|
HC OAT IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200051
|
|
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 OAT IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200051
|
|
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 OB ANTEPARTUM R&B
|
Facility
|
IP
|
$3,563.34
|
|
| Hospital Charge Code |
20000003
|
|
Hospital Revenue Code
|
110
|
| Min. Negotiated Rate |
$1,567.87 |
| Max. Negotiated Rate |
$3,207.01 |
| Rate for Payer: Aetna American Axle |
$2,316.17
|
| Rate for Payer: Aetna Commercial |
$3,028.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,316.17
|
| Rate for Payer: Cash Price |
$2,850.67
|
| Rate for Payer: Cofinity Commercial |
$2,494.34
|
| Rate for Payer: Cofinity Commercial |
$3,064.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,850.67
|
| Rate for Payer: Healthscope Commercial |
$3,207.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,494.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,672.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,028.84
|
| Rate for Payer: PHP Commercial |
$3,028.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,494.34
|
| Rate for Payer: Priority Health SBD |
$2,244.90
|
| Rate for Payer: UMR Bronson Commercial |
$1,567.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,672.50
|
|
|
HC OB DELIVERY R&B
|
Facility
|
IP
|
$1,775.22
|
|
| Hospital Charge Code |
11200001
|
|
Hospital Revenue Code
|
112
|
| Min. Negotiated Rate |
$781.10 |
| Max. Negotiated Rate |
$1,597.70 |
| Rate for Payer: Aetna American Axle |
$1,153.89
|
| Rate for Payer: Aetna Commercial |
$1,508.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,153.89
|
| Rate for Payer: Cash Price |
$1,420.18
|
| Rate for Payer: Cofinity Commercial |
$1,242.65
|
| Rate for Payer: Cofinity Commercial |
$1,526.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,420.18
|
| Rate for Payer: Healthscope Commercial |
$1,597.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,242.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,331.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,508.94
|
| Rate for Payer: PHP Commercial |
$1,508.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,242.65
|
| Rate for Payer: Priority Health SBD |
$1,118.39
|
| Rate for Payer: UMR Bronson Commercial |
$781.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,331.42
|
|
|
HC OB HIGH RISK R&B
|
Facility
|
IP
|
$3,905.86
|
|
| Hospital Charge Code |
20000004
|
|
Hospital Revenue Code
|
110
|
| Min. Negotiated Rate |
$1,718.58 |
| Max. Negotiated Rate |
$3,515.27 |
| Rate for Payer: Aetna American Axle |
$2,538.81
|
| Rate for Payer: Aetna Commercial |
$3,319.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,538.81
|
| Rate for Payer: Cash Price |
$3,124.69
|
| Rate for Payer: Cofinity Commercial |
$2,734.10
|
| Rate for Payer: Cofinity Commercial |
$3,359.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,124.69
|
| Rate for Payer: Healthscope Commercial |
$3,515.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,734.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,929.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,319.98
|
| Rate for Payer: PHP Commercial |
$3,319.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,734.10
|
| Rate for Payer: Priority Health SBD |
$2,460.69
|
| Rate for Payer: UMR Bronson Commercial |
$1,718.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,929.40
|
|
|
HC OB MED OBSERVATION PER HOUR
|
Facility
|
OP
|
$134.33
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200012
|
|
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 |
$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: 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 OB MED OBSERVATION PER HOUR
|
Facility
|
IP
|
$134.33
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200012
|
|
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 OB POSTPARTUM R&B
|
Facility
|
IP
|
$2,510.09
|
|
| Hospital Charge Code |
11200002
|
|
Hospital Revenue Code
|
112
|
| Min. Negotiated Rate |
$1,104.44 |
| Max. Negotiated Rate |
$2,259.08 |
| Rate for Payer: Aetna American Axle |
$1,631.56
|
| Rate for Payer: Aetna Commercial |
$2,133.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,631.56
|
| Rate for Payer: Cash Price |
$2,008.07
|
| Rate for Payer: Cofinity Commercial |
$1,757.06
|
| Rate for Payer: Cofinity Commercial |
$2,158.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,008.07
|
| Rate for Payer: Healthscope Commercial |
$2,259.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,757.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,882.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,133.58
|
| Rate for Payer: PHP Commercial |
