|
HC DECLOT BY THROMBOLYTIC
|
Facility
|
IP
|
$483.16
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
76100005
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$212.59 |
| Max. Negotiated Rate |
$434.84 |
| Rate for Payer: Aetna American Axle |
$314.05
|
| Rate for Payer: Aetna Commercial |
$410.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$314.05
|
| Rate for Payer: Cash Price |
$386.53
|
| Rate for Payer: Cofinity Commercial |
$338.21
|
| Rate for Payer: Cofinity Commercial |
$415.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$338.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$386.53
|
| Rate for Payer: Healthscope Commercial |
$434.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$338.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$362.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$410.69
|
| Rate for Payer: PHP Commercial |
$410.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$314.05
|
| Rate for Payer: Priority Health SBD |
$304.39
|
| Rate for Payer: UMR Bronson Commercial |
$212.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$362.37
|
|
|
HC DECLOT BY THROMBOLYTIC
|
Facility
|
OP
|
$483.16
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
76100005
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$173.39 |
| Max. Negotiated Rate |
$910.59 |
| Rate for Payer: Aetna American Axle |
$314.05
|
| Rate for Payer: Aetna Commercial |
$410.69
|
| Rate for Payer: Aetna Medicare |
$336.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$314.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$404.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$404.36
|
| Rate for Payer: BCBS Complete |
$182.06
|
| Rate for Payer: BCBS MAPPO |
$323.49
|
| Rate for Payer: BCN Medicare Advantage |
$323.49
|
| Rate for Payer: Cash Price |
$386.53
|
| Rate for Payer: Cash Price |
$386.53
|
| Rate for Payer: Cofinity Commercial |
$415.52
|
| Rate for Payer: Cofinity Commercial |
$338.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$338.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$386.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$323.49
|
| Rate for Payer: Healthscope Commercial |
$434.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$338.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$362.37
|
| Rate for Payer: Mclaren Medicaid |
$173.39
|
| Rate for Payer: Mclaren Medicare |
$323.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$339.66
|
| Rate for Payer: Meridian Medicaid |
$182.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$372.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$410.69
|
| Rate for Payer: PACE Medicare |
$307.32
|
| Rate for Payer: PACE SWMI |
$323.49
|
| Rate for Payer: PHP Commercial |
$410.69
|
| Rate for Payer: PHP Medicare Advantage |
$323.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$173.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$314.05
|
| Rate for Payer: Priority Health Medicare |
$323.49
|
| Rate for Payer: Priority Health SBD |
$304.39
|
| Rate for Payer: Railroad Medicare Medicare |
$323.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$910.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$323.49
|
| Rate for Payer: UHC Exchange |
$618.22
|
| Rate for Payer: UHC Medicare Advantage |
$323.49
|
| Rate for Payer: UHCCP Medicaid |
$173.39
|
| Rate for Payer: UMR Bronson Commercial |
$178.77
|
| Rate for Payer: VA VA |
$323.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$362.37
|
|
|
HC DECONTAMINATION AMB/SELF-DIRECTED
|
Facility
|
IP
|
$143.38
|
|
| Hospital Charge Code |
27000613
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$63.09 |
| Max. Negotiated Rate |
$129.04 |
| Rate for Payer: Aetna American Axle |
$93.20
|
| Rate for Payer: Aetna Commercial |
$121.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.20
|
| Rate for Payer: Cash Price |
$114.70
|
| Rate for Payer: Cofinity Commercial |
$100.37
|
| Rate for Payer: Cofinity Commercial |
$123.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$100.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.70
|
| Rate for Payer: Healthscope Commercial |
$129.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$100.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$107.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.87
|
| Rate for Payer: PHP Commercial |
$121.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.20
|
| Rate for Payer: Priority Health SBD |
$90.33
|
| Rate for Payer: UMR Bronson Commercial |
$63.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.53
|
