|
HC NEG PRES WND THRPY DSG SET LAR
|
Facility
|
OP
|
$198.58
|
|
| Hospital Charge Code |
27200138
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$73.47 |
| Max. Negotiated Rate |
$178.72 |
| Rate for Payer: Aetna American Axle |
$129.08
|
| Rate for Payer: Aetna Commercial |
$168.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.08
|
| Rate for Payer: BCBS Complete |
$79.43
|
| Rate for Payer: Cash Price |
$158.86
|
| Rate for Payer: Cofinity Commercial |
$139.01
|
| Rate for Payer: Cofinity Commercial |
$170.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.86
|
| Rate for Payer: Healthscope Commercial |
$178.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$139.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$148.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$168.79
|
| Rate for Payer: PHP Commercial |
$168.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.01
|
| Rate for Payer: Priority Health SBD |
$125.11
|
| Rate for Payer: UMR Bronson Commercial |
$73.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$148.94
|
|
|
HC NEG PRES WND THRPY DSG SET LAR
|
Facility
|
IP
|
$198.58
|
|
| Hospital Charge Code |
27200138
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$87.38 |
| Max. Negotiated Rate |
$178.72 |
| Rate for Payer: Aetna American Axle |
$129.08
|
| Rate for Payer: Aetna Commercial |
$168.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.08
|
| Rate for Payer: Cash Price |
$158.86
|
| Rate for Payer: Cofinity Commercial |
$139.01
|
| Rate for Payer: Cofinity Commercial |
$170.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.86
|
| Rate for Payer: Healthscope Commercial |
$178.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$139.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$148.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$168.79
|
| Rate for Payer: PHP Commercial |
$168.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.01
|
| Rate for Payer: Priority Health SBD |
$125.11
|
| Rate for Payer: UMR Bronson Commercial |
$87.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$148.94
|
|
|
HC NEG PRES WND THRPY DSG SET MED
|
Facility
|
OP
|
$143.06
|
|
| Hospital Charge Code |
27200139
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$52.93 |
| Max. Negotiated Rate |
$128.75 |
| Rate for Payer: Aetna American Axle |
$92.99
|
| Rate for Payer: Aetna Commercial |
$121.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$92.99
|
| Rate for Payer: BCBS Complete |
$57.22
|
| Rate for Payer: Cash Price |
$114.45
|
| Rate for Payer: Cofinity Commercial |
$100.14
|
| Rate for Payer: Cofinity Commercial |
$123.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.45
|
| Rate for Payer: Healthscope Commercial |
$128.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$100.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$107.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$121.60
|
| Rate for Payer: PHP Commercial |
$121.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.14
|
| Rate for Payer: Priority Health SBD |
$90.13
|
| Rate for Payer: UMR Bronson Commercial |
$52.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.30
|
|
|
HC NEG PRES WND THRPY DSG SET MED
|
Facility
|
IP
|
$143.06
|
|
| Hospital Charge Code |
27200139
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$62.95 |
| Max. Negotiated Rate |
$128.75 |
| Rate for Payer: Aetna American Axle |
$92.99
|
| Rate for Payer: Aetna Commercial |
$121.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$92.99
|
| Rate for Payer: Cash Price |
$114.45
|
| Rate for Payer: Cofinity Commercial |
$100.14
|
| Rate for Payer: Cofinity Commercial |
$123.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.45
|
| Rate for Payer: Healthscope Commercial |
$128.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$100.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$107.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$121.60
|
| Rate for Payer: PHP Commercial |
$121.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.14
|
| Rate for Payer: Priority Health SBD |
$90.13
|
| Rate for Payer: UMR Bronson Commercial |
$62.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.30
|
|
|
HC NEG PRES WND THRPY DSG SET SIL
|
Facility
|
IP
|
$267.14
|
|
| Hospital Charge Code |
27200140
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$117.54 |
| Max. Negotiated Rate |
$240.43 |
| Rate for Payer: Aetna American Axle |
$173.64
|
| Rate for Payer: Aetna Commercial |
$227.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.64
|
| Rate for Payer: Cash Price |
$213.71
|
| Rate for Payer: Cofinity Commercial |
$187.00
|
| Rate for Payer: Cofinity Commercial |
$229.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.71
|
| Rate for Payer: Healthscope Commercial |
$240.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$187.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$227.07
|
| Rate for Payer: PHP Commercial |
$227.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$187.00