$2,133.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,757.06
|
| Rate for Payer: Priority Health SBD |
$1,581.36
|
| Rate for Payer: UMR Bronson Commercial |
$1,104.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,882.57
|
|
|
HC OBSERVATION OVERFLOW PER HOUR
|
Facility
|
OP
|
$134.33
|
|
| Hospital Charge Code |
76900005
|
|
Hospital Revenue Code
|
769
|
| Min. Negotiated Rate |
$49.70 |
| 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: BCBS Complete |
$53.73
|
| 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 |
$49.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.75
|
|
|
HC OBSERVATION OVERFLOW PER HOUR
|
Facility
|
IP
|
$134.33
|
|
| Hospital Charge Code |
76900005
|
|
Hospital Revenue Code
|
769
|
| 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 OBSERVATION PER HOUR
|
Facility
|
IP
|
$134.33
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200023
|
|
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 OBSERVATION PER HOUR
|
Facility
|
OP
|
$134.33
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200023
|
|
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 OBS OVERFLOW PER HR
|
Facility
|
OP
|
$134.33
|
|
| Hospital Charge Code |
76900002
|
|
Hospital Revenue Code
|
769
|
| Min. Negotiated Rate |
$49.70 |
| 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: BCBS Complete |
$53.73
|
| 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 |
$49.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.75
|
|
|
HC OBS OVERFLOW PER HR
|
Facility
|
IP
|
$134.33
|
|
| Hospital Charge Code |
76900002
|
|
Hospital Revenue Code
|
769
|
| 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 OB SURGERY ADDL 15 MIN
|
Facility
|
IP
|
$268.65
|
|
| Hospital Charge Code |
36000104
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$118.21 |
| Max. Negotiated Rate |
$241.78 |
| Rate for Payer: Aetna American Axle |
$174.62
|
| Rate for Payer: Aetna Commercial |
$228.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.62
|
| Rate for Payer: Cash Price |
$214.92
|
| Rate for Payer: Cofinity Commercial |
$188.06
|
| Rate for Payer: Cofinity Commercial |
$231.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.92
|
| Rate for Payer: Healthscope Commercial |
$241.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$188.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$201.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$228.35
|
| Rate for Payer: PHP Commercial |
$228.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.06
|
| Rate for Payer: Priority Health SBD |
$169.25
|
| Rate for Payer: UMR Bronson Commercial |
$118.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$201.49
|
|
|
HC OB SURGERY ADDL 15 MIN
|
Facility
|
OP
|
$268.65
|
|
| Hospital Charge Code |
36000104
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$99.40 |
| Max. Negotiated Rate |
$241.78 |
| Rate for Payer: Aetna American Axle |
$174.62
|
| Rate for Payer: Aetna Commercial |
$228.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.62
|
| Rate for Payer: BCBS Complete |
$107.46
|
| Rate for Payer: Cash Price |
$214.92
|
| Rate for Payer: Cofinity Commercial |
$188.06
|
| Rate for Payer: Cofinity Commercial |
$231.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.92
|
| Rate for Payer: Healthscope Commercial |
$241.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$188.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$201.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$228.35
|
| Rate for Payer: PHP Commercial |
$228.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.06
|
| Rate for Payer: Priority Health SBD |
$169.25
|
| Rate for Payer: UMR Bronson Commercial |
$99.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$201.49
|
|
|
HC OB SURGERY INITIAL 30 MIN
|
Facility
|
IP
|
$1,425.06
|
|
| Hospital Charge Code |
36000077
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$627.03 |
| Max. Negotiated Rate |
$1,282.55 |
| Rate for Payer: Aetna American Axle |
$926.29
|
| Rate for Payer: Aetna Commercial |
$1,211.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$926.29
|
| Rate for Payer: Cash Price |
$1,140.05
|
| Rate for Payer: Cofinity Commercial |
$1,225.55
|
| Rate for Payer: Cofinity Commercial |
$997.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,140.05
|
| Rate for Payer: Healthscope Commercial |
$1,282.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$997.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,068.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,211.30
|
| Rate for Payer: PHP Commercial |
$1,211.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$997.54
|
| Rate for Payer: Priority Health SBD |
$897.79
