|
HC GRAFIX PRIME (16 MM) DISC PER SQ CM
|
Facility
|
IP
|
$787.95
|
|
|
Service Code
|
HCPCS Q4133
|
| Hospital Charge Code |
63600158
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$346.70 |
| Max. Negotiated Rate |
$709.15 |
| Rate for Payer: Aetna American Axle |
$512.17
|
| Rate for Payer: Aetna Commercial |
$669.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$512.17
|
| Rate for Payer: Cash Price |
$630.36
|
| Rate for Payer: Cofinity Advantage |
$551.57
|
| Rate for Payer: Cofinity Commercial |
$677.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$630.36
|
| Rate for Payer: Healthscope Commercial |
$709.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$551.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$590.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$669.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$590.96
|
| Rate for Payer: PHP Commercial |
$669.76
|
| Rate for Payer: Priority Health SBD |
$496.41
|
| Rate for Payer: UMR Bronson Commercial |
$346.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$590.96
|
|
|
HC GRAFIX PRIME (16 MM) DISC PER SQ CM
|
Facility
|
OP
|
$787.95
|
|
|
Service Code
|
HCPCS Q4133
|
| Hospital Charge Code |
63600158
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.85 |
| Max. Negotiated Rate |
$790.24 |
| Rate for Payer: Aetna American Axle |
$512.17
|
| Rate for Payer: Aetna Commercial |
$669.76
|
| Rate for Payer: Aetna Medicare |
$128.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$512.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.00
|
| Rate for Payer: BCBS Complete |
$68.10
|
| Rate for Payer: BCBS MAPPO |
$124.00
|
| Rate for Payer: BCBS Trust/PPO |
$790.24
|
| Rate for Payer: BCN Commercial |
$790.24
|
| Rate for Payer: BCN Medicare Advantage |
$124.00
|
| Rate for Payer: Cash Price |
$630.36
|
| Rate for Payer: Cash Price |
$630.36
|
| Rate for Payer: Cofinity Advantage |
$551.57
|
| Rate for Payer: Cofinity Commercial |
$677.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$630.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.00
|
| Rate for Payer: Healthscope Commercial |
$709.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$551.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$590.96
|
| Rate for Payer: Mclaren Medicaid |
$124.00
|
| Rate for Payer: Mclaren Medicare |
$124.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.20
|
| Rate for Payer: Meridian Medicaid |
$130.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$669.76
|
| Rate for Payer: Nomi Health Commercial |
$372.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$590.96
|
| Rate for Payer: PACE Medicare |
$117.80
|
| Rate for Payer: PACE SWMI |
$124.00
|
| Rate for Payer: PHP Commercial |
$669.76
|
| Rate for Payer: PHP Medicare Advantage |
$124.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$401.00
|
| Rate for Payer: Priority Health Medicare |
$124.00
|
| Rate for Payer: Priority Health SBD |
$496.41
|
| Rate for Payer: Priority Health Tiered Network |
$320.80
|
| Rate for Payer: Railroad Medicare Medicare |
$124.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.78
|
| Rate for Payer: UHC Core |
$209.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$124.00
|
| Rate for Payer: UHC Exchange |
$209.78
|
| Rate for Payer: UHC Medicaid |
$64.85
|
| Rate for Payer: UHCCP Medicaid |
$64.85
|
| Rate for Payer: UMR Bronson Commercial |
$291.54
|
| Rate for Payer: VA VA |
$124.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$590.96
|
|
|
HC GRAFIX PRIME 2 X 3 PER SQ CM
|
Facility
|
IP
|
$486.40
|
|
|
Service Code
|
HCPCS Q4133
|
| Hospital Charge Code |
63600160
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$214.02 |
| Max. Negotiated Rate |
$437.76 |
| Rate for Payer: Aetna American Axle |
$316.16
|
| Rate for Payer: Aetna Commercial |
$413.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$316.16
|
| Rate for Payer: Cash Price |
$389.12
|
| Rate for Payer: Cofinity Advantage |
$340.48
|
| Rate for Payer: Cofinity Commercial |
$418.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$389.12
|
| Rate for Payer: Healthscope Commercial |
$437.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$340.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$364.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$413.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$364.80
|
| Rate for Payer: PHP Commercial |
$413.44
|
| Rate for Payer: Priority Health SBD |
$306.43
|
| Rate for Payer: UMR Bronson Commercial |
$214.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$364.80
|
|
|
HC GRAFIX PRIME 2 X 3 PER SQ CM
|
Facility
|
OP
|
$486.40
|
|
|
Service Code
|
HCPCS Q4133
|
| Hospital Charge Code |
63600160
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.85 |
| Max. Negotiated Rate |
$790.24 |
| Rate for Payer: Aetna American Axle |
$316.16