|
|
HC DECONTAMINATION AMB/SELF-DIRECTED
|
Facility
|
OP
|
$143.38
|
|
| Hospital Charge Code |
27000613
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$53.05 |
| Max. Negotiated Rate |
$129.04 |
| Rate for Payer: Aetna American Axle |
$93.20
|
| Rate for Payer: Aetna Commercial |
$121.87
|
| Rate for Payer: Aetna Medicare |
$71.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.20
|
| Rate for Payer: BCBS Complete |
$57.35
|
| Rate for Payer: Cash Price |
$114.70
|
| Rate for Payer: Cofinity Commercial |
$100.37
|
| Rate for Payer: Cofinity Commercial |
$123.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$100.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.70
|
| Rate for Payer: Healthscope Commercial |
$129.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$100.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$107.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.87
|
| Rate for Payer: PHP Commercial |
$121.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.20
|
| Rate for Payer: Priority Health SBD |
$90.33
|
| Rate for Payer: UMR Bronson Commercial |
$53.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.53
|
|
|
HC DECONTAMINATION AMB W/ASSIST
|
Facility
|
OP
|
$823.25
|
|
| Hospital Charge Code |
27000026
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$304.60 |
| Max. Negotiated Rate |
$740.92 |
| Rate for Payer: Aetna American Axle |
$535.11
|
| Rate for Payer: Aetna Commercial |
$699.76
|
| Rate for Payer: Aetna Medicare |
$411.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$535.11
|
| Rate for Payer: BCBS Complete |
$329.30
|
| Rate for Payer: Cash Price |
$658.60
|
| Rate for Payer: Cofinity Commercial |
$576.27
|
| Rate for Payer: Cofinity Commercial |
$708.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$576.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$658.60
|
| Rate for Payer: Healthscope Commercial |
$740.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$576.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$617.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$699.76
|
| Rate for Payer: PHP Commercial |
$699.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$535.11
|
| Rate for Payer: Priority Health SBD |
$518.65
|
| Rate for Payer: UMR Bronson Commercial |
$304.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$617.44
|
|
|
HC DECONTAMINATION AMB W/ASSIST
|
Facility
|
IP
|
$823.25
|
|
| Hospital Charge Code |
27000026
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$362.23 |
| Max. Negotiated Rate |
$740.92 |
| Rate for Payer: Aetna American Axle |
$535.11
|
| Rate for Payer: Aetna Commercial |
$699.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$535.11
|
| Rate for Payer: Cash Price |
$658.60
|
| Rate for Payer: Cofinity Commercial |
$576.27
|
| Rate for Payer: Cofinity Commercial |
$708.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$576.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$658.60
|
| Rate for Payer: Healthscope Commercial |
$740.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$576.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$617.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$699.76
|
| Rate for Payer: PHP Commercial |
$699.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$535.11
|
| Rate for Payer: Priority Health SBD |
$518.65
|
| Rate for Payer: UMR Bronson Commercial |
$362.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$617.44
|
|
|
HC DECONTAMINATION NON AMBULATORY
|
Facility
|
OP
|
$1,646.48
|
|
| Hospital Charge Code |
27000126
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$609.20 |
| Max. Negotiated Rate |
$1,481.83 |
| Rate for Payer: Aetna American Axle |
$1,070.21
|
| Rate for Payer: Aetna Commercial |
$1,399.51
|
| Rate for Payer: Aetna Medicare |
$823.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,070.21
|
| Rate for Payer: BCBS Complete |
$658.59
|
| Rate for Payer: Cash Price |
$1,317.18
|
| Rate for Payer: Cofinity Commercial |
$1,152.54
|
| Rate for Payer: Cofinity Commercial |
$1,415.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,152.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,317.18
|
| Rate for Payer: Healthscope Commercial |
$1,481.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,152.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,234.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,399.51
|
| Rate for Payer: PHP Commercial |
$1,399.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,070.21
|
| Rate for Payer: Priority Health SBD |
$1,037.28
|
