|
HC DENTAL NERVE BLOCK TRIGEMINAL
|
Facility
|
OP
|
$561.86
|
|
|
Service Code
|
CPT 64400
|
| Hospital Charge Code |
45000014
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$154.31 |
| Max. Negotiated Rate |
$810.38 |
| Rate for Payer: Aetna American Axle |
$365.21
|
| Rate for Payer: Aetna Commercial |
$477.58
|
| Rate for Payer: Aetna Medicare |
$299.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$365.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$359.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$359.86
|
| Rate for Payer: BCBS Complete |
$162.02
|
| Rate for Payer: BCBS MAPPO |
$287.89
|
| Rate for Payer: BCN Medicare Advantage |
$287.89
|
| Rate for Payer: Cash Price |
$449.49
|
| Rate for Payer: Cash Price |
$449.49
|
| Rate for Payer: Cofinity Commercial |
$483.20
|
| Rate for Payer: Cofinity Commercial |
$393.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$393.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$449.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$287.89
|
| 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: Mclaren Medicaid |
$154.31
|
| Rate for Payer: Mclaren Medicare |
$287.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$302.28
|
| Rate for Payer: Meridian Medicaid |
$162.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$331.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$477.58
|
| Rate for Payer: PACE Medicare |
$273.50
|
| Rate for Payer: PACE SWMI |
$287.89
|
| Rate for Payer: PHP Commercial |
$477.58
|
| Rate for Payer: PHP Medicare Advantage |
$287.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$154.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$365.21
|
| Rate for Payer: Priority Health Medicare |
$287.89
|
| Rate for Payer: Priority Health SBD |
$353.97
|
| Rate for Payer: Railroad Medicare Medicare |
$287.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$810.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$287.89
|
| Rate for Payer: UHC Exchange |
$550.19
|
| Rate for Payer: UHC Medicare Advantage |
$287.89
|
| Rate for Payer: UHCCP Medicaid |
$154.31
|
| Rate for Payer: UMR Bronson Commercial |
$207.89
|
| Rate for Payer: VA VA |
$287.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$421.39
|
|
|
HC DERMAGRAFT PER SQ CM
|
Facility
|
IP
|
$85.56
|
|
|
Service Code
|
HCPCS Q4106
|
| Hospital Charge Code |
63600004
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.65 |
| Max. Negotiated Rate |
$77.00 |
| Rate for Payer: Aetna American Axle |
$55.61
|
| Rate for Payer: Aetna Commercial |
$72.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.61
|
| Rate for Payer: Cash Price |
$68.45
|
| Rate for Payer: Cofinity Commercial |
$59.89
|
| Rate for Payer: Cofinity Commercial |
$73.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$59.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.45
|
| Rate for Payer: Healthscope Commercial |
$77.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$59.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.73
|
| Rate for Payer: PHP Commercial |
$72.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.61
|
| Rate for Payer: Priority Health SBD |
$53.90
|
| Rate for Payer: UMR Bronson Commercial |
$37.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.17
|
|
|
HC DERMAGRAFT PER SQ CM
|
Facility
|
OP
|
$85.56
|
|
|
Service Code
|
HCPCS Q4106
|
| Hospital Charge Code |
63600004
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.66 |
| Max. Negotiated Rate |
$77.00 |
| Rate for Payer: Aetna American Axle |
$55.61
|
| Rate for Payer: Aetna Commercial |
$72.73
|
| Rate for Payer: Aetna Medicare |
$42.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.61
|
| Rate for Payer: BCBS Complete |
$34.22
|
| Rate for Payer: Cash Price |
$68.45
|
| Rate for Payer: Cofinity Commercial |
$59.89
|
| Rate for Payer: Cofinity Commercial |
$73.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$59.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.45
|
| Rate for Payer: Healthscope Commercial |
$77.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$59.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.73
|
| Rate for Payer: PHP Commercial |
$72.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.61
|
| Rate for Payer: Priority Health SBD |
$53.90
|
| Rate for Payer: UMR Bronson Commercial |
$31.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.17
|
|
|
HC DES ADD.BRANCH
|
Facility
|
OP
|
$17,010.57
|
|
|
Service Code
|
CPT C9601
|
| Hospital Charge Code |
48100076
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$6,293.91 |
| Max. Negotiated Rate |
$15,309.51 |
| Rate for Payer: Aetna American Axle |
$11,056.87
|
| Rate for Payer: Aetna Commercial |
$14,458.98
|
| Rate for Payer: Aetna Medicare |
$8,505.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,056.87
|
| Rate for Payer: BCBS Complete |
$6,804.23
|
| Rate for Payer: Cash Price |
$13,608.46
|
| Rate for Payer: Cofinity Commercial |
$11,907.40
|
| Rate for Payer: Cofinity Commercial |
$14,629.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$11,907.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,608.46
|
| Rate for Payer: Healthscope Commercial |