|
| Rate for Payer: Aetna Commercial |
$413.44
|
| Rate for Payer: Aetna Medicare |
$128.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$316.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.00
|
| Rate for Payer: BCBS Complete |
$68.10
|
| Rate for Payer: BCBS MAPPO |
$124.00
|
| Rate for Payer: BCBS Trust/PPO |
$790.24
|
| Rate for Payer: BCN Commercial |
$790.24
|
| Rate for Payer: BCN Medicare Advantage |
$124.00
|
| Rate for Payer: Cash Price |
$389.12
|
| Rate for Payer: Cash Price |
$389.12
|
| Rate for Payer: Cofinity Advantage |
$340.48
|
| Rate for Payer: Cofinity Commercial |
$418.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$389.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.00
|
| Rate for Payer: Healthscope Commercial |
$437.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$340.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$364.80
|
| Rate for Payer: Mclaren Medicaid |
$124.00
|
| Rate for Payer: Mclaren Medicare |
$124.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.20
|
| Rate for Payer: Meridian Medicaid |
$130.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$413.44
|
| Rate for Payer: Nomi Health Commercial |
$372.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$364.80
|
| Rate for Payer: PACE Medicare |
$117.80
|
| Rate for Payer: PACE SWMI |
$124.00
|
| Rate for Payer: PHP Commercial |
$413.44
|
| Rate for Payer: PHP Medicare Advantage |
$124.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$401.00
|
| Rate for Payer: Priority Health Medicare |
$124.00
|
| Rate for Payer: Priority Health SBD |
$306.43
|
| Rate for Payer: Priority Health Tiered Network |
$320.80
|
| Rate for Payer: Railroad Medicare Medicare |
$124.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.78
|
| Rate for Payer: UHC Core |
$209.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$124.00
|
| Rate for Payer: UHC Exchange |
$209.78
|
| Rate for Payer: UHC Medicaid |
$64.85
|
| Rate for Payer: UHCCP Medicaid |
$64.85
|
| Rate for Payer: UMR Bronson Commercial |
$179.97
|
| Rate for Payer: VA VA |
$124.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$364.80
|
|
|
HC GRAFIX PRIME 3 X 3 PER SQ CM
|
Facility
|
OP
|
$343.19
|
|
|
Service Code
|
HCPCS Q4133
|
| Hospital Charge Code |
63600244
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.85 |
| Max. Negotiated Rate |
$790.24 |
| Rate for Payer: Aetna American Axle |
$223.07
|
| Rate for Payer: Aetna Commercial |
$291.71
|
| Rate for Payer: Aetna Medicare |
$128.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$223.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.00
|
| Rate for Payer: BCBS Complete |
$68.10
|
| Rate for Payer: BCBS MAPPO |
$124.00
|
| Rate for Payer: BCBS Trust/PPO |
$790.24
|
| Rate for Payer: BCN Commercial |
$790.24
|
| Rate for Payer: BCN Medicare Advantage |
$124.00
|
| Rate for Payer: Cash Price |
$274.55
|
| Rate for Payer: Cash Price |
$274.55
|
| Rate for Payer: Cofinity Advantage |
$240.23
|
| Rate for Payer: Cofinity Commercial |
$295.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$274.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.00
|
| Rate for Payer: Healthscope Commercial |
$308.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$240.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$257.39
|
| Rate for Payer: Mclaren Medicaid |
$124.00
|
| Rate for Payer: Mclaren Medicare |
$124.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.20
|
| Rate for Payer: Meridian Medicaid |
$130.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$291.71
|
| Rate for Payer: Nomi Health Commercial |
$372.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$257.39
|
| Rate for Payer: PACE Medicare |
$117.80
|
| Rate for Payer: PACE SWMI |
$124.00
|
| Rate for Payer: PHP Commercial |
$291.71
|
| Rate for Payer: PHP Medicare Advantage |
$124.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$401.00
|
| Rate for Payer: Priority Health Medicare |
$124.00
|
| Rate for Payer: Priority Health SBD |
$216.21
|
| Rate for Payer: Priority Health Tiered Network |
$320.80
|
| Rate for Payer: Railroad Medicare Medicare |
$124.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.78
|
| Rate for Payer: UHC Core |
$209.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$124.00
|
| Rate for Payer: UHC Exchange |
$209.78
|
| Rate for Payer: UHC Medicaid |
$64.85
|
| Rate for Payer: UHCCP Medicaid |
$64.85
|
| Rate for Payer: UMR Bronson Commercial |
$126.98
|
| Rate for Payer: VA VA |
$124.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$257.39
|
|
|
HC GRAFIX PRIME 3 X 3 PER SQ CM
|
Facility
|
IP
|
$343.19
|
|
|
Service Code
|
HCPCS Q4133
|
| Hospital Charge Code |
63600244
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$151.00 |
| Max. Negotiated Rate |
$308.87 |
| Rate for Payer: Aetna American Axle |
$223.07
|