| Rate for Payer: UMR Bronson Commercial |
$609.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,234.86
|
|
|
HC DECONTAMINATION NON AMBULATORY
|
Facility
|
IP
|
$1,646.48
|
|
| Hospital Charge Code |
27000126
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$724.45 |
| Max. Negotiated Rate |
$1,481.83 |
| Rate for Payer: Aetna American Axle |
$1,070.21
|
| Rate for Payer: Aetna Commercial |
$1,399.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,070.21
|
| Rate for Payer: Cash Price |
$1,317.18
|
| Rate for Payer: Cofinity Commercial |
$1,152.54
|
| Rate for Payer: Cofinity Commercial |
$1,415.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,152.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,317.18
|
| Rate for Payer: Healthscope Commercial |
$1,481.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,152.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,234.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,399.51
|
| Rate for Payer: PHP Commercial |
$1,399.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,070.21
|
| Rate for Payer: Priority Health SBD |
$1,037.28
|
| Rate for Payer: UMR Bronson Commercial |
$724.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,234.86
|
|
|
HC DEFINITY CONTRAST 1ST ML
|
Facility
|
IP
|
$296.10
|
|
|
Service Code
|
HCPCS Q9957
|
| Hospital Charge Code |
63600002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$130.28 |
| Max. Negotiated Rate |
$266.49 |
| Rate for Payer: Aetna American Axle |
$192.47
|
| Rate for Payer: Aetna Commercial |
$251.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$192.47
|
| Rate for Payer: Cash Price |
$236.88
|
| Rate for Payer: Cofinity Commercial |
$207.27
|
| Rate for Payer: Cofinity Commercial |
$254.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$207.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.88
|
| Rate for Payer: Healthscope Commercial |
$266.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$207.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$222.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$251.69
|
| Rate for Payer: PHP Commercial |
$251.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.47
|
| Rate for Payer: Priority Health SBD |
$186.54
|
| Rate for Payer: UMR Bronson Commercial |
$130.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$222.07
|
|
|
HC DEFINITY CONTRAST 1ST ML
|
Facility
|
OP
|
$296.10
|
|
|
Service Code
|
HCPCS Q9957
|
| Hospital Charge Code |
63600002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$109.56 |
| Max. Negotiated Rate |
$266.49 |
| Rate for Payer: Aetna American Axle |
$192.47
|
| Rate for Payer: Aetna Commercial |
$251.69
|
| Rate for Payer: Aetna Medicare |
$148.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$192.47
|
| Rate for Payer: BCBS Complete |
$118.44
|
| Rate for Payer: Cash Price |
$236.88
|
| Rate for Payer: Cofinity Commercial |
$207.27
|
| Rate for Payer: Cofinity Commercial |
$254.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$207.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.88
|
| Rate for Payer: Healthscope Commercial |
$266.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$207.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$222.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$251.69
|
| Rate for Payer: PHP Commercial |
$251.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.47
|
| Rate for Payer: Priority Health SBD |
$186.54
|
| Rate for Payer: UMR Bronson Commercial |
$109.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$222.07
|
|
|
HC DEFINITY CONTRAST 2ND ML
|
Facility
|
IP
|
$296.10
|
|
|
Service Code
|
HCPCS Q9957
|
| Hospital Charge Code |
63600003
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$130.28 |
| Max. Negotiated Rate |
$266.49 |
| Rate for Payer: Aetna American Axle |
$192.47
|
| Rate for Payer: Aetna Commercial |
$251.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$192.47
|
| Rate for Payer: Cash Price |
$236.88
|
| Rate for Payer: Cofinity Commercial |
$207.27
|
| Rate for Payer: Cofinity Commercial |
$254.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$207.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.88
|
| Rate for Payer: Healthscope Commercial |
$266.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$207.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$222.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$251.69
|
| Rate for Payer: PHP Commercial |
$251.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.47
|
| Rate for Payer: Priority Health SBD |
$186.54
|