|
| Rate for Payer: Priority Health SBD |
$168.30
|
| Rate for Payer: UMR Bronson Commercial |
$117.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.36
|
|
|
HC NEG PRES WND THRPY DSG SET SIL
|
Facility
|
OP
|
$267.14
|
|
| Hospital Charge Code |
27200140
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$98.84 |
| Max. Negotiated Rate |
$240.43 |
| Rate for Payer: Aetna American Axle |
$173.64
|
| Rate for Payer: Aetna Commercial |
$227.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.64
|
| Rate for Payer: BCBS Complete |
$106.86
|
| Rate for Payer: Cash Price |
$213.71
|
| Rate for Payer: Cofinity Commercial |
$187.00
|
| Rate for Payer: Cofinity Commercial |
$229.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.71
|
| Rate for Payer: Healthscope Commercial |
$240.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$187.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$227.07
|
| Rate for Payer: PHP Commercial |
$227.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$187.00
|
| Rate for Payer: Priority Health SBD |
$168.30
|
| Rate for Payer: UMR Bronson Commercial |
$98.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.36
|
|
|
HC NEG PRES WND THRPY DSG SET SMA
|
Facility
|
OP
|
$113.72
|
|
| Hospital Charge Code |
27200141
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.08 |
| Max. Negotiated Rate |
$102.35 |
| Rate for Payer: Aetna American Axle |
$73.92
|
| Rate for Payer: Aetna Commercial |
$96.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.92
|
| Rate for Payer: BCBS Complete |
$45.49
|
| Rate for Payer: Cash Price |
$90.98
|
| Rate for Payer: Cofinity Commercial |
$79.60
|
| Rate for Payer: Cofinity Commercial |
$97.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.98
|
| Rate for Payer: Healthscope Commercial |
$102.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$79.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$96.66
|
| Rate for Payer: PHP Commercial |
$96.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.60
|
| Rate for Payer: Priority Health SBD |
$71.64
|
| Rate for Payer: UMR Bronson Commercial |
$42.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.29
|
|
|
HC NEG PRES WND THRPY DSG SET SMA
|
Facility
|
IP
|
$113.72
|
|
| Hospital Charge Code |
27200141
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$50.04 |
| Max. Negotiated Rate |
$102.35 |
| Rate for Payer: Aetna American Axle |
$73.92
|
| Rate for Payer: Aetna Commercial |
$96.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.92
|
| Rate for Payer: Cash Price |
$90.98
|
| Rate for Payer: Cofinity Commercial |
$79.60
|
| Rate for Payer: Cofinity Commercial |
$97.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.98
|
| Rate for Payer: Healthscope Commercial |
$102.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$79.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$96.66
|
| Rate for Payer: PHP Commercial |
$96.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.60
|
| Rate for Payer: Priority Health SBD |
$71.64
|
| Rate for Payer: UMR Bronson Commercial |
$50.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.29
|
|
|
HC NEG PRES WOUND TX SET MED
|
Facility
|
OP
|
$78.42
|
|
| Hospital Charge Code |
27200127
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$29.02 |
| Max. Negotiated Rate |
$70.58 |
| Rate for Payer: Aetna American Axle |
$50.97
|
| Rate for Payer: Aetna Commercial |
$66.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.97
|
| Rate for Payer: BCBS Complete |
$31.37
|
| Rate for Payer: Cash Price |
$62.74
|
| Rate for Payer: Cofinity Commercial |
$54.89
|
| Rate for Payer: Cofinity Commercial |
$67.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.74
|
| Rate for Payer: Healthscope Commercial |
$70.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$54.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$66.66
|
| Rate for Payer: PHP Commercial |
$66.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.89
|
| Rate for Payer: Priority Health SBD |
$49.40
|
| Rate for Payer: UMR Bronson Commercial |
$29.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.82
|
|
|
HC NEG PRES WOUND TX SET MED
|
Facility
|
IP
|
$78.42
|
|
| Hospital Charge Code |
27200127
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$34.50 |
| Max. Negotiated Rate |
$70.58 |
| Rate for Payer: Aetna American Axle |
$50.97
|
| Rate for Payer: Aetna Commercial |
$66.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.97
|
| Rate for Payer: Cash Price |
$62.74
|
| Rate for Payer: Cofinity Commercial |
$54.89
|
| Rate for Payer: Cofinity Commercial |
$67.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.74
|
| Rate for Payer: Healthscope Commercial |
$70.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$54.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$66.66
|
| Rate for Payer: PHP Commercial |
$66.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.89
|
| Rate for Payer: Priority Health SBD |
$49.40
