|
HC NURSEMAID ELBOW REDUCTION
|
Facility
|
OP
|
$211.74
|
|
|
Service Code
|
CPT 24640
|
| Hospital Charge Code |
45000008
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$78.34 |
| Max. Negotiated Rate |
$659.87 |
| Rate for Payer: Aetna American Axle |
$137.63
|
| Rate for Payer: Aetna Commercial |
$179.98
|
| Rate for Payer: Aetna Medicare |
$218.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$262.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$262.02
|
| Rate for Payer: BCBS Complete |
$120.41
|
| Rate for Payer: BCBS MAPPO |
$209.62
|
| Rate for Payer: BCBS Trust/PPO |
$144.98
|
| Rate for Payer: BCN Medicare Advantage |
$209.62
|
| Rate for Payer: Cash Price |
$169.39
|
| Rate for Payer: Cash Price |
$169.39
|
| Rate for Payer: Cofinity Commercial |
$182.10
|
| Rate for Payer: Cofinity Commercial |
$148.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$209.62
|
| Rate for Payer: Healthscope Commercial |
$190.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$148.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.80
|
| Rate for Payer: Mclaren Medicaid |
$114.66
|
| Rate for Payer: Mclaren Medicare |
$209.62
|
| Rate for Payer: Meridian Medicaid |
$120.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$220.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$241.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$179.98
|
| Rate for Payer: PACE Medicare |
$199.14
|
| Rate for Payer: PACE SWMI |
$209.62
|
| Rate for Payer: PHP Commercial |
$179.98
|
| Rate for Payer: PHP Medicare Advantage |
$209.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$114.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$659.87
|
| Rate for Payer: Priority Health Medicare |
$209.62
|
| Rate for Payer: Priority Health Narrow Network |
$527.90
|
| Rate for Payer: Priority Health SBD |
$133.40
|
| Rate for Payer: Railroad Medicare Medicare |
$209.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$87.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$209.62
|
| Rate for Payer: UHC Exchange |
$79.24
|
| Rate for Payer: UHC Medicare Advantage |
$215.91
|
| Rate for Payer: UMR Bronson Commercial |
$78.34
|
| Rate for Payer: VA VA |
$209.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$158.80
|
|
|
HC NUSHIELD (1.6 SQ CM DISC) PER SQ CM
|
Facility
|
OP
|
$604.35
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600153
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$223.61 |
| Max. Negotiated Rate |
$543.92 |
| Rate for Payer: Aetna American Axle |
$392.83
|
| Rate for Payer: Aetna Commercial |
$513.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$392.83
|
| Rate for Payer: BCBS Complete |
$241.74
|
| Rate for Payer: Cash Price |
$483.48
|
| Rate for Payer: Cofinity Commercial |
$423.04
|
| Rate for Payer: Cofinity Commercial |
$519.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$483.48
|
| Rate for Payer: Healthscope Commercial |
$543.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$423.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$453.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$513.70
|
| Rate for Payer: PHP Commercial |
$513.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$423.04
|
| Rate for Payer: Priority Health SBD |
$380.74
|
| Rate for Payer: UMR Bronson Commercial |
$223.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$453.26
|
|
|
HC NUSHIELD (1.6 SQ CM DISC) PER SQ CM
|
Facility
|
IP
|
$604.35
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600153
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$265.91 |
| Max. Negotiated Rate |
$543.92 |
| Rate for Payer: Aetna American Axle |
$392.83
|
| Rate for Payer: Aetna Commercial |
$513.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$392.83
|
| Rate for Payer: Cash Price |
$483.48
|
| Rate for Payer: Cofinity Commercial |
$423.04
|
| Rate for Payer: Cofinity Commercial |
$519.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$483.48
|
| Rate for Payer: Healthscope Commercial |
$543.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$423.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$453.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$513.70
|
| Rate for Payer: PHP Commercial |
$513.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$423.04
|
| Rate for Payer: Priority Health SBD |
$380.74
|
| Rate for Payer: UMR Bronson Commercial |
$265.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$453.26
|
|
|
HC NUSHIELD 2X3 PER SQ CM
|
Facility
|
IP
|
$322.52
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600154
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$141.91 |
| Max. Negotiated Rate |
$290.27 |
| Rate for Payer: Aetna American Axle |
$209.64
|
| Rate for Payer: Aetna Commercial |
$274.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$209.64
|
| Rate for Payer: Cash Price |
$258.02
|
| Rate for Payer: Cofinity Commercial |
$225.76
|
| Rate for Payer: Cofinity Commercial |
$277.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$258.02
|
| Rate for Payer: Healthscope Commercial |
$290.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$225.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$241.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$274.14
|
| Rate for Payer: PHP Commercial |
$274.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$225.76