| Rate for Payer: UMR Bronson Commercial |
$130.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$222.07
|
|
|
HC DEFINITY CONTRAST 2ND ML
|
Facility
|
OP
|
$296.10
|
|
|
Service Code
|
HCPCS Q9957
|
| Hospital Charge Code |
63600003
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$109.56 |
| Max. Negotiated Rate |
$266.49 |
| Rate for Payer: Aetna American Axle |
$192.47
|
| Rate for Payer: Aetna Commercial |
$251.69
|
| Rate for Payer: Aetna Medicare |
$148.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$192.47
|
| Rate for Payer: BCBS Complete |
$118.44
|
| Rate for Payer: Cash Price |
$236.88
|
| Rate for Payer: Cofinity Commercial |
$207.27
|
| Rate for Payer: Cofinity Commercial |
$254.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$207.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.88
|
| Rate for Payer: Healthscope Commercial |
$266.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$207.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$222.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$251.69
|
| Rate for Payer: PHP Commercial |
$251.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.47
|
| Rate for Payer: Priority Health SBD |
$186.54
|
| Rate for Payer: UMR Bronson Commercial |
$109.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$222.07
|
|
|
HC DEGARELIX INJECTION PER 1MG
|
Facility
|
OP
|
$6.24
|
|
|
Service Code
|
HCPCS J9155
|
| Hospital Charge Code |
63600146
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.31 |
| Max. Negotiated Rate |
$12.53 |
| Rate for Payer: Aetna American Axle |
$4.06
|
| Rate for Payer: Aetna Commercial |
$5.30
|
| Rate for Payer: Aetna Medicare |
$4.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.56
|
| Rate for Payer: BCBS Complete |
$2.50
|
| Rate for Payer: BCBS MAPPO |
$4.45
|
| Rate for Payer: BCN Medicare Advantage |
$4.45
|
| Rate for Payer: Cash Price |
$4.99
|
| Rate for Payer: Cash Price |
$4.99
|
| Rate for Payer: Cofinity Commercial |
$5.37
|
| Rate for Payer: Cofinity Commercial |
$4.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$4.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.45
|
| Rate for Payer: Healthscope Commercial |
$5.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.68
|
| Rate for Payer: Mclaren Medicaid |
$2.39
|
| Rate for Payer: Mclaren Medicare |
$4.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.67
|
| Rate for Payer: Meridian Medicaid |
$2.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.30
|
| Rate for Payer: PACE Medicare |
$4.23
|
| Rate for Payer: PACE SWMI |
$4.45
|
| Rate for Payer: PHP Commercial |
$5.30
|
| Rate for Payer: PHP Medicare Advantage |
$4.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.06
|
| Rate for Payer: Priority Health Medicare |
$4.45
|
| Rate for Payer: Priority Health SBD |
$3.93
|
| Rate for Payer: Railroad Medicare Medicare |
$4.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.45
|
| Rate for Payer: UHC Exchange |
$8.50
|
| Rate for Payer: UHC Medicare Advantage |
$4.45
|
| Rate for Payer: UHCCP Medicaid |
$2.39
|
| Rate for Payer: UMR Bronson Commercial |
$2.31
|
| Rate for Payer: VA VA |
$4.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.68
|
|
|
HC DEGARELIX INJECTION PER 1MG
|
Facility
|
IP
|
$6.24
|
|
|
Service Code
|
HCPCS J9155
|
| Hospital Charge Code |
63600146
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.75 |
| Max. Negotiated Rate |
$5.62 |
| Rate for Payer: Aetna American Axle |
$4.06
|
| Rate for Payer: Aetna Commercial |
$5.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.06
|
| Rate for Payer: Cash Price |
$4.99
|
| Rate for Payer: Cofinity Commercial |
$4.37
|
| Rate for Payer: Cofinity Commercial |
$5.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$4.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.99
|
| Rate for Payer: Healthscope Commercial |
$5.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.30
|
| Rate for Payer: PHP Commercial |
$5.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.06
|
| Rate for Payer: Priority Health SBD |
$3.93
|
| Rate for Payer: UMR Bronson Commercial |
$2.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.68
|
|
|
HC DEGLYCEROLIZED RED BLOOD CELLS
|
Facility
|
IP
|
$944.06
|
|
|
Service Code
|
HCPCS P9039
|
| Hospital Charge Code |
39000049
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$415.39 |
| Max. Negotiated Rate |
$849.65 |
| Rate for Payer: Aetna American Axle |
$613.64
|
| Rate for Payer: Aetna Commercial |
$802.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$613.64
|
| Rate for Payer: Cash Price |