$15,309.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11,907.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12,757.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,458.98
|
| Rate for Payer: PHP Commercial |
$14,458.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,056.87
|
| Rate for Payer: Priority Health SBD |
$10,716.66
|
| Rate for Payer: UMR Bronson Commercial |
$6,293.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12,757.93
|
|
|
HC DES ADD.BRANCH
|
Facility
|
IP
|
$17,010.57
|
|
|
Service Code
|
CPT C9601
|
| Hospital Charge Code |
48100076
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$7,484.65 |
| Max. Negotiated Rate |
$15,309.51 |
| Rate for Payer: Aetna American Axle |
$11,056.87
|
| Rate for Payer: Aetna Commercial |
$14,458.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,056.87
|
| Rate for Payer: Cash Price |
$13,608.46
|
| Rate for Payer: Cofinity Commercial |
$11,907.40
|
| Rate for Payer: Cofinity Commercial |
$14,629.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$11,907.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,608.46
|
| Rate for Payer: Healthscope Commercial |
$15,309.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11,907.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12,757.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,458.98
|
| Rate for Payer: PHP Commercial |
$14,458.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,056.87
|
| Rate for Payer: Priority Health SBD |
$10,716.66
|
| Rate for Payer: UMR Bronson Commercial |
$7,484.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12,757.93
|
|
|
HC DESTR LESION ROOF OF MOUTH
|
Facility
|
IP
|
$8,109.00
|
|
|
Service Code
|
CPT 42160
|
| Hospital Charge Code |
76100393
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,567.96 |
| Max. Negotiated Rate |
$7,298.10 |
| Rate for Payer: Aetna American Axle |
$5,270.85
|
| Rate for Payer: Aetna Commercial |
$6,892.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,270.85
|
| Rate for Payer: Cash Price |
$6,487.20
|
| Rate for Payer: Cofinity Commercial |
$5,676.30
|
| Rate for Payer: Cofinity Commercial |
$6,973.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,676.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,487.20
|
| Rate for Payer: Healthscope Commercial |
$7,298.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,676.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,081.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,892.65
|
| Rate for Payer: PHP Commercial |
$6,892.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,270.85
|
| Rate for Payer: Priority Health SBD |
$5,108.67
|
| Rate for Payer: UMR Bronson Commercial |
$3,567.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,081.75
|
|
|
HC DESTR LESION ROOF OF MOUTH
|
Facility
|
OP
|
$8,109.00
|
|
|
Service Code
|
CPT 42160
|
| Hospital Charge Code |
76100393
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,695.31 |
| Max. Negotiated Rate |
$8,903.25 |
| Rate for Payer: Aetna American Axle |
$5,270.85
|
| Rate for Payer: Aetna Commercial |
$6,892.65
|
| Rate for Payer: Aetna Medicare |
$3,289.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,270.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,953.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,953.62
|
| Rate for Payer: BCBS Complete |
$1,780.08
|
| Rate for Payer: BCBS MAPPO |
$3,162.90
|
| Rate for Payer: BCN Medicare Advantage |
$3,162.90
|
| Rate for Payer: Cash Price |
$6,487.20
|
| Rate for Payer: Cash Price |
$6,487.20
|
| Rate for Payer: Cofinity Commercial |
$6,973.74
|
| Rate for Payer: Cofinity Commercial |
$5,676.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,676.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,487.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,162.90
|
| Rate for Payer: Healthscope Commercial |
$7,298.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,676.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,081.75
|
| Rate for Payer: Mclaren Medicaid |
$1,695.31
|
| Rate for Payer: Mclaren Medicare |
$3,162.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,321.05
|
| Rate for Payer: Meridian Medicaid |
$1,780.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,637.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,892.65
|
| Rate for Payer: PACE Medicare |
$3,004.76
|
| Rate for Payer: PACE SWMI |
$3,162.90
|
| Rate for Payer: PHP Commercial |
$6,892.65
|
| Rate for Payer: PHP Medicare Advantage |
$3,162.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,695.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,270.85
|
| Rate for Payer: Priority Health Medicare |
$3,162.90
|
| Rate for Payer: Priority Health SBD |
$5,108.67
|
| Rate for Payer: Railroad Medicare Medicare |
$3,162.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,903.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,162.90
|
| Rate for Payer: UHC Exchange |
$6,044.62
|
| Rate for Payer: UHC Medicare Advantage |
$3,162.90
|
| Rate for Payer: UHCCP Medicaid |
$1,695.31
|
| Rate for Payer: UMR Bronson Commercial |
$3,000.33
|
| Rate for Payer: VA VA |