|
| Rate for Payer: UMR Bronson Commercial |
$627.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,068.80
|
|
|
HC OB SURGERY INITIAL 30 MIN
|
Facility
|
OP
|
$1,425.06
|
|
| Hospital Charge Code |
36000077
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$527.27 |
| Max. Negotiated Rate |
$1,282.55 |
| Rate for Payer: Aetna American Axle |
$926.29
|
| Rate for Payer: Aetna Commercial |
$1,211.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$926.29
|
| Rate for Payer: BCBS Complete |
$570.02
|
| Rate for Payer: Cash Price |
$1,140.05
|
| Rate for Payer: Cofinity Commercial |
$1,225.55
|
| Rate for Payer: Cofinity Commercial |
$997.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,140.05
|
| Rate for Payer: Healthscope Commercial |
$1,282.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$997.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,068.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,211.30
|
| Rate for Payer: PHP Commercial |
$1,211.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$997.54
|
| Rate for Payer: Priority Health SBD |
$897.79
|
| Rate for Payer: UMR Bronson Commercial |
$527.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,068.80
|
|
|
HC OB VAC DEL KIT DISP (OB)
|
Facility
|
OP
|
$252.72
|
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$93.51 |
| Max. Negotiated Rate |
$227.45 |
| Rate for Payer: Aetna American Axle |
$164.27
|
| Rate for Payer: Aetna Commercial |
$214.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.27
|
| Rate for Payer: BCBS Complete |
$101.09
|
| Rate for Payer: Cash Price |
$202.18
|
| Rate for Payer: Cofinity Commercial |
$176.90
|
| Rate for Payer: Cofinity Commercial |
$217.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$202.18
|
| Rate for Payer: Healthscope Commercial |
$227.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$176.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$189.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$214.81
|
| Rate for Payer: PHP Commercial |
$214.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.90
|
| Rate for Payer: Priority Health SBD |
$159.21
|
| Rate for Payer: UMR Bronson Commercial |
$93.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$189.54
|
|
|
HC OB VAC DEL KIT DISP (OB)
|
Facility
|
IP
|
$252.72
|
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$111.20 |
| Max. Negotiated Rate |
$227.45 |
| Rate for Payer: Aetna American Axle |
$164.27
|
| Rate for Payer: Aetna Commercial |
$214.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.27
|
| Rate for Payer: Cash Price |
$202.18
|
| Rate for Payer: Cofinity Commercial |
$176.90
|
| Rate for Payer: Cofinity Commercial |
$217.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$202.18
|
| Rate for Payer: Healthscope Commercial |
$227.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$176.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$189.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$214.81
|
| Rate for Payer: PHP Commercial |
$214.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.90
|
| Rate for Payer: Priority Health SBD |
$159.21
|
| Rate for Payer: UMR Bronson Commercial |
$111.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$189.54
|
|
|
HC OCCLUSION CATH
|
Facility
|
IP
|
$4,661.40
|
|
|
Service Code
|
HCPCS C2628
|
| Hospital Charge Code |
27200344
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,051.02 |
| Max. Negotiated Rate |
$4,195.26 |
| Rate for Payer: Aetna American Axle |
$3,029.91
|
| Rate for Payer: Aetna Commercial |
$3,962.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,029.91
|
| Rate for Payer: Cash Price |
$3,729.12
|
| Rate for Payer: Cofinity Commercial |
$3,262.98
|
| Rate for Payer: Cofinity Commercial |
$4,008.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,729.12
|
| Rate for Payer: Healthscope Commercial |
$4,195.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,262.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,496.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,962.19
|
| Rate for Payer: PHP Commercial |
$3,962.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,262.98
|
| Rate for Payer: Priority Health SBD |
$2,936.68
|
| Rate for Payer: UMR Bronson Commercial |
$2,051.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,496.05
|
|
|
HC OCCLUSION CATH
|
Facility
|
OP
|
$4,661.40
|
|
|
Service Code
|
HCPCS C2628
|
| Hospital Charge Code |
27200344
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,724.72 |
| Max. Negotiated Rate |
$4,195.26 |
| Rate for Payer: Aetna American Axle |
$3,029.91
|
| Rate for Payer: Aetna Commercial |
$3,962.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,029.91