$755.25
|
| Rate for Payer: Cofinity Commercial |
$660.84
|
| Rate for Payer: Cofinity Commercial |
$811.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$660.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$755.25
|
| Rate for Payer: Healthscope Commercial |
$849.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$660.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$708.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$802.45
|
| Rate for Payer: PHP Commercial |
$802.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$613.64
|
| Rate for Payer: Priority Health SBD |
$594.76
|
| Rate for Payer: UMR Bronson Commercial |
$415.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$708.04
|
|
|
HC DEGLYCEROLIZED RED BLOOD CELLS
|
Facility
|
OP
|
$944.06
|
|
|
Service Code
|
HCPCS P9039
|
| Hospital Charge Code |
39000049
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$341.74 |
| Max. Negotiated Rate |
$1,794.72 |
| Rate for Payer: Aetna American Axle |
$613.64
|
| Rate for Payer: Aetna Commercial |
$802.45
|
| Rate for Payer: Aetna Medicare |
$663.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$613.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$796.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$796.98
|
| Rate for Payer: BCBS Complete |
$358.83
|
| Rate for Payer: BCBS MAPPO |
$637.58
|
| Rate for Payer: BCN Medicare Advantage |
$637.58
|
| Rate for Payer: Cash Price |
$755.25
|
| Rate for Payer: Cash Price |
$755.25
|
| Rate for Payer: Cash Price |
$755.25
|
| Rate for Payer: Cofinity Commercial |
$660.84
|
| Rate for Payer: Cofinity Commercial |
$811.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$660.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$755.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$637.58
|
| Rate for Payer: Healthscope Commercial |
$849.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$660.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$708.04
|
| Rate for Payer: Mclaren Medicaid |
$341.74
|
| Rate for Payer: Mclaren Medicare |
$637.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$669.46
|
| Rate for Payer: Meridian Medicaid |
$358.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$733.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$802.45
|
| Rate for Payer: PACE Medicare |
$605.70
|
| Rate for Payer: PACE SWMI |
$637.58
|
| Rate for Payer: PHP Commercial |
$802.45
|
| Rate for Payer: PHP Medicare Advantage |
$637.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$341.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$613.64
|
| Rate for Payer: Priority Health Medicare |
$637.58
|
| Rate for Payer: Priority Health SBD |
$594.76
|
| Rate for Payer: Railroad Medicare Medicare |
$637.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,794.72
|
| Rate for Payer: UHC Core |
$446.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$637.58
|
| Rate for Payer: UHC Exchange |
$1,218.48
|
| Rate for Payer: UHC Medicare Advantage |
$637.58
|
| Rate for Payer: UHCCP Medicaid |
$341.74
|
| Rate for Payer: UMR Bronson Commercial |
$349.30
|
| Rate for Payer: VA VA |
$637.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$708.04
|
|
|
HC DELAY FLAP/SCTJ FLAP EYELIDS NOSE EARS/LIPS
|
Facility
|
OP
|
$5,205.06
|
|
|
Service Code
|
CPT 15630
|
| Hospital Charge Code |
76100415
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$956.23 |
| Max. Negotiated Rate |
$5,021.81 |
| Rate for Payer: Aetna American Axle |
$3,383.29
|
| Rate for Payer: Aetna Commercial |
$4,424.30
|
| Rate for Payer: Aetna Medicare |
$1,855.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,383.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,230.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,230.01
|
| Rate for Payer: BCBS Complete |
$1,004.04
|
| Rate for Payer: BCBS MAPPO |
$1,784.01
|
| Rate for Payer: BCN Medicare Advantage |
$1,784.01
|
| Rate for Payer: Cash Price |
$4,164.05
|
| Rate for Payer: Cash Price |
$4,164.05
|
| Rate for Payer: Cofinity Commercial |
$4,476.35
|
| Rate for Payer: Cofinity Commercial |
$3,643.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,643.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,164.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,784.01
|
| Rate for Payer: Healthscope Commercial |
$4,684.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,643.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,903.80
|
| Rate for Payer: Mclaren Medicaid |
$956.23
|
| Rate for Payer: Mclaren Medicare |
$1,784.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,873.21