| Rate for Payer: Aetna Commercial |
$291.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$223.07
|
| Rate for Payer: Cash Price |
$274.55
|
| Rate for Payer: Cofinity Advantage |
$240.23
|
| Rate for Payer: Cofinity Commercial |
$295.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$274.55
|
| Rate for Payer: Healthscope Commercial |
$308.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$240.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$257.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$291.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$257.39
|
| Rate for Payer: PHP Commercial |
$291.71
|
| Rate for Payer: Priority Health SBD |
$216.21
|
| Rate for Payer: UMR Bronson Commercial |
$151.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$257.39
|
|
|
HC GRAFIX PRIME 3 X 4 PER SQ CM
|
Facility
|
OP
|
$283.54
|
|
|
Service Code
|
HCPCS Q4133
|
| Hospital Charge Code |
63600161
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.85 |
| Max. Negotiated Rate |
$790.24 |
| Rate for Payer: Aetna American Axle |
$184.30
|
| Rate for Payer: Aetna Commercial |
$241.01
|
| Rate for Payer: Aetna Medicare |
$128.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.00
|
| Rate for Payer: BCBS Complete |
$68.10
|
| Rate for Payer: BCBS MAPPO |
$124.00
|
| Rate for Payer: BCBS Trust/PPO |
$790.24
|
| Rate for Payer: BCN Commercial |
$790.24
|
| Rate for Payer: BCN Medicare Advantage |
$124.00
|
| Rate for Payer: Cash Price |
$226.83
|
| Rate for Payer: Cash Price |
$226.83
|
| Rate for Payer: Cofinity Advantage |
$198.48
|
| Rate for Payer: Cofinity Commercial |
$243.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$226.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.00
|
| Rate for Payer: Healthscope Commercial |
$255.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$198.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$212.66
|
| Rate for Payer: Mclaren Medicaid |
$124.00
|
| Rate for Payer: Mclaren Medicare |
$124.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.20
|
| Rate for Payer: Meridian Medicaid |
$130.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.01
|
| Rate for Payer: Nomi Health Commercial |
$372.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$212.66
|
| Rate for Payer: PACE Medicare |
$117.80
|
| Rate for Payer: PACE SWMI |
$124.00
|
| Rate for Payer: PHP Commercial |
$241.01
|
| Rate for Payer: PHP Medicare Advantage |
$124.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$401.00
|
| Rate for Payer: Priority Health Medicare |
$124.00
|
| Rate for Payer: Priority Health SBD |
$178.63
|
| Rate for Payer: Priority Health Tiered Network |
$320.80
|
| Rate for Payer: Railroad Medicare Medicare |
$124.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.78
|
| Rate for Payer: UHC Core |
$209.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$124.00
|
| Rate for Payer: UHC Exchange |
$209.78
|
| Rate for Payer: UHC Medicaid |
$64.85
|
| Rate for Payer: UHCCP Medicaid |
$64.85
|
| Rate for Payer: UMR Bronson Commercial |
$104.91
|
| Rate for Payer: VA VA |
$124.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$212.66
|
|
|
HC GRAFIX PRIME 3 X 4 PER SQ CM
|
Facility
|
IP
|
$283.54
|
|
|
Service Code
|
HCPCS Q4133
|
| Hospital Charge Code |
63600161
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$124.76 |
| Max. Negotiated Rate |
$255.19 |
| Rate for Payer: Aetna American Axle |
$184.30
|
| Rate for Payer: Aetna Commercial |
$241.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.30
|
| Rate for Payer: Cash Price |
$226.83
|
| Rate for Payer: Cofinity Advantage |
$198.48
|
| Rate for Payer: Cofinity Commercial |
$243.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$226.83
|
| Rate for Payer: Healthscope Commercial |
$255.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$198.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$212.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$212.66
|
| Rate for Payer: PHP Commercial |
$241.01
|
| Rate for Payer: Priority Health SBD |
$178.63
|
| Rate for Payer: UMR Bronson Commercial |
$124.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$212.66
|
|
|
HC GRAFT EPIDERMAL 1ST 100 SQ CM FEET, HANDS, FACE
|
Facility
|
IP
|
$2,507.96
|
|
|
Service Code
|
CPT 15115
|
| Hospital Charge Code |
76100067
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,103.50 |
| Max. Negotiated Rate |
$2,257.16 |
| Rate for Payer: Aetna American Axle |
$1,630.17
|
| Rate for Payer: Aetna Commercial |
$2,131.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,630.17
|
| Rate for Payer: Cash Price |
$2,006.37
|
| Rate for Payer: Cofinity Advantage |
$1,755.57
|
| Rate for Payer: Cofinity Commercial |
$2,156.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,006.37
|
| Rate for Payer: Healthscope Commercial |