|
| Rate for Payer: Priority Health SBD |
$203.19
|
| Rate for Payer: UMR Bronson Commercial |
$141.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$241.89
|
|
|
HC NUSHIELD 2X3 PER SQ CM
|
Facility
|
OP
|
$322.52
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600154
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$119.33 |
| Max. Negotiated Rate |
$290.27 |
| Rate for Payer: Aetna American Axle |
$209.64
|
| Rate for Payer: Aetna Commercial |
$274.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$209.64
|
| Rate for Payer: BCBS Complete |
$129.01
|
| Rate for Payer: Cash Price |
$258.02
|
| Rate for Payer: Cofinity Commercial |
$225.76
|
| Rate for Payer: Cofinity Commercial |
$277.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$258.02
|
| Rate for Payer: Healthscope Commercial |
$290.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$225.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$241.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$274.14
|
| Rate for Payer: PHP Commercial |
$274.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$225.76
|
| Rate for Payer: Priority Health SBD |
$203.19
|
| Rate for Payer: UMR Bronson Commercial |
$119.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$241.89
|
|
|
HC NUSHIELD 2X4 PER SQ CM
|
Facility
|
OP
|
$302.82
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600175
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$112.04 |
| Max. Negotiated Rate |
$272.54 |
| Rate for Payer: Aetna American Axle |
$196.83
|
| Rate for Payer: Aetna Commercial |
$257.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.83
|
| Rate for Payer: BCBS Complete |
$121.13
|
| Rate for Payer: Cash Price |
$242.26
|
| Rate for Payer: Cofinity Commercial |
$211.97
|
| Rate for Payer: Cofinity Commercial |
$260.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.26
|
| Rate for Payer: Healthscope Commercial |
$272.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$211.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$227.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$257.40
|
| Rate for Payer: PHP Commercial |
$257.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$211.97
|
| Rate for Payer: Priority Health SBD |
$190.78
|
| Rate for Payer: UMR Bronson Commercial |
$112.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$227.12
|
|
|
HC NUSHIELD 2X4 PER SQ CM
|
Facility
|
IP
|
$302.82
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600175
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$133.24 |
| Max. Negotiated Rate |
$272.54 |
| Rate for Payer: Aetna American Axle |
$196.83
|
| Rate for Payer: Aetna Commercial |
$257.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.83
|
| Rate for Payer: Cash Price |
$242.26
|
| Rate for Payer: Cofinity Commercial |
$211.97
|
| Rate for Payer: Cofinity Commercial |
$260.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.26
|
| Rate for Payer: Healthscope Commercial |
$272.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$211.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$227.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$257.40
|
| Rate for Payer: PHP Commercial |
$257.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$211.97
|
| Rate for Payer: Priority Health SBD |
$190.78
|
| Rate for Payer: UMR Bronson Commercial |
$133.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$227.12
|
|
|
HC NUSHIELD 3X4 PER SQ CM
|
Facility
|
OP
|
$292.19
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600176
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$108.11 |
| Max. Negotiated Rate |
$262.97 |
| Rate for Payer: Aetna American Axle |
$189.92
|
| Rate for Payer: Aetna Commercial |
$248.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$189.92
|
| Rate for Payer: BCBS Complete |
$116.88
|
| Rate for Payer: Cash Price |
$233.75
|
| Rate for Payer: Cofinity Commercial |
$204.53
|
| Rate for Payer: Cofinity Commercial |
$251.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.75
|
| Rate for Payer: Healthscope Commercial |
$262.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$204.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$219.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$248.36
|
| Rate for Payer: PHP Commercial |
$248.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$204.53
|
| Rate for Payer: Priority Health SBD |
$184.08
|
| Rate for Payer: UMR Bronson Commercial |
$108.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$219.14
|
|
|
HC NUSHIELD 3X4 PER SQ CM
|
Facility
|
IP
|
$292.19
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600176
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$128.56 |
| Max. Negotiated Rate |
$262.97 |
| Rate for Payer: Aetna American Axle |
$189.92
|
| Rate for Payer: Aetna Commercial |
$248.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$189.92
|
| Rate for Payer: Cash Price |
$233.75
|
| Rate for Payer: Cofinity Commercial |
$204.53
|
| Rate for Payer: Cofinity Commercial |
$251.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.75
|
| Rate for Payer: Healthscope Commercial |
$262.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$204.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$219.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$248.36