|
| Rate for Payer: UMR Bronson Commercial |
$34.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.82
|
|
|
HC NEG PRES WOUND TX SET SMALL
|
Facility
|
OP
|
$113.72
|
|
| Hospital Charge Code |
27200128
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.08 |
| Max. Negotiated Rate |
$102.35 |
| Rate for Payer: Aetna American Axle |
$73.92
|
| Rate for Payer: Aetna Commercial |
$96.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.92
|
| Rate for Payer: BCBS Complete |
$45.49
|
| Rate for Payer: Cash Price |
$90.98
|
| Rate for Payer: Cofinity Commercial |
$79.60
|
| Rate for Payer: Cofinity Commercial |
$97.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.98
|
| Rate for Payer: Healthscope Commercial |
$102.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$79.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$96.66
|
| Rate for Payer: PHP Commercial |
$96.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.60
|
| Rate for Payer: Priority Health SBD |
$71.64
|
| Rate for Payer: UMR Bronson Commercial |
$42.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.29
|
|
|
HC NEG PRES WOUND TX SET SMALL
|
Facility
|
IP
|
$113.72
|
|
| Hospital Charge Code |
27200128
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$50.04 |
| Max. Negotiated Rate |
$102.35 |
| Rate for Payer: Aetna American Axle |
$73.92
|
| Rate for Payer: Aetna Commercial |
$96.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.92
|
| Rate for Payer: Cash Price |
$90.98
|
| Rate for Payer: Cofinity Commercial |
$79.60
|
| Rate for Payer: Cofinity Commercial |
$97.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.98
|
| Rate for Payer: Healthscope Commercial |
$102.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$79.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$96.66
|
| Rate for Payer: PHP Commercial |
$96.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.60
|
| Rate for Payer: Priority Health SBD |
$71.64
|
| Rate for Payer: UMR Bronson Commercial |
$50.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.29
|
|
|
HC NEG PRES Y CONNECTOR
|
Facility
|
OP
|
$7.71
|
|
| Hospital Charge Code |
27000174
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.85 |
| Max. Negotiated Rate |
$6.94 |
| Rate for Payer: Aetna American Axle |
$5.01
|
| Rate for Payer: Aetna Commercial |
$6.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.01
|
| Rate for Payer: BCBS Complete |
$3.08
|
| Rate for Payer: Cash Price |
$6.17
|
| Rate for Payer: Cofinity Commercial |
$5.40
|
| Rate for Payer: Cofinity Commercial |
$6.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.17
|
| Rate for Payer: Healthscope Commercial |
$6.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6.55
|
| Rate for Payer: PHP Commercial |
$6.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.40
|
| Rate for Payer: Priority Health SBD |
$4.86
|
| Rate for Payer: UMR Bronson Commercial |
$2.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.78
|
|
|
HC NEG PRES Y CONNECTOR
|
Facility
|
IP
|
$7.71
|
|
| Hospital Charge Code |
27000174
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.39 |
| Max. Negotiated Rate |
$6.94 |
| Rate for Payer: Aetna American Axle |
$5.01
|
| Rate for Payer: Aetna Commercial |
$6.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.01
|
| Rate for Payer: Cash Price |
$6.17
|
| Rate for Payer: Cofinity Commercial |
$5.40
|
| Rate for Payer: Cofinity Commercial |
$6.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.17
|
| Rate for Payer: Healthscope Commercial |
$6.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6.55
|
| Rate for Payer: PHP Commercial |
$6.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.40
|
| Rate for Payer: Priority Health SBD |
$4.86
|
| Rate for Payer: UMR Bronson Commercial |
$3.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.78
|
|
|
HC NEISSERIA GONORRHOEAE AMP DNA
|
Facility
|
IP
|
$66.30
|
|
|
Service Code
|
CPT 87591
|
| Hospital Charge Code |
30600163
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$29.17 |
| Max. Negotiated Rate |
$59.67 |
| Rate for Payer: Aetna American Axle |
$43.10
|
| Rate for Payer: Aetna Commercial |
$56.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.10
|
| Rate for Payer: Cash Price |
$53.04
|
| Rate for Payer: Cofinity Commercial |
$46.41
|
| Rate for Payer: Cofinity Commercial |
$57.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.04
|
| Rate for Payer: Healthscope Commercial |
$59.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$56.36
|
| Rate for Payer: PHP Commercial |
$56.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.41
|
| Rate for Payer: Priority Health SBD |
$41.77
|
| Rate for Payer: UMR Bronson Commercial |
$29.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.72
|
|
|
HC NEISSERIA GONORRHOEAE AMP DNA
|
Facility
|
OP
|
$66.30
|
|
|
Service Code
|
CPT 87591
|
| Hospital Charge Code |
30600163
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$19.19 |
| Max. Negotiated Rate |
