47
|
Rate for Payer: Priority Health SBD |
$8.74
|
Rate for Payer: Railroad Medicare Medicare |
$13.19
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$15.83
|
Rate for Payer: UHC Core |
$21.76
|
Rate for Payer: UHC Dual Complete DSNP |
$13.19
|
Rate for Payer: UHC Exchange |
$13.19
|
Rate for Payer: UHC Medicare Advantage |
$13.59
|
Rate for Payer: UMR Bronson Commercial |
$5.13
|
Rate for Payer: VA VA |
$13.19
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.40
|
|
HC MENENCEPH CMPT 13
|
Facility
|
IP
|
$13.87
|
|
Service Code
|
CPT 86654
|
Hospital Charge Code |
30200259
|
Hospital Revenue Code
|
302
|
Min. Negotiated Rate |
$6.10 |
Max. Negotiated Rate |
$12.48 |
Rate for Payer: Aetna American Axle |
$9.02
|
Rate for Payer: Aetna Commercial |
$11.79
|
Rate for Payer: Aetna New Business (MI Preferred) |
$9.02
|
Rate for Payer: Cash Price |
$11.10
|
Rate for Payer: Cofinity Commercial |
$11.93
|
Rate for Payer: Cofinity Commercial |
$9.71
|
Rate for Payer: Encore Health Key Benefits Commercial |
$11.10
|
Rate for Payer: Healthscope Commercial |
$12.48
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.71
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.40
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.79
|
Rate for Payer: PHP Commercial |
$11.79
|
Rate for Payer: Priority Health Cigna Priority Health |
$9.71
|
Rate for Payer: Priority Health SBD |
$8.74
|
Rate for Payer: UMR Bronson Commercial |
$6.10
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.40
|
|
HC MENENCEPH CMPT 14
|
Facility
|
IP
|
$13.87
|
|
Service Code
|
CPT 86710
|
Hospital Charge Code |
30200300
|
Hospital Revenue Code
|
302
|
Min. Negotiated Rate |
$6.10 |
Max. Negotiated Rate |
$12.48 |
Rate for Payer: Aetna American Axle |
$9.02
|
Rate for Payer: Aetna Commercial |
$11.79
|
Rate for Payer: Aetna New Business (MI Preferred) |
$9.02
|
Rate for Payer: Cash Price |
$11.10
|
Rate for Payer: Cofinity Commercial |
$11.93
|
Rate for Payer: Cofinity Commercial |
$9.71
|
Rate for Payer: Encore Health Key Benefits Commercial |
$11.10
|
Rate for Payer: Healthscope Commercial |
$12.48
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.71
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.40
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.79
|
Rate for Payer: PHP Commercial |
$11.79
|
Rate for Payer: Priority Health Cigna Priority Health |
$9.71
|
Rate for Payer: Priority Health SBD |
$8.74
|
Rate for Payer: UMR Bronson Commercial |
$6.10
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.40
|
|
HC MENENCEPH CMPT 14
|
Facility
|
OP
|
$13.87
|
|
Service Code
|
CPT 86710
|
Hospital Charge Code |
30200300
|
Hospital Revenue Code
|
302
|
Min. Negotiated Rate |
$5.13 |
Max. Negotiated Rate |
$22.36 |
Rate for Payer: Aetna American Axle |
$9.02
|
Rate for Payer: Aetna Commercial |
$11.79
|
Rate for Payer: Aetna Medicare |
$14.09
|
Rate for Payer: Aetna New Business (MI Preferred) |
$9.02
|
Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.94
|
Rate for Payer: Amish Plain Church Group Commercial |
$16.94
|
Rate for Payer: BCBS Complete |
$7.78
|
Rate for Payer: BCBS MAPPO |
$13.55
|
Rate for Payer: BCBS Trust/PPO |
$12.18
|
Rate for Payer: BCN Medicare Advantage |
$13.55
|
Rate for Payer: Cash Price |
$11.10
|
Rate for Payer: Cash Price |
$11.10
|
Rate for Payer: Cofinity Commercial |
$11.93
|
Rate for Payer: Cofinity Commercial |
$9.71
|
Rate for Payer: Encore Health Key Benefits Commercial |
$11.10
|
Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.55
|
Rate for Payer: Healthscope Commercial |
$12.48
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.71
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.40
|
Rate for Payer: Mclaren Medicaid |
$7.41
|
Rate for Payer: Mclaren Medicare |
$13.55
|
Rate for Payer: Meridian Medicaid |
$7.78
|
Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14.23
|
Rate for Payer: MI Amish Medical Board Commercial |
$15.58
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.79
|
Rate for Payer: PACE Medicare |
$12.87
|
Rate for Payer: PACE SWMI |
$13.55
|
Rate for Payer: PHP Commercial |
$11.79
|
Rate for Payer: PHP Medicare Advantage |
$13.55
|
Rate for Payer: Priority Health Choice Medicaid |
$7.41
|
Rate for Payer: Priority Health Cigna Priority Health |
$9.71
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.23
|
Rate for Payer: Priority Health Medicare |
$13.55
|
Rate for Payer: Priority Health Narrow Network |
$14.58
|
Rate for Payer: Priority Health SBD |
$8.74
|
Rate for Payer: Railroad Medicare Medicare |
$13.55
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$16.26
|
Rate for Payer: UHC Core |
$22.36
|
Rate for Payer: UHC Dual Complete DSNP |
$13.55
|
Rate for Payer: UHC Exchange |
$13.55
|
Rate for Payer: UHC Medicare Advantage |
$13.96
|
Rate for Payer: UMR Bronson Commercial |
$5.13
|
Rate for Payer: VA VA |
$13.55
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.40
|
|
HC MENENCEPH CMPT 15
|
Facility
|
IP
|
$13.87
|
|
Service Code
|
CPT 86765
|
Hospital Charge Code |
30200319
|
Hospital Revenue Code
|
302
|
Min. Negotiated Rate |
$6.10 |
Max. Negotiated Rate |
$12.48 |
Rate for Payer: Aetna American Axle |
$9.02
|
Rate for Payer: Aetna Commercial |
$11.79
|
Rate for Payer: Aetna New Business (MI Preferred) |
$9.02
|
Rate for Payer: Cash Price |
$11.10
|
Rate for Payer: Cofinity Commercial |
$11.93
|
Rate for Payer: Cofinity Commercial |
$9.71
|
Rate for Payer: Encore Health Key Benefits Commercial |
$11.10
|
Rate for Payer: Healthscope Commercial |
$12.48
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.71
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.40
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.79
|
Rate for Payer: PHP Commercial |
$11.79
|
Rate for Payer: Priority Health Cigna Priority Health |
$9.71
|
Rate for Payer: Priority Health SBD |
$8.74
|
Rate for Payer: UMR Bronson Commercial |
$6.10
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.40
|
|