|
| Rate for Payer: PHP Commercial |
$248.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$204.53
|
| Rate for Payer: Priority Health SBD |
$184.08
|
| Rate for Payer: UMR Bronson Commercial |
$128.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$219.14
|
|
|
HC NUSHIELD 4X4 PER SQ CM
|
Facility
|
IP
|
$227.11
|
|
|
Service Code
|
CPT Q4160
|
| Hospital Charge Code |
63600177
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$99.93 |
| Max. Negotiated Rate |
$204.40 |
| Rate for Payer: Aetna American Axle |
$147.62
|
| Rate for Payer: Aetna Commercial |
$193.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$147.62
|
| Rate for Payer: Cash Price |
$181.69
|
| Rate for Payer: Cofinity Commercial |
$158.98
|
| Rate for Payer: Cofinity Commercial |
$195.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$181.69
|
| Rate for Payer: Healthscope Commercial |
$204.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$158.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$170.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$193.04
|
| Rate for Payer: PHP Commercial |
$193.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.98
|
| Rate for Payer: Priority Health SBD |
$143.08
|
| Rate for Payer: UMR Bronson Commercial |
$99.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$170.33
|
|
|
HC NUSHIELD 4X4 PER SQ CM
|
Facility
|
OP
|
$227.11
|
|
|
Service Code
|
CPT Q4160
|
| Hospital Charge Code |
63600177
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$84.03 |
| Max. Negotiated Rate |
$204.40 |
| Rate for Payer: Aetna American Axle |
$147.62
|
| Rate for Payer: Aetna Commercial |
$193.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$147.62
|
| Rate for Payer: BCBS Complete |
$90.84
|
| Rate for Payer: Cash Price |
$181.69
|
| Rate for Payer: Cofinity Commercial |
$158.98
|
| Rate for Payer: Cofinity Commercial |
$195.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$181.69
|
| Rate for Payer: Healthscope Commercial |
$204.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$158.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$170.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$193.04
|
| Rate for Payer: PHP Commercial |
$193.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.98
|
| Rate for Payer: Priority Health SBD |
$143.08
|
| Rate for Payer: UMR Bronson Commercial |
$84.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$170.33
|
|
|
HC NUSHIELD 4X6 PER SQ CM
|
Facility
|
IP
|
$159.38
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600178
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$70.13 |
| Max. Negotiated Rate |
$143.44 |
| Rate for Payer: Aetna American Axle |
$103.60
|
| Rate for Payer: Aetna Commercial |
$135.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$103.60
|
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: Cofinity Commercial |
$111.57
|
| Rate for Payer: Cofinity Commercial |
$137.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.50
|
| Rate for Payer: Healthscope Commercial |
$143.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$111.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$119.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$135.47
|
| Rate for Payer: PHP Commercial |
$135.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.57
|
| Rate for Payer: Priority Health SBD |
$100.41
|
| Rate for Payer: UMR Bronson Commercial |
$70.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$119.54
|
|
|
HC NUSHIELD 4X6 PER SQ CM
|
Facility
|
OP
|
$159.38
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600178
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$58.97 |
| Max. Negotiated Rate |
$143.44 |
| Rate for Payer: Aetna American Axle |
$103.60
|
| Rate for Payer: Aetna Commercial |
$135.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$103.60
|
| Rate for Payer: BCBS Complete |
$63.75
|
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: Cofinity Commercial |
$111.57
|
| Rate for Payer: Cofinity Commercial |
$137.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.50
|
| Rate for Payer: Healthscope Commercial |
$143.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$111.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$119.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$135.47
|
| Rate for Payer: PHP Commercial |
$135.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.57
|
| Rate for Payer: Priority Health SBD |
$100.41
|
| Rate for Payer: UMR Bronson Commercial |
$58.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$119.54
|
|
|
HC NUSHIELD 6X6 PER SQ CM
|
Facility
|
OP
|
$141.11
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600166
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$52.21 |
| Max. Negotiated Rate |
$127.00 |
| Rate for Payer: Aetna American Axle |
$91.72
|
| Rate for Payer: Aetna Commercial |
$119.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.72
|
| Rate for Payer: BCBS Complete |
$56.44
|
| Rate for Payer: Cash Price |
$112.89
|
| Rate for Payer: Cofinity Commercial |
$121.35
|
| Rate for Payer: Cofinity Commercial |
$98.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.89
|
| Rate for Payer: Healthscope Commercial |
$127.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$98.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$119.94