$3,162.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,081.75
|
|
|
HC DESTR MALIG LESION FACE,EAR,EYELID,NOSE,LIP,MUC MEM <0.6 CM
|
Facility
|
OP
|
$242.62
|
|
|
Service Code
|
CPT 17280
|
| Hospital Charge Code |
76100155
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$89.77 |
| Max. Negotiated Rate |
$545.50 |
| Rate for Payer: Aetna American Axle |
$157.70
|
| Rate for Payer: Aetna Commercial |
$206.23
|
| Rate for Payer: Aetna Medicare |
$201.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$157.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$242.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$242.24
|
| Rate for Payer: BCBS Complete |
$109.07
|
| Rate for Payer: BCBS MAPPO |
$193.79
|
| Rate for Payer: BCN Medicare Advantage |
$193.79
|
| Rate for Payer: Cash Price |
$194.10
|
| Rate for Payer: Cash Price |
$194.10
|
| Rate for Payer: Cofinity Commercial |
$208.65
|
| Rate for Payer: Cofinity Commercial |
$169.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$169.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$194.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$193.79
|
| Rate for Payer: Healthscope Commercial |
$218.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$169.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$181.97
|
| Rate for Payer: Mclaren Medicaid |
$103.87
|
| Rate for Payer: Mclaren Medicare |
$193.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$203.48
|
| Rate for Payer: Meridian Medicaid |
$109.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$222.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$206.23
|
| Rate for Payer: PACE Medicare |
$184.10
|
| Rate for Payer: PACE SWMI |
$193.79
|
| Rate for Payer: PHP Commercial |
$206.23
|
| Rate for Payer: PHP Medicare Advantage |
$193.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.70
|
| Rate for Payer: Priority Health Medicare |
$193.79
|
| Rate for Payer: Priority Health SBD |
$152.85
|
| Rate for Payer: Railroad Medicare Medicare |
$193.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$545.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$193.79
|
| Rate for Payer: UHC Exchange |
$370.35
|
| Rate for Payer: UHC Medicare Advantage |
$193.79
|
| Rate for Payer: UHCCP Medicaid |
$103.87
|
| Rate for Payer: UMR Bronson Commercial |
$89.77
|
| Rate for Payer: VA VA |
$193.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$181.97
|
|
|
HC DESTR MALIG LESION FACE,EAR,EYELID,NOSE,LIP,MUC MEM <0.6 CM
|
Facility
|
IP
|
$242.62
|
|
|
Service Code
|
CPT 17280
|
| Hospital Charge Code |
76100155
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$106.75 |
| Max. Negotiated Rate |
$218.36 |
| Rate for Payer: Aetna American Axle |
$157.70
|
| Rate for Payer: Aetna Commercial |
$206.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$157.70
|
| Rate for Payer: Cash Price |
$194.10
|
| Rate for Payer: Cofinity Commercial |
$169.83
|
| Rate for Payer: Cofinity Commercial |
$208.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$169.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$194.10
|
| Rate for Payer: Healthscope Commercial |
$218.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$169.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$181.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$206.23
|
| Rate for Payer: PHP Commercial |
$206.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.70
|
| Rate for Payer: Priority Health SBD |
$152.85
|
| Rate for Payer: UMR Bronson Commercial |
$106.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$181.97
|
|
|
HC DESTR MALIG LESION FACE,EAR,EYELID,NOSE,LIP,MUC MEM 0.6 TO 1.0 CM
|
Facility
|
IP
|
$392.23
|
|
|
Service Code
|
CPT 17281
|
| Hospital Charge Code |
76100147
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$172.58 |
| Max. Negotiated Rate |
$353.01 |
| Rate for Payer: Aetna American Axle |
$254.95
|
| Rate for Payer: Aetna Commercial |
$333.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$254.95
|
| Rate for Payer: Cash Price |
$313.78
|
| Rate for Payer: Cofinity Commercial |
$274.56
|
| Rate for Payer: Cofinity Commercial |
$337.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$274.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$313.78
|
| Rate for Payer: Healthscope Commercial |
$353.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$274.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$294.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$333.40
|
| Rate for Payer: PHP Commercial |
$333.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$254.95
|
| Rate for Payer: Priority Health SBD |
$247.10
|
| Rate for Payer: UMR Bronson Commercial |
$172.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$294.17
|
|
|
HC DESTR MALIG LESION FACE,EAR,EYELID,NOSE,LIP,MUC MEM 0.6 TO 1.0 CM
|
Facility
|
OP
|
$392.23
|
|
|
Service Code
|
CPT 17281
|
| Hospital Charge Code |
76100147
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$103.87 |
| Max. Negotiated Rate |
$545.50 |
| Rate for Payer: Aetna American Axle |
$254.95
|
| Rate for Payer: Aetna Commercial |
$333.40
|
| Rate for Payer: Aetna Medicare |