$59.67 |
| Rate for Payer: Aetna American Axle |
$43.10
|
| Rate for Payer: Aetna Commercial |
$56.36
|
| Rate for Payer: Aetna Medicare |
$36.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: BCBS Complete |
$20.16
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$31.56
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$53.04
|
| Rate for Payer: Cash Price |
$53.04
|
| Rate for Payer: Cofinity Commercial |
$46.41
|
| Rate for Payer: Cofinity Commercial |
$57.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$59.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.72
|
| Rate for Payer: Mclaren Medicaid |
$19.19
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Medicaid |
$20.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$56.36
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$56.36
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$48.14
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health Narrow Network |
$38.51
|
| Rate for Payer: Priority Health SBD |
$41.77
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.11
|
| Rate for Payer: UHC Core |
$57.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.09
|
| Rate for Payer: UHC Exchange |
$35.09
|
| Rate for Payer: UHC Medicare Advantage |
$36.14
|
| Rate for Payer: UMR Bronson Commercial |
$24.53
|
| Rate for Payer: VA VA |
$35.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.72
|
|
|
HC NEISSERIA MENINGITITIS
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600275
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.87 |
| Max. Negotiated Rate |
$57.89 |
| Rate for Payer: Aetna American Axle |
$33.15
|
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna Medicare |
$36.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: BCBS Complete |
$20.16
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$31.56
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Cofinity Commercial |
$35.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.25
|
| Rate for Payer: Mclaren Medicaid |
$19.19
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Medicaid |
$20.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health SBD |
$32.13
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.11
|
| Rate for Payer: UHC Core |
$57.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.09
|
| Rate for Payer: UHC Exchange |
$35.09
|
| Rate for Payer: UHC Medicare Advantage |
$36.14
|
| Rate for Payer: UMR Bronson Commercial |
$18.87
|
| Rate for Payer: VA VA |
$35.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.25
|
|
|
HC NEISSERIA MENINGITITIS
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600275
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$22.44 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna American Axle |
$33.15
|
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.15
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$35.70
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health SBD |
$32.13
|
| Rate for Payer: UMR Bronson Commercial |
$22.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.25
|
|
|
HC NEONATAL VENT INIT DAY
|
Facility
|
OP
|
$1,538.29
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
41000037
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$88.41 |
| Max. Negotiated Rate |
$1,753.55 |
| Rate for Payer: Aetna American Axle |
$999.89
|
| Rate for Payer: Aetna Commercial |
$1,307.55
|
| Rate for Payer: Aetna Medicare |
$579.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$999.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$696.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$696.29
|
| Rate for Payer: BCBS Complete |
$319.96
|
| Rate for Payer: BCBS MAPPO |
$557.03
|
| Rate for Payer: BCBS Trust/PPO |
$90.49
|
| Rate for Payer: BCN Medicare Advantage |
$557.03
|
| Rate for Payer: Cash Price |
$1,230.63
|
| Rate for Payer: Cash Price |
$1,230.63
|
| Rate for Payer: Cash Price |
$1,230.63
|
| Rate for Payer: Cofinity Commercial |
$1,322.93
|
| Rate for Payer: Cofinity Commercial |
$1,076.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,230.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$557.03
|
| Rate for Payer: Healthscope Commercial |
$1,384.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,076.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,153.72
|
| Rate for Payer: Mclaren Medicaid |
$304.70
|
| Rate for Payer: Mclaren Medicare |
$557.03
|
| Rate for Payer: Meridian Medicaid |
$319.96
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$584.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$640.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,307.55
|
| Rate for Payer: PACE Medicare |
$529.18
|
| Rate for Payer: PACE SWMI |
$557.03
|
| Rate for Payer: PHP Commercial |
$1,307.55
|
| Rate for Payer: PHP Medicare Advantage |
$557.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$304.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,076.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,753.55