$2,257.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,755.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,880.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,131.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,880.97
|
| Rate for Payer: PHP Commercial |
$2,131.77
|
| Rate for Payer: Priority Health SBD |
$1,580.01
|
| Rate for Payer: UMR Bronson Commercial |
$1,103.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,880.97
|
|
|
HC GRAFT EPIDERMAL 1ST 100 SQ CM FEET, HANDS, FACE
|
Facility
|
OP
|
$2,507.96
|
|
|
Service Code
|
CPT 15115
|
| Hospital Charge Code |
76100067
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$927.95 |
| Max. Negotiated Rate |
$6,648.46 |
| Rate for Payer: Aetna American Axle |
$1,630.17
|
| Rate for Payer: Aetna Commercial |
$2,131.77
|
| Rate for Payer: Aetna Medicare |
$2,138.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,630.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,569.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,569.82
|
| Rate for Payer: BCBS Complete |
$1,129.08
|
| Rate for Payer: BCBS MAPPO |
$2,055.86
|
| Rate for Payer: BCBS Trust/PPO |
$1,693.74
|
| Rate for Payer: BCN Commercial |
$1,693.74
|
| Rate for Payer: BCN Medicare Advantage |
$2,055.86
|
| Rate for Payer: Cash Price |
$2,006.37
|
| Rate for Payer: Cash Price |
$2,006.37
|
| Rate for Payer: Cash Price |
$2,006.37
|
| Rate for Payer: Cofinity Advantage |
$1,755.57
|
| Rate for Payer: Cofinity Commercial |
$2,156.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,006.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,055.86
|
| Rate for Payer: Healthscope Commercial |
$2,257.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,755.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,880.97
|
| Rate for Payer: Mclaren Medicaid |
$2,055.86
|
| Rate for Payer: Mclaren Medicare |
$2,055.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,158.65
|
| Rate for Payer: Meridian Medicaid |
$2,158.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,364.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,261.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,131.77
|
| Rate for Payer: Nomi Health Commercial |
$6,167.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,880.97
|
| Rate for Payer: PACE Medicare |
$1,953.07
|
| Rate for Payer: PACE SWMI |
$2,055.86
|
| Rate for Payer: PHP Commercial |
$2,131.77
|
| Rate for Payer: PHP Medicare Advantage |
$2,055.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,075.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,648.46
|
| Rate for Payer: Priority Health Medicare |
$2,055.86
|
| Rate for Payer: Priority Health SBD |
$1,580.01
|
| Rate for Payer: Priority Health Tiered Network |
$5,318.77
|
| Rate for Payer: Railroad Medicare Medicare |
$2,055.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,630.17
|
| Rate for Payer: UHC Core |
$1,306.65
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,055.86
|
| Rate for Payer: UHC Exchange |
$985.63
|
| Rate for Payer: UHC Medicaid |
$1,075.21
|
| Rate for Payer: UHCCP Medicaid |
$1,075.21
|
| Rate for Payer: UMR Bronson Commercial |
$927.95
|
| Rate for Payer: VA VA |
$2,055.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,880.97
|
|
|
HC GRAFT EPIDERMAL 1ST 100 SQ CM LEGS, ARMS, TRUNK
|
Facility
|
IP
|
$3,283.73
|
|
|
Service Code
|
CPT 15110
|
| Hospital Charge Code |
76100066
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,444.84 |
| Max. Negotiated Rate |
$2,955.36 |
| Rate for Payer: Aetna American Axle |
$2,134.42
|
| Rate for Payer: Aetna Commercial |
$2,791.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,134.42
|
| Rate for Payer: Cash Price |
$2,626.98
|
| Rate for Payer: Cofinity Advantage |
$2,298.61
|
| Rate for Payer: Cofinity Commercial |
$2,824.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,626.98
|
| Rate for Payer: Healthscope Commercial |
$2,955.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,298.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,462.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,791.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,462.80
|
| Rate for Payer: PHP Commercial |
$2,791.17
|
| Rate for Payer: Priority Health SBD |
$2,068.75
|
| Rate for Payer: UMR Bronson Commercial |
$1,444.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,462.80
|
|
|
HC GRAFT EPIDERMAL 1ST 100 SQ CM LEGS, ARMS, TRUNK
|
Facility
|
OP
|
$3,283.73
|
|
|
Service Code
|
CPT 15110
|
| Hospital Charge Code |
76100066
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,075.21 |
| Max. Negotiated Rate |
$6,648.46 |
| Rate for Payer: Aetna American Axle |
$2,134.42
|
| Rate for Payer: Aetna Commercial |
$2,791.17
|
| Rate for Payer: Aetna Medicare |
$2,138.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,134.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,569.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,569.82