|
| Rate for Payer: BCBS Complete |
$1,864.56
|
| Rate for Payer: Cash Price |
$3,729.12
|
| Rate for Payer: Cofinity Commercial |
$3,262.98
|
| Rate for Payer: Cofinity Commercial |
$4,008.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,729.12
|
| Rate for Payer: Healthscope Commercial |
$4,195.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,262.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,496.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,962.19
|
| Rate for Payer: PHP Commercial |
$3,962.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,262.98
|
| Rate for Payer: Priority Health SBD |
$2,936.68
|
| Rate for Payer: UMR Bronson Commercial |
$1,724.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,496.05
|
|
|
HC OCCULT BLOOD OTHER SOURCES
|
Facility
|
IP
|
$30.10
|
|
|
Service Code
|
CPT 82271
|
| Hospital Charge Code |
30100122
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.24 |
| Max. Negotiated Rate |
$27.09 |
| Rate for Payer: Aetna American Axle |
$19.56
|
| Rate for Payer: Aetna Commercial |
$25.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.56
|
| Rate for Payer: Cash Price |
$24.08
|
| Rate for Payer: Cofinity Commercial |
$21.07
|
| Rate for Payer: Cofinity Commercial |
$25.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.08
|
| Rate for Payer: Healthscope Commercial |
$27.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.58
|
| Rate for Payer: PHP Commercial |
$25.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.07
|
| Rate for Payer: Priority Health SBD |
$18.96
|
| Rate for Payer: UMR Bronson Commercial |
$13.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.58
|
|
|
HC OCCULT BLOOD OTHER SOURCES
|
Facility
|
OP
|
$30.10
|
|
|
Service Code
|
CPT 82271
|
| Hospital Charge Code |
30100122
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.84 |
| Max. Negotiated Rate |
$27.09 |
| Rate for Payer: Aetna American Axle |
$19.56
|
| Rate for Payer: Aetna Commercial |
$25.58
|
| Rate for Payer: Aetna Medicare |
$5.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.65
|
| Rate for Payer: BCBS Complete |
$3.06
|
| Rate for Payer: BCBS MAPPO |
$5.32
|
| Rate for Payer: BCBS Trust/PPO |
$4.78
|
| Rate for Payer: BCN Medicare Advantage |
$5.32
|
| Rate for Payer: Cash Price |
$24.08
|
| Rate for Payer: Cash Price |
$24.08
|
| Rate for Payer: Cofinity Commercial |
$21.07
|
| Rate for Payer: Cofinity Commercial |
$25.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.32
|
| Rate for Payer: Healthscope Commercial |
$27.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.58
|
| Rate for Payer: Mclaren Medicaid |
$2.91
|
| Rate for Payer: Mclaren Medicare |
$5.32
|
| Rate for Payer: Meridian Medicaid |
$3.06
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.58
|
| Rate for Payer: PACE Medicare |
$5.05
|
| Rate for Payer: PACE SWMI |
$5.32
|
| Rate for Payer: PHP Commercial |
$25.58
|
| Rate for Payer: PHP Medicare Advantage |
$5.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.55
|
| Rate for Payer: Priority Health Medicare |
$5.32
|
| Rate for Payer: Priority Health Narrow Network |
$2.84
|
| Rate for Payer: Priority Health SBD |
$18.96
|
| Rate for Payer: Railroad Medicare Medicare |
$5.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.38
|
| Rate for Payer: UHC Core |
$5.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.32
|
| Rate for Payer: UHC Exchange |
$5.32
|
| Rate for Payer: UHC Medicare Advantage |
$5.48
|
| Rate for Payer: UMR Bronson Commercial |
$11.14
|
| Rate for Payer: VA VA |
$5.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.58
|
|
|
HC OCT CATHETER
|
Facility
|
IP
|
$2,529.70
|
|
|
Service Code
|
HCPCS C1753
|
| Hospital Charge Code |
27200243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,113.07 |
| Max. Negotiated Rate |
$2,276.73 |
| Rate for Payer: Aetna American Axle |
$1,644.30
|
| Rate for Payer: Aetna Commercial |
$2,150.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,644.30
|
| Rate for Payer: Cash Price |
$2,023.76
|
| Rate for Payer: Cofinity Commercial |
$1,770.79
|
| Rate for Payer: Cofinity Commercial |
$2,175.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,023.76
|
| Rate for Payer: Healthscope Commercial |
$2,276.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,770.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,897.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,150.24
|
| Rate for Payer: PHP Commercial |
$2,150.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,770.79
|
| Rate for Payer: Priority Health SBD |
$1,593.71
|
| Rate for Payer: UMR Bronson Commercial |
$1,113.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,897.28
|
|