|
| Rate for Payer: Priority Health Medicare |
$557.03
|
| Rate for Payer: Priority Health Narrow Network |
$1,402.84
|
| Rate for Payer: Priority Health SBD |
$969.12
|
| Rate for Payer: Railroad Medicare Medicare |
$557.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$97.25
|
| Rate for Payer: UHC Core |
$294.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$557.03
|
| Rate for Payer: UHC Exchange |
$88.41
|
| Rate for Payer: UHC Medicare Advantage |
$573.74
|
| Rate for Payer: UMR Bronson Commercial |
$569.17
|
| Rate for Payer: VA VA |
$557.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,153.72
|
|
|
HC NEONATAL VENT INIT DAY
|
Facility
|
IP
|
$1,538.29
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
41000037
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$676.85 |
| Max. Negotiated Rate |
$1,384.46 |
| Rate for Payer: Aetna American Axle |
$999.89
|
| Rate for Payer: Aetna Commercial |
$1,307.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$999.89
|
| Rate for Payer: Cash Price |
$1,230.63
|
| Rate for Payer: Cofinity Commercial |
$1,076.80
|
| Rate for Payer: Cofinity Commercial |
$1,322.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,230.63
|
| Rate for Payer: Healthscope Commercial |
$1,384.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,076.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,153.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,307.55
|
| Rate for Payer: PHP Commercial |
$1,307.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,076.80
|
| Rate for Payer: Priority Health SBD |
$969.12
|
| Rate for Payer: UMR Bronson Commercial |
$676.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,153.72
|
|
|
HC NEONATAL VENT SUB DAY
|
Facility
|
IP
|
$1,173.97
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
41000038
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$516.55 |
| Max. Negotiated Rate |
$1,056.57 |
| Rate for Payer: Aetna American Axle |
$763.08
|
| Rate for Payer: Aetna Commercial |
$997.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$763.08
|
| Rate for Payer: Cash Price |
$939.18
|
| Rate for Payer: Cofinity Commercial |
$1,009.61
|
| Rate for Payer: Cofinity Commercial |
$821.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$939.18
|
| Rate for Payer: Healthscope Commercial |
$1,056.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$821.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$880.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$997.87
|
| Rate for Payer: PHP Commercial |
$997.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$821.78
|
| Rate for Payer: Priority Health SBD |
$739.60
|
| Rate for Payer: UMR Bronson Commercial |
$516.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$880.48
|
|
|
HC NEONATAL VENT SUB DAY
|
Facility
|
OP
|
$1,173.97
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
41000038
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$62.21 |
| Max. Negotiated Rate |
$1,753.55 |
| Rate for Payer: Aetna American Axle |
$763.08
|
| Rate for Payer: Aetna Commercial |
$997.87
|
| Rate for Payer: Aetna Medicare |
$579.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$763.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$696.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$696.29
|
| Rate for Payer: BCBS Complete |
$319.96
|
| Rate for Payer: BCBS MAPPO |
$557.03
|
| Rate for Payer: BCBS Trust/PPO |
$68.70
|
| Rate for Payer: BCN Medicare Advantage |
$557.03
|
| Rate for Payer: Cash Price |
$939.18
|
| Rate for Payer: Cash Price |
$939.18
|
| Rate for Payer: Cash Price |
$939.18
|
| Rate for Payer: Cofinity Commercial |
$821.78
|
| Rate for Payer: Cofinity Commercial |
$1,009.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$939.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$557.03
|
| Rate for Payer: Healthscope Commercial |
$1,056.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$821.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$880.48
|
| Rate for Payer: Mclaren Medicaid |
$304.70
|
| Rate for Payer: Mclaren Medicare |
$557.03
|
| Rate for Payer: Meridian Medicaid |
$319.96
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$584.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$640.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$997.87
|
| Rate for Payer: PACE Medicare |
$529.18
|
| Rate for Payer: PACE SWMI |
$557.03
|
| Rate for Payer: PHP Commercial |
$997.87
|
| Rate for Payer: PHP Medicare Advantage |
$557.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$304.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$821.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,753.55
|
| Rate for Payer: Priority Health Medicare |
$557.03
|
| Rate for Payer: Priority Health Narrow Network |
$1,402.84
|
| Rate for Payer: Priority Health SBD |
$739.60
|
| Rate for Payer: Railroad Medicare Medicare |
$557.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.43
|
| Rate for Payer: UHC Core |