|
| Rate for Payer: BCBS Complete |
$1,129.08
|
| Rate for Payer: BCBS MAPPO |
$2,055.86
|
| Rate for Payer: BCBS Trust/PPO |
$1,236.67
|
| Rate for Payer: BCN Commercial |
$1,236.67
|
| Rate for Payer: BCN Medicare Advantage |
$2,055.86
|
| Rate for Payer: Cash Price |
$2,626.98
|
| Rate for Payer: Cash Price |
$2,626.98
|
| Rate for Payer: Cash Price |
$2,626.98
|
| Rate for Payer: Cofinity Advantage |
$2,298.61
|
| Rate for Payer: Cofinity Commercial |
$2,824.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,626.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,055.86
|
| Rate for Payer: Healthscope Commercial |
$2,955.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,298.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,462.80
|
| Rate for Payer: Mclaren Medicaid |
$2,055.86
|
| Rate for Payer: Mclaren Medicare |
$2,055.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,158.65
|
| Rate for Payer: Meridian Medicaid |
$2,158.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,364.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,261.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,791.17
|
| Rate for Payer: Nomi Health Commercial |
$6,167.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,462.80
|
| Rate for Payer: PACE Medicare |
$1,953.07
|
| Rate for Payer: PACE SWMI |
$2,055.86
|
| Rate for Payer: PHP Commercial |
$2,791.17
|
| Rate for Payer: PHP Medicare Advantage |
$2,055.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,075.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,648.46
|
| Rate for Payer: Priority Health Medicare |
$2,055.86
|
| Rate for Payer: Priority Health SBD |
$2,068.75
|
| Rate for Payer: Priority Health Tiered Network |
$5,318.77
|
| Rate for Payer: Railroad Medicare Medicare |
$2,055.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,134.42
|
| Rate for Payer: UHC Core |
$1,710.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,055.86
|
| Rate for Payer: UHC Exchange |
$1,290.51
|
| Rate for Payer: UHC Medicaid |
$1,075.21
|
| Rate for Payer: UHCCP Medicaid |
$1,075.21
|
| Rate for Payer: UMR Bronson Commercial |
$1,214.98
|
| Rate for Payer: VA VA |
$2,055.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,462.80
|
|
|
HC GRAM STAIN
|
Facility
|
IP
|
$52.34
|
|
|
Service Code
|
CPT 87205
|
| Hospital Charge Code |
30600104
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$23.03 |
| Max. Negotiated Rate |
$47.11 |
| Rate for Payer: Aetna American Axle |
$34.02
|
| Rate for Payer: Aetna Commercial |
$44.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.02
|
| Rate for Payer: Cash Price |
$41.87
|
| Rate for Payer: Cofinity Advantage |
$36.64
|
| Rate for Payer: Cofinity Commercial |
$45.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.87
|
| Rate for Payer: Healthscope Commercial |
$47.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$36.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.26
|
| Rate for Payer: PHP Commercial |
$44.49
|
| Rate for Payer: Priority Health SBD |
$32.97
|
| Rate for Payer: UMR Bronson Commercial |
$23.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.26
|
|
|
HC GRAM STAIN
|
Facility
|
OP
|
$52.34
|
|
|
Service Code
|
CPT 87205
|
| Hospital Charge Code |
30600104
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.23 |
| Max. Negotiated Rate |
$47.11 |
| Rate for Payer: Aetna American Axle |
$34.02
|
| Rate for Payer: Aetna Commercial |
$44.49
|
| Rate for Payer: Aetna Medicare |
$4.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.34
|
| Rate for Payer: BCBS Complete |
$2.35
|
| Rate for Payer: BCBS MAPPO |
$4.27
|
| Rate for Payer: BCBS Trust/PPO |
$4.93
|
| Rate for Payer: BCN Commercial |
$4.93
|
| Rate for Payer: BCN Medicare Advantage |
$4.27
|
| Rate for Payer: Cash Price |
$41.87
|
| Rate for Payer: Cash Price |
$41.87
|
| Rate for Payer: Cofinity Advantage |
$36.64
|
| Rate for Payer: Cofinity Commercial |
$45.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.27
|
| Rate for Payer: Healthscope Commercial |
$47.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$36.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.26
|
| Rate for Payer: Mclaren Medicaid |
$4.27
|
| Rate for Payer: Mclaren Medicare |
$4.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.48
|
| Rate for Payer: Meridian Medicaid |
$4.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.49
|
| Rate for Payer: Nomi Health Commercial |
$6.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.26
|
| Rate for Payer: PACE Medicare |
$4.06
|
| Rate for Payer: PACE SWMI |
$4.27
|
| Rate for Payer: PHP Commercial |
$44.49
|
| Rate for Payer: PHP Medicare Advantage |
$4.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4.27
|
| Rate for Payer: Priority Health Medicare |
$4.27
|
| Rate for Payer: Priority Health SBD |