$201.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$254.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$242.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$242.24
|
| Rate for Payer: BCBS Complete |
$109.07
|
| Rate for Payer: BCBS MAPPO |
$193.79
|
| Rate for Payer: BCN Medicare Advantage |
$193.79
|
| Rate for Payer: Cash Price |
$313.78
|
| Rate for Payer: Cash Price |
$313.78
|
| Rate for Payer: Cofinity Commercial |
$337.32
|
| Rate for Payer: Cofinity Commercial |
$274.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$274.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$313.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$193.79
|
| Rate for Payer: Healthscope Commercial |
$353.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$274.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$294.17
|
| Rate for Payer: Mclaren Medicaid |
$103.87
|
| Rate for Payer: Mclaren Medicare |
$193.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$203.48
|
| Rate for Payer: Meridian Medicaid |
$109.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$222.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$333.40
|
| Rate for Payer: PACE Medicare |
$184.10
|
| Rate for Payer: PACE SWMI |
$193.79
|
| Rate for Payer: PHP Commercial |
$333.40
|
| Rate for Payer: PHP Medicare Advantage |
$193.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$254.95
|
| Rate for Payer: Priority Health Medicare |
$193.79
|
| Rate for Payer: Priority Health SBD |
$247.10
|
| Rate for Payer: Railroad Medicare Medicare |
$193.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$545.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$193.79
|
| Rate for Payer: UHC Exchange |
$370.35
|
| Rate for Payer: UHC Medicare Advantage |
$193.79
|
| Rate for Payer: UHCCP Medicaid |
$103.87
|
| Rate for Payer: UMR Bronson Commercial |
$145.13
|
| Rate for Payer: VA VA |
$193.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$294.17
|
|
|
HC DESTR MALIG LESION FACE,EAR,EYELID,NOSE,LIP,MUC MEM 2.1-3 CM
|
Facility
|
IP
|
$392.23
|
|
|
Service Code
|
CPT 17283
|
| Hospital Charge Code |
76100156
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$172.58 |
| Max. Negotiated Rate |
$353.01 |
| Rate for Payer: Aetna American Axle |
$254.95
|
| Rate for Payer: Aetna Commercial |
$333.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$254.95
|
| Rate for Payer: Cash Price |
$313.78
|
| Rate for Payer: Cofinity Commercial |
$274.56
|
| Rate for Payer: Cofinity Commercial |
$337.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$274.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$313.78
|
| Rate for Payer: Healthscope Commercial |
$353.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$274.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$294.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$333.40
|
| Rate for Payer: PHP Commercial |
$333.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$254.95
|
| Rate for Payer: Priority Health SBD |
$247.10
|
| Rate for Payer: UMR Bronson Commercial |
$172.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$294.17
|
|
|
HC DESTR MALIG LESION FACE,EAR,EYELID,NOSE,LIP,MUC MEM 2.1-3 CM
|
Facility
|
OP
|
$392.23
|
|
|
Service Code
|
CPT 17283
|
| Hospital Charge Code |
76100156
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$145.13 |
| Max. Negotiated Rate |
$1,096.83 |
| Rate for Payer: Aetna American Axle |
$254.95
|
| Rate for Payer: Aetna Commercial |
$333.40
|
| Rate for Payer: Aetna Medicare |
$405.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$254.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$487.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$487.06
|
| Rate for Payer: BCBS Complete |
$219.30
|
| Rate for Payer: BCBS MAPPO |
$389.65
|
| Rate for Payer: BCN Medicare Advantage |
$389.65
|
| Rate for Payer: Cash Price |
$313.78
|
| Rate for Payer: Cash Price |
$313.78
|
| Rate for Payer: Cofinity Commercial |
$337.32
|
| Rate for Payer: Cofinity Commercial |
$274.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$274.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$313.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$389.65
|
| Rate for Payer: Healthscope Commercial |
$353.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$274.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$294.17
|
| Rate for Payer: Mclaren Medicaid |
$208.85
|
| Rate for Payer: Mclaren Medicare |
$389.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$409.13
|
| Rate for Payer: Meridian Medicaid |
$219.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$448.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$333.40
|
| Rate for Payer: PACE Medicare |
$370.17
|
| Rate for Payer: PACE SWMI |
$389.65
|
| Rate for Payer: PHP Commercial |
$333.40
|
| Rate for Payer: PHP Medicare Advantage |
$389.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$254.95
|
| Rate for Payer: Priority Health Medicare |
$389.65
|
| Rate for Payer: Priority Health SBD |
$247.10
|
| Rate for Payer: Railroad Medicare Medicare |
$389.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,096.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$389.65
|
| Rate for Payer: UHC Exchange |
$744.66
|