|
| Rate for Payer: Meridian Medicaid |
$1,004.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,051.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,424.30
|
| Rate for Payer: PACE Medicare |
$1,694.81
|
| Rate for Payer: PACE SWMI |
$1,784.01
|
| Rate for Payer: PHP Commercial |
$4,424.30
|
| Rate for Payer: PHP Medicare Advantage |
$1,784.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$956.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,383.29
|
| Rate for Payer: Priority Health Medicare |
$1,784.01
|
| Rate for Payer: Priority Health SBD |
$3,279.19
|
| Rate for Payer: Railroad Medicare Medicare |
$1,784.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,021.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,784.01
|
| Rate for Payer: UHC Exchange |
$3,409.42
|
| Rate for Payer: UHC Medicare Advantage |
$1,784.01
|
| Rate for Payer: UHCCP Medicaid |
$956.23
|
| Rate for Payer: UMR Bronson Commercial |
$1,925.87
|
| Rate for Payer: VA VA |
$1,784.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,903.80
|
|
|
HC DELAY FLAP/SCTJ FLAP EYELIDS NOSE EARS/LIPS
|
Facility
|
IP
|
$5,205.06
|
|
|
Service Code
|
CPT 15630
|
| Hospital Charge Code |
76100415
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,290.23 |
| Max. Negotiated Rate |
$4,684.55 |
| Rate for Payer: Aetna American Axle |
$3,383.29
|
| Rate for Payer: Aetna Commercial |
$4,424.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,383.29
|
| Rate for Payer: Cash Price |
$4,164.05
|
| Rate for Payer: Cofinity Commercial |
$3,643.54
|
| Rate for Payer: Cofinity Commercial |
$4,476.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,643.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,164.05
|
| Rate for Payer: Healthscope Commercial |
$4,684.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,643.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,903.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,424.30
|
| Rate for Payer: PHP Commercial |
$4,424.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,383.29
|
| Rate for Payer: Priority Health SBD |
$3,279.19
|
| Rate for Payer: UMR Bronson Commercial |
$2,290.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,903.80
|
|
|
HC DELIVERY/BIRTH RM RESUSCITATION
|
Facility
|
IP
|
$837.20
|
|
|
Service Code
|
CPT 99465
|
| Hospital Charge Code |
72000011
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$368.37 |
| Max. Negotiated Rate |
$753.48 |
| Rate for Payer: Aetna American Axle |
$544.18
|
| Rate for Payer: Aetna Commercial |
$711.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$544.18
|
| Rate for Payer: Cash Price |
$669.76
|
| Rate for Payer: Cofinity Commercial |
$586.04
|
| Rate for Payer: Cofinity Commercial |
$719.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$586.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$669.76
|
| Rate for Payer: Healthscope Commercial |
$753.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$586.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$627.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$711.62
|
| Rate for Payer: PHP Commercial |
$711.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$544.18
|
| Rate for Payer: Priority Health SBD |
$527.44
|
| Rate for Payer: UMR Bronson Commercial |
$368.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$627.90
|
|
|
HC DELIVERY/BIRTH RM RESUSCITATION
|
Facility
|
OP
|
$837.20
|
|
|
Service Code
|
CPT 99465
|
| Hospital Charge Code |
72000011
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$309.76 |
| Max. Negotiated Rate |
$2,286.00 |
| Rate for Payer: Aetna American Axle |
$544.18
|
| Rate for Payer: Aetna Commercial |
$711.62
|
| Rate for Payer: Aetna Medicare |
$663.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$544.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$797.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$797.75
|
| Rate for Payer: BCBS Complete |
$359.18
|
| Rate for Payer: BCBS MAPPO |
$638.20
|
| Rate for Payer: BCN Medicare Advantage |
$638.20
|
| Rate for Payer: Cash Price |
$669.76
|
| Rate for Payer: Cash Price |
$669.76
|
| Rate for Payer: Cash Price |
$669.76
|
| Rate for Payer: Cofinity Commercial |
$586.04
|
| Rate for Payer: Cofinity Commercial |
$719.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$586.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$669.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$638.20
|
| Rate for Payer: Healthscope Commercial |
$753.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$586.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$627.90