$32.97
|
| Rate for Payer: Priority Health Tiered Network |
$3.42
|
| Rate for Payer: Railroad Medicare Medicare |
$4.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.41
|
| Rate for Payer: UHC Core |
$6.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4.27
|
| Rate for Payer: UHC Exchange |
$6.41
|
| Rate for Payer: UHC Medicaid |
$2.23
|
| Rate for Payer: UHCCP Medicaid |
$2.23
|
| Rate for Payer: UMR Bronson Commercial |
$19.37
|
| Rate for Payer: VA VA |
$4.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.26
|
|
|
HC GRANULOCYTES
|
Facility
|
IP
|
$1,964.28
|
|
|
Service Code
|
HCPCS P9050
|
| Hospital Charge Code |
39000057
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$864.28 |
| Max. Negotiated Rate |
$1,767.85 |
| Rate for Payer: Aetna American Axle |
$1,276.78
|
| Rate for Payer: Aetna Commercial |
$1,669.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,276.78
|
| Rate for Payer: Cash Price |
$1,571.42
|
| Rate for Payer: Cofinity Advantage |
$1,375.00
|
| Rate for Payer: Cofinity Commercial |
$1,689.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,571.42
|
| Rate for Payer: Healthscope Commercial |
$1,767.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,375.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,473.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,669.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,473.21
|
| Rate for Payer: PHP Commercial |
$1,669.64
|
| Rate for Payer: Priority Health SBD |
$1,237.50
|
| Rate for Payer: UMR Bronson Commercial |
$864.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,473.21
|
|
|
HC GRANULOCYTES
|
Facility
|
OP
|
$1,964.28
|
|
|
Service Code
|
HCPCS P9050
|
| Hospital Charge Code |
39000057
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$726.78 |
| Max. Negotiated Rate |
$4,016.84 |
| Rate for Payer: Aetna American Axle |
$1,276.78
|
| Rate for Payer: Aetna Commercial |
$1,669.64
|
| Rate for Payer: Aetna Medicare |
$982.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,276.78
|
| Rate for Payer: BCBS Complete |
$785.71
|
| Rate for Payer: BCBS Trust/PPO |
$4,016.84
|
| Rate for Payer: BCN Commercial |
$4,016.84
|
| Rate for Payer: Cash Price |
$1,571.42
|
| Rate for Payer: Cash Price |
$1,571.42
|
| Rate for Payer: Cofinity Advantage |
$1,375.00
|
| Rate for Payer: Cofinity Commercial |
$1,689.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,571.42
|
| Rate for Payer: Healthscope Commercial |
$1,767.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,375.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,473.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,571.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,669.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,473.21
|
| Rate for Payer: PHP Commercial |
$1,669.64
|
| Rate for Payer: Priority Health SBD |
$1,237.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,276.78
|
| Rate for Payer: UHC Core |
$1,023.39
|
| Rate for Payer: UHC Exchange |
$771.96
|
| Rate for Payer: UMR Bronson Commercial |
$726.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,473.21
|
|
|
HC GRASS ALLERGEN PANEL
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200122
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna American Axle |
$16.84
|
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: BCBS Complete |
$2.87
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$6.04
|
| Rate for Payer: BCN Commercial |
$6.04
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Advantage |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.43
|
| Rate for Payer: Mclaren Medicaid |
$5.22
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$7.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.22
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$16.32
|
| Rate for Payer: Priority Health Tiered Network |
$4.18
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.83
|
| Rate for Payer: UHC Core |
$7.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.22
|
| Rate for Payer: UHC Exchange |
$7.83
|
| Rate for Payer: UHC Medicaid |
$2.73
|
| Rate for Payer: UHCCP Medicaid |
$2.73
|
| Rate for Payer: UMR Bronson Commercial |
$9.58
|
| Rate for Payer: VA VA |
$5.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.43
|
|
|
HC GRASS ALLERGEN PANEL
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200122
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.40 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna American Axle |
$16.84
|
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Advantage |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: Priority Health SBD |
$16.32
|
| Rate for Payer: UMR Bronson Commercial |
$11.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.43
|
|
|
HC GREAT LAKES DISABILITY FILM(EACH)
|
Facility
|
OP
|
$20.00
|
|