| Rate for Payer: UHC Medicare Advantage |
$389.65
|
| Rate for Payer: UHCCP Medicaid |
$208.85
|
| Rate for Payer: UMR Bronson Commercial |
$145.13
|
| Rate for Payer: VA VA |
$389.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$294.17
|
|
|
HC DESTR MALIG LESION FACE,EAR,EYELID,NOSE,LIP,MUC MEM 3.1-4 CM
|
Facility
|
OP
|
$602.39
|
|
|
Service Code
|
CPT 17284
|
| Hospital Charge Code |
76100157
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$222.88 |
| Max. Negotiated Rate |
$1,680.50 |
| Rate for Payer: Aetna American Axle |
$391.55
|
| Rate for Payer: Aetna Commercial |
$512.03
|
| Rate for Payer: Aetna Medicare |
$620.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$391.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$746.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$746.25
|
| Rate for Payer: BCBS Complete |
$335.99
|
| Rate for Payer: BCBS MAPPO |
$597.00
|
| Rate for Payer: BCN Medicare Advantage |
$597.00
|
| Rate for Payer: Cash Price |
$481.91
|
| Rate for Payer: Cash Price |
$481.91
|
| Rate for Payer: Cofinity Commercial |
$518.06
|
| Rate for Payer: Cofinity Commercial |
$421.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$421.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$481.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$597.00
|
| Rate for Payer: Healthscope Commercial |
$542.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$421.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$451.79
|
| Rate for Payer: Mclaren Medicaid |
$319.99
|
| Rate for Payer: Mclaren Medicare |
$597.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$626.85
|
| Rate for Payer: Meridian Medicaid |
$335.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$686.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$512.03
|
| Rate for Payer: PACE Medicare |
$567.15
|
| Rate for Payer: PACE SWMI |
$597.00
|
| Rate for Payer: PHP Commercial |
$512.03
|
| Rate for Payer: PHP Medicare Advantage |
$597.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$319.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$391.55
|
| Rate for Payer: Priority Health Medicare |
$597.00
|
| Rate for Payer: Priority Health SBD |
$379.51
|
| Rate for Payer: Railroad Medicare Medicare |
$597.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,680.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$597.00
|
| Rate for Payer: UHC Exchange |
$1,140.93
|
| Rate for Payer: UHC Medicare Advantage |
$597.00
|
| Rate for Payer: UHCCP Medicaid |
$319.99
|
| Rate for Payer: UMR Bronson Commercial |
$222.88
|
| Rate for Payer: VA VA |
$597.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$451.79
|
|
|
HC DESTR MALIG LESION FACE,EAR,EYELID,NOSE,LIP,MUC MEM 3.1-4 CM
|
Facility
|
IP
|
$602.39
|
|
|
Service Code
|
CPT 17284
|
| Hospital Charge Code |
76100157
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$265.05 |
| Max. Negotiated Rate |
$542.15 |
| Rate for Payer: Aetna American Axle |
$391.55
|
| Rate for Payer: Aetna Commercial |
$512.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$391.55
|
| Rate for Payer: Cash Price |
$481.91
|
| Rate for Payer: Cofinity Commercial |
$421.67
|
| Rate for Payer: Cofinity Commercial |
$518.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$421.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$481.91
|
| Rate for Payer: Healthscope Commercial |
$542.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$421.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$451.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$512.03
|
| Rate for Payer: PHP Commercial |
$512.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$391.55
|
| Rate for Payer: Priority Health SBD |
$379.51
|
| Rate for Payer: UMR Bronson Commercial |
$265.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$451.79
|
|
|
HC DESTR MALIG LESION FACE,EAR,EYELID,NOSE,LIP,MUC MEM >4 CM
|
Facility
|
OP
|
$602.39
|
|
|
Service Code
|
CPT 17286
|
| Hospital Charge Code |
76100158
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$222.88 |
| Max. Negotiated Rate |
$1,680.50 |
| Rate for Payer: Aetna American Axle |
$391.55
|
| Rate for Payer: Aetna Commercial |
$512.03
|
| Rate for Payer: Aetna Medicare |
$620.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$391.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$746.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$746.25
|
| Rate for Payer: BCBS Complete |
$335.99
|
| Rate for Payer: BCBS MAPPO |
$597.00
|
| Rate for Payer: BCN Medicare Advantage |
$597.00
|
| Rate for Payer: Cash Price |
$481.91
|
| Rate for Payer: Cash Price |
$481.91
|
| Rate for Payer: Cofinity Commercial |
$518.06
|
| Rate for Payer: Cofinity Commercial |
$421.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$421.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$481.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$597.00
|
| Rate for Payer: Healthscope Commercial |
$542.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$421.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$451.79
|
| Rate for Payer: Mclaren Medicaid |
$319.99
|
| Rate for Payer: Mclaren Medicare |