|
| Rate for Payer: PHP Commercial |
$119.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.78
|
| Rate for Payer: Priority Health SBD |
$88.90
|
| Rate for Payer: UMR Bronson Commercial |
$52.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.83
|
|
|
HC NUSHIELD 6X6 PER SQ CM
|
Facility
|
IP
|
$141.11
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600166
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$62.09 |
| Max. Negotiated Rate |
$127.00 |
| Rate for Payer: Aetna American Axle |
$91.72
|
| Rate for Payer: Aetna Commercial |
$119.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.72
|
| Rate for Payer: Cash Price |
$112.89
|
| Rate for Payer: Cofinity Commercial |
$121.35
|
| Rate for Payer: Cofinity Commercial |
$98.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.89
|
| Rate for Payer: Healthscope Commercial |
$127.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$98.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$119.94
|
| Rate for Payer: PHP Commercial |
$119.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.78
|
| Rate for Payer: Priority Health SBD |
$88.90
|
| Rate for Payer: UMR Bronson Commercial |
$62.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.83
|
|
|
HC NUT ALLERGEN PANEL
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200123
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.95 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna American Axle |
$16.18
|
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.18
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$17.42
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health SBD |
$15.68
|
| Rate for Payer: UMR Bronson Commercial |
$10.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.67
|
|
|
HC NUT ALLERGEN PANEL
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200123
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna American Axle |
$16.18
|
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: BCBS Complete |
$3.00
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$4.70
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$17.42
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.67
|
| Rate for Payer: Mclaren Medicaid |
$2.86
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Medicaid |
$3.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7.16
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$5.73
|
| Rate for Payer: Priority Health SBD |
$15.68
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.26
|
| Rate for Payer: UHC Core |
$8.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$5.22
|
| Rate for Payer: UHC Medicare Advantage |
$5.38
|
| Rate for Payer: UMR Bronson Commercial |
$9.21
|
| Rate for Payer: VA VA |
$5.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.67
|
|
|
HC NVU OBSERVATION PER HOUR
|
Facility
|
IP
|
$134.33
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200004
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$59.11 |
| Max. Negotiated Rate |
$120.90 |
| Rate for Payer: Aetna American Axle |
$87.31
|
| Rate for Payer: Aetna Commercial |
$114.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.31
|
| Rate for Payer: Cash Price |
$107.46
|
| Rate for Payer: Cofinity Commercial |
$115.52
|
| Rate for Payer: Cofinity Commercial |
$94.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.46
|
| Rate for Payer: Healthscope Commercial |
$120.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$94.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$114.18
|
| Rate for Payer: PHP Commercial |
$114.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.03
|
| Rate for Payer: Priority Health SBD |
$84.63
|
| Rate for Payer: UMR Bronson Commercial |
$59.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.75
|
|
|
HC NVU OBSERVATION PER HOUR
|
Facility
|
OP
|
$134.33
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200004
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$49.70 |
| Max. Negotiated Rate |
$4,092.00 |
| Rate for Payer: Aetna American Axle |
$87.31
|
| Rate for Payer: Aetna Commercial |
$114.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.31
|
| Rate for Payer: BCBS Complete |
$53.73
|
| Rate for Payer: BCBS Trust/PPO |
$118.88
|
| Rate for Payer: Cash Price |
$107.46
|
| Rate for Payer: Cash Price |
$107.46
|
| Rate for Payer: Cash Price |
$107.46
|
| Rate for Payer: Cofinity Commercial |
$94.03
|
| Rate for Payer: Cofinity Commercial |
$115.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.46
|
| Rate for Payer: Healthscope Commercial |
$120.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$94.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.75
|
| Rate for Payer: Meridian Medicaid |
$1,000.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$114.18
|
| Rate for Payer: PHP Commercial |
$114.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.03
|
| Rate for Payer: Priority Health SBD |
$84.63
|
| Rate for Payer: UHC Core |
$4,092.00
|
| Rate for Payer: UMR Bronson Commercial |
$49.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.75
|
|
|
HC OAK IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200050
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.95 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna American Axle |