| Hospital Charge Code |
32000267
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$7.40 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Aetna American Axle |
$13.00
|
| Rate for Payer: Aetna Commercial |
$17.00
|
| Rate for Payer: Aetna Medicare |
$10.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.00
|
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cofinity Advantage |
$14.00
|
| Rate for Payer: Cofinity Commercial |
$17.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.00
|
| Rate for Payer: Healthscope Commercial |
$18.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.00
|
| Rate for Payer: PHP Commercial |
$17.00
|
| Rate for Payer: Priority Health SBD |
$12.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.00
|
| Rate for Payer: UHC Core |
$10.42
|
| Rate for Payer: UHC Exchange |
$7.86
|
| Rate for Payer: UMR Bronson Commercial |
$7.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.00
|
|
|
HC GREAT LAKES DISABILITY FILM(EACH)
|
Facility
|
IP
|
$20.00
|
|
| Hospital Charge Code |
32000267
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$8.80 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Aetna American Axle |
$13.00
|
| Rate for Payer: Aetna Commercial |
$17.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cofinity Advantage |
$14.00
|
| Rate for Payer: Cofinity Commercial |
$17.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.00
|
| Rate for Payer: Healthscope Commercial |
$18.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.00
|
| Rate for Payer: PHP Commercial |
$17.00
|
| Rate for Payer: Priority Health SBD |
$12.60
|
| Rate for Payer: UMR Bronson Commercial |
$8.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.00
|
|
|
HC GROIN/PSEUDO IMAGING BILATERAL
|
Facility
|
IP
|
$1,472.60
|
|
|
Service Code
|
CPT 93925
|
| Hospital Charge Code |
92100027
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$647.94 |
| Max. Negotiated Rate |
$1,325.34 |
| Rate for Payer: Aetna American Axle |
$957.19
|
| Rate for Payer: Aetna Commercial |
$1,251.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$957.19
|
| Rate for Payer: Cash Price |
$1,178.08
|
| Rate for Payer: Cofinity Advantage |
$1,030.82
|
| Rate for Payer: Cofinity Commercial |
$1,266.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,178.08
|
| Rate for Payer: Healthscope Commercial |
$1,325.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,030.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,104.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,251.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,104.45
|
| Rate for Payer: PHP Commercial |
$1,251.71
|
| Rate for Payer: Priority Health SBD |
$927.74
|
| Rate for Payer: UMR Bronson Commercial |
$647.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,104.45
|
|
|
HC GROIN/PSEUDO IMAGING BILATERAL
|
Facility
|
OP
|
$1,472.60
|
|
|
Service Code
|
CPT 93925
|
| Hospital Charge Code |
92100027
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$124.34 |
| Max. Negotiated Rate |
$1,325.34 |
| Rate for Payer: Aetna American Axle |
$957.19
|
| Rate for Payer: Aetna Commercial |
$1,251.71
|
| Rate for Payer: Aetna Medicare |
$247.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$957.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$297.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$297.18
|
| Rate for Payer: BCBS Complete |
$130.57
|
| Rate for Payer: BCBS MAPPO |
$237.74
|
| Rate for Payer: BCBS Trust/PPO |
$842.50
|
| Rate for Payer: BCN Commercial |
$842.50
|
| Rate for Payer: BCN Medicare Advantage |
$237.74
|
| Rate for Payer: Cash Price |
$1,178.08
|
| Rate for Payer: Cash Price |
$1,178.08
|
| Rate for Payer: Cofinity Advantage |
$1,030.82
|
| Rate for Payer: Cofinity Commercial |
$1,266.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,178.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$237.74
|
| Rate for Payer: Healthscope Commercial |
$1,325.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,030.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,104.45
|
| Rate for Payer: Mclaren Medicaid |
$237.74
|
| Rate for Payer: Mclaren Medicare |
$237.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$249.63
|
| Rate for Payer: Meridian Medicaid |
$249.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$273.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$261.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,251.71
|
| Rate for Payer: Nomi Health Commercial |
$713.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,104.45
|
| Rate for Payer: PACE Medicare |
$225.85
|
| Rate for Payer: PACE SWMI |
$237.74
|
| Rate for Payer: PHP Commercial |
$1,251.71
|
| Rate for Payer: PHP Medicare Advantage |
$237.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$124.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$768.83
|