$597.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$626.85
|
| Rate for Payer: Meridian Medicaid |
$335.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$686.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$512.03
|
| Rate for Payer: PACE Medicare |
$567.15
|
| Rate for Payer: PACE SWMI |
$597.00
|
| Rate for Payer: PHP Commercial |
$512.03
|
| Rate for Payer: PHP Medicare Advantage |
$597.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$319.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$391.55
|
| Rate for Payer: Priority Health Medicare |
$597.00
|
| Rate for Payer: Priority Health SBD |
$379.51
|
| Rate for Payer: Railroad Medicare Medicare |
$597.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,680.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$597.00
|
| Rate for Payer: UHC Exchange |
$1,140.93
|
| Rate for Payer: UHC Medicare Advantage |
$597.00
|
| Rate for Payer: UHCCP Medicaid |
$319.99
|
| Rate for Payer: UMR Bronson Commercial |
$222.88
|
| Rate for Payer: VA VA |
$597.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$451.79
|
|
|
HC DESTR MALIG LESION FACE,EAR,EYELID,NOSE,LIP,MUC MEM >4 CM
|
Facility
|
IP
|
$602.39
|
|
|
Service Code
|
CPT 17286
|
| Hospital Charge Code |
76100158
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$265.05 |
| Max. Negotiated Rate |
$542.15 |
| Rate for Payer: Aetna American Axle |
$391.55
|
| Rate for Payer: Aetna Commercial |
$512.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$391.55
|
| Rate for Payer: Cash Price |
$481.91
|
| Rate for Payer: Cofinity Commercial |
$421.67
|
| Rate for Payer: Cofinity Commercial |
$518.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$421.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$481.91
|
| Rate for Payer: Healthscope Commercial |
$542.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$421.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$451.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$512.03
|
| Rate for Payer: PHP Commercial |
$512.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$391.55
|
| Rate for Payer: Priority Health SBD |
$379.51
|
| Rate for Payer: UMR Bronson Commercial |
$265.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$451.79
|
|
|
HC DESTR PENIS LESION, SIMPLE, CRYO
|
Facility
|
OP
|
$176.87
|
|
|
Service Code
|
CPT 54056
|
| Hospital Charge Code |
76100144
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$65.44 |
| Max. Negotiated Rate |
$545.50 |
| Rate for Payer: Aetna American Axle |
$114.97
|
| Rate for Payer: Aetna Commercial |
$150.34
|
| Rate for Payer: Aetna Medicare |
$201.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$242.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$242.24
|
| Rate for Payer: BCBS Complete |
$109.07
|
| Rate for Payer: BCBS MAPPO |
$193.79
|
| Rate for Payer: BCN Medicare Advantage |
$193.79
|
| Rate for Payer: Cash Price |
$141.50
|
| Rate for Payer: Cash Price |
$141.50
|
| Rate for Payer: Cofinity Commercial |
$152.11
|
| Rate for Payer: Cofinity Commercial |
$123.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$123.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$193.79
|
| Rate for Payer: Healthscope Commercial |
$159.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$123.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.65
|
| Rate for Payer: Mclaren Medicaid |
$103.87
|
| Rate for Payer: Mclaren Medicare |
$193.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$203.48
|
| Rate for Payer: Meridian Medicaid |
$109.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$222.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.34
|
| Rate for Payer: PACE Medicare |
$184.10
|
| Rate for Payer: PACE SWMI |
$193.79
|
| Rate for Payer: PHP Commercial |
$150.34
|
| Rate for Payer: PHP Medicare Advantage |
$193.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.97
|
| Rate for Payer: Priority Health Medicare |
$193.79
|
| Rate for Payer: Priority Health SBD |
$111.43
|
| Rate for Payer: Railroad Medicare Medicare |
$193.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$545.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$193.79
|
| Rate for Payer: UHC Exchange |
$370.35
|
| Rate for Payer: UHC Medicare Advantage |
$193.79
|
| Rate for Payer: UHCCP Medicaid |
$103.87
|
| Rate for Payer: UMR Bronson Commercial |
$65.44
|
| Rate for Payer: VA VA |
$193.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.65
|
|
|
HC DESTR PENIS LESION, SIMPLE, CRYO
|
Facility
|
IP
|
$176.87
|
|
|
Service Code
|
CPT 54056
|
| Hospital Charge Code |
76100144
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$77.82 |
| Max. Negotiated Rate |
$159.18 |
| Rate for Payer: Aetna American Axle |
$114.97
|
| Rate for Payer: Aetna Commercial |
$150.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.97
|
| Rate for Payer: Cash Price |
$141.50
|
| Rate for Payer: Cofinity Commercial |
$123.81
|
| Rate for Payer: Cofinity Commercial |
$152.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$123.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.50
|
| Rate for Payer: Healthscope Commercial |
$159.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$123.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.34