$16.18
|
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.18
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$17.42
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health SBD |
$15.68
|
| Rate for Payer: UMR Bronson Commercial |
$10.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.67
|
|
|
HC OAK IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200050
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna American Axle |
$16.18
|
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: BCBS Complete |
$3.00
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$4.70
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$17.42
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.67
|
| Rate for Payer: Mclaren Medicaid |
$2.86
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Medicaid |
$3.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7.16
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$5.73
|
| Rate for Payer: Priority Health SBD |
$15.68
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.26
|
| Rate for Payer: UHC Core |
$8.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$5.22
|
| Rate for Payer: UHC Medicare Advantage |
$5.38
|
| Rate for Payer: UMR Bronson Commercial |
$9.21
|
| Rate for Payer: VA VA |
$5.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.67
|
|
|
HC OASIS ULTRA TRI LAYER WD MATRIX PER SQ CM
|
Facility
|
OP
|
$53.13
|
|
|
Service Code
|
HCPCS Q4124
|
| Hospital Charge Code |
63600059
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.16 |
| Max. Negotiated Rate |
$47.82 |
| Rate for Payer: Aetna American Axle |
$34.53
|
| Rate for Payer: Aetna Commercial |
$45.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.53
|
| Rate for Payer: BCBS Complete |
$21.25
|
| Rate for Payer: BCBS Trust/PPO |
$11.16
|
| Rate for Payer: Cash Price |
$42.50
|
| Rate for Payer: Cash Price |
$42.50
|
| Rate for Payer: Cofinity Commercial |
$45.69
|
| Rate for Payer: Cofinity Commercial |
$37.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.50
|
| Rate for Payer: Healthscope Commercial |
$47.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.16
|
| Rate for Payer: PHP Commercial |
$45.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.19
|
| Rate for Payer: Priority Health SBD |
$33.47
|
| Rate for Payer: UMR Bronson Commercial |
$19.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.85
|
|
|
HC OASIS ULTRA TRI LAYER WD MATRIX PER SQ CM
|
Facility
|
IP
|
$53.13
|
|
|
Service Code
|
HCPCS Q4124
|
| Hospital Charge Code |
63600059
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.38 |
| Max. Negotiated Rate |
$47.82 |
| Rate for Payer: Aetna American Axle |
$34.53
|
| Rate for Payer: Aetna Commercial |
$45.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.53
|
| Rate for Payer: Cash Price |
$42.50
|
| Rate for Payer: Cofinity Commercial |
$37.19
|
| Rate for Payer: Cofinity Commercial |
$45.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.50
|
| Rate for Payer: Healthscope Commercial |
$47.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.16
|
| Rate for Payer: PHP Commercial |
$45.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.19
|
| Rate for Payer: Priority Health SBD |
$33.47
|
| Rate for Payer: UMR Bronson Commercial |
$23.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.85
|
|
|
HC OASIS WD MATRIX PER SQ CM
|
Facility
|
IP
|
$31.29
|
|
|
Service Code
|
HCPCS Q4102
|
| Hospital Charge Code |
63600050
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.77 |
| Max. Negotiated Rate |
$28.16 |
| Rate for Payer: Aetna American Axle |
$20.34
|
| Rate for Payer: Aetna Commercial |
$26.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.34
|
| Rate for Payer: Cash Price |
$25.03
|
| Rate for Payer: Cofinity Commercial |
$21.90
|
| Rate for Payer: Cofinity Commercial |
$26.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.03
|
| Rate for Payer: Healthscope Commercial |
$28.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.60
|
| Rate for Payer: PHP Commercial |
$26.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.90
|
| Rate for Payer: Priority Health SBD |
$19.71
|
| Rate for Payer: UMR Bronson Commercial |
$13.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.47
|
|
|
HC OASIS WD MATRIX PER SQ CM
|
Facility
|
OP
|
$31.29
|
|
|
Service Code
|
HCPCS Q4102
|
| Hospital Charge Code |
63600050
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.58 |
| Max. Negotiated Rate |
$1,555.13 |
| Rate for Payer: Aetna American Axle |
$20.34
|
| Rate for Payer: Aetna Commercial |
$26.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.34
|
| Rate for Payer: BCBS Complete |
$12.52
|
| Rate for Payer: BCBS Trust/PPO |
$1,555.13
|
| Rate for Payer: Cash Price |
$25.03
|
| Rate for Payer: Cash Price |
$25.03
|
| Rate for Payer: Cofinity Commercial |
$21.90
|
| Rate for Payer: Cofinity Commercial |
$26.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.03
|
| Rate for Payer: Healthscope Commercial |
$28.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.60
|
| Rate for Payer: PHP Commercial |
$26.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.90
|
| Rate for Payer: Priority Health SBD |
$19.71
|
| Rate for Payer: UMR Bronson Commercial |
$11.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.47
|
|