| Rate for Payer: Priority Health Medicare |
$237.74
|
| Rate for Payer: Priority Health SBD |
$927.74
|
| Rate for Payer: Priority Health Tiered Network |
$615.06
|
| Rate for Payer: Railroad Medicare Medicare |
$237.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$957.19
|
| Rate for Payer: UHC Core |
$767.22
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$237.74
|
| Rate for Payer: UHC Exchange |
$578.73
|
| Rate for Payer: UHC Medicaid |
$124.34
|
| Rate for Payer: UHCCP Medicaid |
$124.34
|
| Rate for Payer: UMR Bronson Commercial |
$544.86
|
| Rate for Payer: VA VA |
$237.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,104.45
|
|
|
HC GROIN/PSEUDO IMAGING (R OR L)
|
Facility
|
OP
|
$940.65
|
|
|
Service Code
|
CPT 93926
|
| Hospital Charge Code |
92100026
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$846.59 |
| Rate for Payer: Aetna American Axle |
$611.42
|
| Rate for Payer: Aetna Commercial |
$799.55
|
| Rate for Payer: Aetna Medicare |
$108.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$611.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$504.38
|
| Rate for Payer: BCN Commercial |
$504.38
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$752.52
|
| Rate for Payer: Cash Price |
$752.52
|
| Rate for Payer: Cofinity Advantage |
$658.46
|
| Rate for Payer: Cofinity Commercial |
$808.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$752.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$846.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$658.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$705.49
|
| Rate for Payer: Mclaren Medicaid |
$104.17
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Medicaid |
$109.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$799.55
|
| Rate for Payer: Nomi Health Commercial |
$312.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$705.49
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$799.55
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$336.87
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health SBD |
$592.61
|
| Rate for Payer: Priority Health Tiered Network |
$269.50
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$611.42
|
| Rate for Payer: UHC Core |
$490.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$369.68
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: UMR Bronson Commercial |
$348.04
|
| Rate for Payer: VA VA |
$104.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$705.49
|
|
|
HC GROIN/PSEUDO IMAGING (R OR L)
|
Facility
|
IP
|
$940.65
|
|
|
Service Code
|
CPT 93926
|
| Hospital Charge Code |
92100026
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$413.89 |
| Max. Negotiated Rate |
$846.59 |
| Rate for Payer: Aetna American Axle |
$611.42
|
| Rate for Payer: Aetna Commercial |
$799.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$611.42
|
| Rate for Payer: Cash Price |
$752.52
|
| Rate for Payer: Cofinity Advantage |
$658.46
|
| Rate for Payer: Cofinity Commercial |
$808.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$752.52
|
| Rate for Payer: Healthscope Commercial |
$846.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$658.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$705.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$799.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$705.49
|
| Rate for Payer: PHP Commercial |
$799.55
|
| Rate for Payer: Priority Health SBD |
$592.61
|
| Rate for Payer: UMR Bronson Commercial |
$413.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$705.49
|
|
|
HC GROSHONG REPAIR KIT
|
Facility
|
OP
|
$473.46
|
|
| Hospital Charge Code |
27200125
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$175.18 |
| Max. Negotiated Rate |
$426.11 |
| Rate for Payer: Aetna American Axle |
$307.75
|
| Rate for Payer: Aetna Commercial |
$402.44
|
| Rate for Payer: Aetna Medicare |
$236.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$307.75
|
| Rate for Payer: BCBS Complete |
$189.38
|
| Rate for Payer: Cash Price |
$378.77
|
| Rate for Payer: Cofinity Advantage |
$331.42
|
| Rate for Payer: Cofinity Commercial |
$407.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$378.77
|
| Rate for Payer: Healthscope Commercial |
$426.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$331.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$355.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$378.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$402.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$355.10
|
| Rate for Payer: PHP Commercial |
$402.44
|
| Rate for Payer: Priority Health SBD |
$298.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$307.75
|
| Rate for Payer: UHC Core |
$246.67
|
| Rate for Payer: UHC Exchange |
$186.07
|
| Rate for Payer: UMR Bronson Commercial |
$175.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$355.10
|
|