|
| Rate for Payer: PHP Commercial |
$150.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.97
|
| Rate for Payer: Priority Health SBD |
$111.43
|
| Rate for Payer: UMR Bronson Commercial |
$77.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.65
|
|
|
HC DESTRUCT ANAL LESN(S) SIMPLE CHEM
|
Facility
|
OP
|
$490.03
|
|
|
Service Code
|
CPT 46900
|
| Hospital Charge Code |
76100219
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$181.31 |
| Max. Negotiated Rate |
$1,096.83 |
| Rate for Payer: Aetna American Axle |
$318.52
|
| Rate for Payer: Aetna Commercial |
$416.53
|
| Rate for Payer: Aetna Medicare |
$405.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$318.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$487.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$487.06
|
| Rate for Payer: BCBS Complete |
$219.30
|
| Rate for Payer: BCBS MAPPO |
$389.65
|
| Rate for Payer: BCN Medicare Advantage |
$389.65
|
| Rate for Payer: Cash Price |
$392.02
|
| Rate for Payer: Cash Price |
$392.02
|
| Rate for Payer: Cofinity Commercial |
$421.43
|
| Rate for Payer: Cofinity Commercial |
$343.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$343.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$392.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$389.65
|
| Rate for Payer: Healthscope Commercial |
$441.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$343.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$367.52
|
| Rate for Payer: Mclaren Medicaid |
$208.85
|
| Rate for Payer: Mclaren Medicare |
$389.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$409.13
|
| Rate for Payer: Meridian Medicaid |
$219.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$448.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$416.53
|
| Rate for Payer: PACE Medicare |
$370.17
|
| Rate for Payer: PACE SWMI |
$389.65
|
| Rate for Payer: PHP Commercial |
$416.53
|
| Rate for Payer: PHP Medicare Advantage |
$389.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$318.52
|
| Rate for Payer: Priority Health Medicare |
$389.65
|
| Rate for Payer: Priority Health SBD |
$308.72
|
| Rate for Payer: Railroad Medicare Medicare |
$389.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,096.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$389.65
|
| Rate for Payer: UHC Exchange |
$744.66
|
| Rate for Payer: UHC Medicare Advantage |
$389.65
|
| Rate for Payer: UHCCP Medicaid |
$208.85
|
| Rate for Payer: UMR Bronson Commercial |
$181.31
|
| Rate for Payer: VA VA |
$389.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$367.52
|
|
|
HC DESTRUCT ANAL LESN(S) SIMPLE CHEM
|
Facility
|
IP
|
$490.03
|
|
|
Service Code
|
CPT 46900
|
| Hospital Charge Code |
76100219
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$215.61 |
| Max. Negotiated Rate |
$441.03 |
| Rate for Payer: Aetna American Axle |
$318.52
|
| Rate for Payer: Aetna Commercial |
$416.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$318.52
|
| Rate for Payer: Cash Price |
$392.02
|
| Rate for Payer: Cofinity Commercial |
$343.02
|
| Rate for Payer: Cofinity Commercial |
$421.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$343.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$392.02
|
| Rate for Payer: Healthscope Commercial |
$441.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$343.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$367.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$416.53
|
| Rate for Payer: PHP Commercial |
$416.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$318.52
|
| Rate for Payer: Priority Health SBD |
$308.72
|
| Rate for Payer: UMR Bronson Commercial |
$215.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$367.52
|
|
|
HC DESTRUCT BENIGN LESIONS 15 OR MORE
|
Facility
|
IP
|
$161.82
|
|
|
Service Code
|
CPT 17111
|
| Hospital Charge Code |
76100124
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$71.20 |
| Max. Negotiated Rate |
$145.64 |
| Rate for Payer: Aetna American Axle |
$105.18
|
| Rate for Payer: Aetna Commercial |
$137.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.18
|
| Rate for Payer: Cash Price |
$129.46
|
| Rate for Payer: Cofinity Commercial |
$113.27
|
| Rate for Payer: Cofinity Commercial |
$139.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$113.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.46
|
| Rate for Payer: Healthscope Commercial |
$145.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$113.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$121.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.55
|
| Rate for Payer: PHP Commercial |
$137.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.18
|
| Rate for Payer: Priority Health SBD |
$101.95
|
| Rate for Payer: UMR Bronson Commercial |
$71.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$121.36
|
|
|
HC DESTRUCT BENIGN LESIONS 15 OR MORE
|
Facility
|
OP
|
$161.82
|
|
|
Service Code
|
CPT 17111
|
| Hospital Charge Code |
76100124
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$59.87 |
| Max. Negotiated Rate |
$545.50 |
| Rate for Payer: Aetna American Axle |
$105.18
|