|
| Rate for Payer: Mclaren Medicaid |
$342.08
|
| Rate for Payer: Mclaren Medicare |
$638.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$670.11
|
| Rate for Payer: Meridian Medicaid |
$359.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$733.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$711.62
|
| Rate for Payer: PACE Medicare |
$606.29
|
| Rate for Payer: PACE SWMI |
$638.20
|
| Rate for Payer: PHP Commercial |
$711.62
|
| Rate for Payer: PHP Medicare Advantage |
$638.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$342.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$544.18
|
| Rate for Payer: Priority Health Medicare |
$638.20
|
| Rate for Payer: Priority Health SBD |
$527.44
|
| Rate for Payer: Railroad Medicare Medicare |
$638.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,796.47
|
| Rate for Payer: UHC Core |
$2,286.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$638.20
|
| Rate for Payer: UHC Exchange |
$1,219.66
|
| Rate for Payer: UHC Medicare Advantage |
$638.20
|
| Rate for Payer: UHCCP Medicaid |
$342.08
|
| Rate for Payer: UMR Bronson Commercial |
$309.76
|
| Rate for Payer: VA VA |
$638.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$627.90
|
|
|
HC DEMO EVAL NEB MDI IPPB
|
Facility
|
IP
|
$244.93
|
|
|
Service Code
|
CPT 94664
|
| Hospital Charge Code |
41000009
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$107.77 |
| Max. Negotiated Rate |
$220.44 |
| Rate for Payer: Aetna American Axle |
$159.20
|
| Rate for Payer: Aetna Commercial |
$208.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.20
|
| Rate for Payer: Cash Price |
$195.94
|
| Rate for Payer: Cofinity Commercial |
$171.45
|
| Rate for Payer: Cofinity Commercial |
$210.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$171.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.94
|
| Rate for Payer: Healthscope Commercial |
$220.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$171.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.19
|
| Rate for Payer: PHP Commercial |
$208.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.20
|
| Rate for Payer: Priority Health SBD |
$154.31
|
| Rate for Payer: UMR Bronson Commercial |
$107.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.70
|
|
|
HC DEMO EVAL NEB MDI IPPB
|
Facility
|
OP
|
$244.93
|
|
|
Service Code
|
CPT 94664
|
| Hospital Charge Code |
41000009
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$90.62 |
| Max. Negotiated Rate |
$558.36 |
| Rate for Payer: Aetna American Axle |
$159.20
|
| Rate for Payer: Aetna Commercial |
$208.19
|
| Rate for Payer: Aetna Medicare |
$206.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$247.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$247.95
|
| Rate for Payer: BCBS Complete |
$111.64
|
| Rate for Payer: BCBS MAPPO |
$198.36
|
| Rate for Payer: BCN Medicare Advantage |
$198.36
|
| Rate for Payer: Cash Price |
$195.94
|
| Rate for Payer: Cash Price |
$195.94
|
| Rate for Payer: Cash Price |
$195.94
|
| Rate for Payer: Cofinity Commercial |
$171.45
|
| Rate for Payer: Cofinity Commercial |
$210.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$171.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$198.36
|
| Rate for Payer: Healthscope Commercial |
$220.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$171.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.70
|
| Rate for Payer: Mclaren Medicaid |
$106.32
|
| Rate for Payer: Mclaren Medicare |
$198.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$208.28
|
| Rate for Payer: Meridian Medicaid |
$111.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$228.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.19
|
| Rate for Payer: PACE Medicare |
$188.44
|
| Rate for Payer: PACE SWMI |
$198.36
|
| Rate for Payer: PHP Commercial |
$208.19
|
| Rate for Payer: PHP Medicare Advantage |
$198.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$106.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.20
|
| Rate for Payer: Priority Health Medicare |
$198.36
|
| Rate for Payer: Priority Health SBD |
$154.31
|
| Rate for Payer: Railroad Medicare Medicare |
$198.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$558.36
|
| Rate for Payer: UHC Core |
$294.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$198.36
|
| Rate for Payer: UHC Exchange |
$379.09
|
| Rate for Payer: UHC Medicare Advantage |
$198.36
|
| Rate for Payer: UHCCP Medicaid |
$106.32
|
| Rate for Payer: UMR Bronson Commercial |
$90.62
|
| Rate for Payer: VA VA |