$294.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$557.03
|
| Rate for Payer: UHC Exchange |
$62.21
|
| Rate for Payer: UHC Medicare Advantage |
$573.74
|
| Rate for Payer: UMR Bronson Commercial |
$434.37
|
| Rate for Payer: VA VA |
$557.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$880.48
|
|
|
HC NEPHROSTOGRAM URETEROGRAM EXISTING ACCESS
|
Facility
|
IP
|
$1,180.78
|
|
|
Service Code
|
CPT 50431
|
| Hospital Charge Code |
36100503
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$519.54 |
| Max. Negotiated Rate |
$1,062.70 |
| Rate for Payer: Aetna American Axle |
$767.51
|
| Rate for Payer: Aetna Commercial |
$1,003.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$767.51
|
| Rate for Payer: Cash Price |
$944.62
|
| Rate for Payer: Cofinity Commercial |
$1,015.47
|
| Rate for Payer: Cofinity Commercial |
$826.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$944.62
|
| Rate for Payer: Healthscope Commercial |
$1,062.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$826.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$885.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,003.66
|
| Rate for Payer: PHP Commercial |
$1,003.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$826.55
|
| Rate for Payer: Priority Health SBD |
$743.89
|
| Rate for Payer: UMR Bronson Commercial |
$519.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$885.58
|
|
|
HC NEPHROSTOGRAM URETEROGRAM EXISTING ACCESS
|
Facility
|
OP
|
$1,180.78
|
|
|
Service Code
|
CPT 50431
|
| Hospital Charge Code |
36100503
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$63.85 |
| Max. Negotiated Rate |
$1,911.48 |
| Rate for Payer: Aetna American Axle |
$767.51
|
| Rate for Payer: Aetna Commercial |
$1,003.66
|
| Rate for Payer: Aetna Medicare |
$631.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$767.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$759.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$759.00
|
| Rate for Payer: BCBS Complete |
$348.78
|
| Rate for Payer: BCBS MAPPO |
$607.20
|
| Rate for Payer: BCBS Trust/PPO |
$749.85
|
| Rate for Payer: BCN Medicare Advantage |
$607.20
|
| Rate for Payer: Cash Price |
$944.62
|
| Rate for Payer: Cash Price |
$944.62
|
| Rate for Payer: Cofinity Commercial |
$826.55
|
| Rate for Payer: Cofinity Commercial |
$1,015.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$944.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$607.20
|
| Rate for Payer: Healthscope Commercial |
$1,062.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$826.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$885.58
|
| Rate for Payer: Mclaren Medicaid |
$332.14
|
| Rate for Payer: Mclaren Medicare |
$607.20
|
| Rate for Payer: Meridian Medicaid |
$348.78
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$637.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$698.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,003.66
|
| Rate for Payer: PACE Medicare |
$576.84
|
| Rate for Payer: PACE SWMI |
$607.20
|
| Rate for Payer: PHP Commercial |
$1,003.66
|
| Rate for Payer: PHP Medicare Advantage |
$607.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$332.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$826.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,911.48
|
| Rate for Payer: Priority Health Medicare |
$607.20
|
| Rate for Payer: Priority Health Narrow Network |
$1,529.18
|
| Rate for Payer: Priority Health SBD |
$743.89
|
| Rate for Payer: Railroad Medicare Medicare |
$607.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.24
|
| Rate for Payer: UHC Core |
$981.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$607.20
|
| Rate for Payer: UHC Exchange |
$63.85
|
| Rate for Payer: UHC Medicare Advantage |
$625.42
|
| Rate for Payer: UMR Bronson Commercial |
$436.89
|
| Rate for Payer: VA VA |
$607.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$885.58
|
|
|
HC NEPHROSTOGRAM URETEROGRAM NEW ACCESS
|
Facility
|
IP
|
$1,180.78
|
|
|
Service Code
|
CPT 50430
|
| Hospital Charge Code |
36100502
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$519.54 |
| Max. Negotiated Rate |
$1,062.70 |
| Rate for Payer: Aetna American Axle |
$767.51
|
| Rate for Payer: Aetna Commercial |
$1,003.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$767.51
|
| Rate for Payer: Cash Price |
$944.62
|
| Rate for Payer: Cofinity Commercial |
$1,015.47
|
| Rate for Payer: Cofinity Commercial |
$826.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$944.62
|
| Rate for Payer: Healthscope Commercial |
$1,062.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$826.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$885.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,003.66
|
| Rate for Payer: PHP Commercial |
$1,003.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$826.55
|
| Rate for Payer: Priority Health SBD |
$743.89
|
| Rate for Payer: UMR Bronson Commercial |
$519.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$885.58
|
|