| Rate for Payer: Aetna Commercial |
$137.55
|
| Rate for Payer: Aetna Medicare |
$201.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$242.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$242.24
|
| Rate for Payer: BCBS Complete |
$109.07
|
| Rate for Payer: BCBS MAPPO |
$193.79
|
| Rate for Payer: BCN Medicare Advantage |
$193.79
|
| Rate for Payer: Cash Price |
$129.46
|
| Rate for Payer: Cash Price |
$129.46
|
| Rate for Payer: Cofinity Commercial |
$139.17
|
| Rate for Payer: Cofinity Commercial |
$113.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$113.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$193.79
|
| Rate for Payer: Healthscope Commercial |
$145.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$113.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$121.36
|
| Rate for Payer: Mclaren Medicaid |
$103.87
|
| Rate for Payer: Mclaren Medicare |
$193.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$203.48
|
| Rate for Payer: Meridian Medicaid |
$109.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$222.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.55
|
| Rate for Payer: PACE Medicare |
$184.10
|
| Rate for Payer: PACE SWMI |
$193.79
|
| Rate for Payer: PHP Commercial |
$137.55
|
| Rate for Payer: PHP Medicare Advantage |
$193.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.18
|
| Rate for Payer: Priority Health Medicare |
$193.79
|
| Rate for Payer: Priority Health SBD |
$101.95
|
| Rate for Payer: Railroad Medicare Medicare |
$193.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$545.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$193.79
|
| Rate for Payer: UHC Exchange |
$370.35
|
| Rate for Payer: UHC Medicare Advantage |
$193.79
|
| Rate for Payer: UHCCP Medicaid |
$103.87
|
| Rate for Payer: UMR Bronson Commercial |
$59.87
|
| Rate for Payer: VA VA |
$193.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$121.36
|
|
|
HC DESTRUCT BENIGN LESIONS UP TO 14 LESIONS
|
Facility
|
OP
|
$176.53
|
|
|
Service Code
|
CPT 17110
|
| Hospital Charge Code |
76100123
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$65.32 |
| Max. Negotiated Rate |
$545.50 |
| Rate for Payer: Aetna American Axle |
$114.74
|
| Rate for Payer: Aetna Commercial |
$150.05
|
| Rate for Payer: Aetna Medicare |
$201.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$242.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$242.24
|
| Rate for Payer: BCBS Complete |
$109.07
|
| Rate for Payer: BCBS MAPPO |
$193.79
|
| Rate for Payer: BCN Medicare Advantage |
$193.79
|
| Rate for Payer: Cash Price |
$141.22
|
| Rate for Payer: Cash Price |
$141.22
|
| Rate for Payer: Cofinity Commercial |
$151.82
|
| Rate for Payer: Cofinity Commercial |
$123.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$123.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$193.79
|
| Rate for Payer: Healthscope Commercial |
$158.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$123.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.40
|
| Rate for Payer: Mclaren Medicaid |
$103.87
|
| Rate for Payer: Mclaren Medicare |
$193.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$203.48
|
| Rate for Payer: Meridian Medicaid |
$109.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$222.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.05
|
| Rate for Payer: PACE Medicare |
$184.10
|
| Rate for Payer: PACE SWMI |
$193.79
|
| Rate for Payer: PHP Commercial |
$150.05
|
| Rate for Payer: PHP Medicare Advantage |
$193.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.74
|
| Rate for Payer: Priority Health Medicare |
$193.79
|
| Rate for Payer: Priority Health SBD |
$111.21
|
| Rate for Payer: Railroad Medicare Medicare |
$193.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$545.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$193.79
|
| Rate for Payer: UHC Exchange |
$370.35
|
| Rate for Payer: UHC Medicare Advantage |
$193.79
|
| Rate for Payer: UHCCP Medicaid |
$103.87
|
| Rate for Payer: UMR Bronson Commercial |
$65.32
|
| Rate for Payer: VA VA |
$193.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.40
|
|
|
HC DESTRUCT BENIGN LESIONS UP TO 14 LESIONS
|
Facility
|
IP
|
$176.53
|
|
|
Service Code
|
CPT 17110
|
| Hospital Charge Code |
76100123
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$77.67 |
| Max. Negotiated Rate |
$158.88 |
| Rate for Payer: Aetna American Axle |
$114.74
|
| Rate for Payer: Aetna Commercial |
$150.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.74
|
| Rate for Payer: Cash Price |
$141.22
|
| Rate for Payer: Cofinity Commercial |
$123.57
|
| Rate for Payer: Cofinity Commercial |
$151.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$123.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.22
|
| Rate for Payer: Healthscope Commercial |
$158.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$123.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.05
|
| Rate for Payer: PHP Commercial |
$150.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.74
|
| Rate for Payer: Priority Health SBD |
$111.21
|
| Rate for Payer: UMR Bronson Commercial |
$77.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.40
|
|