$198.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.70
|
|
|
HC DEMO HOME USE INR MONITOR
|
Facility
|
IP
|
$586.39
|
|
|
Service Code
|
HCPCS G0248
|
| Hospital Charge Code |
51000042
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$258.01 |
| Max. Negotiated Rate |
$527.75 |
| Rate for Payer: Aetna American Axle |
$381.15
|
| Rate for Payer: Aetna Commercial |
$498.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$381.15
|
| Rate for Payer: Cash Price |
$469.11
|
| Rate for Payer: Cofinity Commercial |
$410.47
|
| Rate for Payer: Cofinity Commercial |
$504.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$410.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$469.11
|
| Rate for Payer: Healthscope Commercial |
$527.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$410.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$439.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$498.43
|
| Rate for Payer: PHP Commercial |
$498.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$381.15
|
| Rate for Payer: Priority Health SBD |
$369.43
|
| Rate for Payer: UMR Bronson Commercial |
$258.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$439.79
|
|
|
HC DEMO HOME USE INR MONITOR
|
Facility
|
OP
|
$586.39
|
|
|
Service Code
|
HCPCS G0248
|
| Hospital Charge Code |
51000042
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$67.36 |
| Max. Negotiated Rate |
$527.75 |
| Rate for Payer: Aetna American Axle |
$381.15
|
| Rate for Payer: Aetna Commercial |
$498.43
|
| Rate for Payer: Aetna Medicare |
$130.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$381.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.10
|
| Rate for Payer: BCBS Complete |
$70.73
|
| Rate for Payer: BCBS MAPPO |
$125.68
|
| Rate for Payer: BCN Medicare Advantage |
$125.68
|
| Rate for Payer: Cash Price |
$469.11
|
| Rate for Payer: Cash Price |
$469.11
|
| Rate for Payer: Cofinity Commercial |
$504.30
|
| Rate for Payer: Cofinity Commercial |
$410.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$410.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$469.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.68
|
| Rate for Payer: Healthscope Commercial |
$527.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$410.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$439.79
|
| Rate for Payer: Mclaren Medicaid |
$67.36
|
| Rate for Payer: Mclaren Medicare |
$125.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$131.96
|
| Rate for Payer: Meridian Medicaid |
$70.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$144.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$498.43
|
| Rate for Payer: PACE Medicare |
$119.40
|
| Rate for Payer: PACE SWMI |
$125.68
|
| Rate for Payer: PHP Commercial |
$498.43
|
| Rate for Payer: PHP Medicare Advantage |
$125.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$381.15
|
| Rate for Payer: Priority Health Medicare |
$125.68
|
| Rate for Payer: Priority Health SBD |
$369.43
|
| Rate for Payer: Railroad Medicare Medicare |
$125.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$353.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.68
|
| Rate for Payer: UHC Exchange |
$240.19
|
| Rate for Payer: UHC Medicare Advantage |
$125.68
|
| Rate for Payer: UHCCP Medicaid |
$67.36
|
| Rate for Payer: UMR Bronson Commercial |
$216.96
|
| Rate for Payer: VA VA |
$125.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$439.79
|
|
|
HC DENTAL NERVE BLOCK TRIGEMINAL
|
Facility
|
IP
|
$561.86
|
|
|
Service Code
|
CPT 64400
|
| Hospital Charge Code |
45000014
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$247.22 |
| Max. Negotiated Rate |
$505.67 |
| Rate for Payer: Aetna American Axle |
$365.21
|
| Rate for Payer: Aetna Commercial |
$477.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$365.21
|
| Rate for Payer: Cash Price |
$449.49
|
| Rate for Payer: Cofinity Commercial |
$393.30
|
| Rate for Payer: Cofinity Commercial |
$483.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$393.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$449.49
|
| Rate for Payer: Healthscope Commercial |
$505.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$393.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$421.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$477.58
|
| Rate for Payer: PHP Commercial |
$477.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$365.21
|
| Rate for Payer: Priority Health SBD |
$353.97
|
| Rate for Payer: UMR Bronson Commercial |
$247.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$421.39
|
|
