|
HC EO W/O JOINTS CF
|
Facility
|
IP
|
$275.71
|
|
|
Service Code
|
HCPCS L3702
|
| Hospital Charge Code |
27400050
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$121.31 |
| Max. Negotiated Rate |
$248.14 |
| Rate for Payer: Aetna American Axle |
$179.21
|
| Rate for Payer: Aetna Commercial |
$234.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.21
|
| Rate for Payer: Cash Price |
$220.57
|
| Rate for Payer: Cofinity Commercial |
$193.00
|
| Rate for Payer: Cofinity Commercial |
$237.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$193.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.57
|
| Rate for Payer: Healthscope Commercial |
$248.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$193.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.35
|
| Rate for Payer: PHP Commercial |
$234.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.21
|
| Rate for Payer: Priority Health SBD |
$173.70
|
| Rate for Payer: UMR Bronson Commercial |
$121.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.78
|
|
|
HC EP+ABL ARRHYTHMIA
|
Facility
|
OP
|
$17,739.50
|
|
|
Service Code
|
CPT 93653
|
| Hospital Charge Code |
48100091
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$6,563.61 |
| Max. Negotiated Rate |
$67,348.90 |
| Rate for Payer: Aetna American Axle |
$11,530.67
|
| Rate for Payer: Aetna Commercial |
$15,078.58
|
| Rate for Payer: Aetna Medicare |
$24,882.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,530.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29,907.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29,907.33
|
| Rate for Payer: BCBS Complete |
$13,465.47
|
| Rate for Payer: BCBS MAPPO |
$23,925.86
|
| Rate for Payer: BCN Medicare Advantage |
$23,925.86
|
| Rate for Payer: Cash Price |
$14,191.60
|
| Rate for Payer: Cash Price |
$14,191.60
|
| Rate for Payer: Cofinity Commercial |
$15,255.97
|
| Rate for Payer: Cofinity Commercial |
$12,417.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$12,417.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,191.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23,925.86
|
| Rate for Payer: Healthscope Commercial |
$15,965.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12,417.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13,304.62
|
| Rate for Payer: Mclaren Medicaid |
$12,824.26
|
| Rate for Payer: Mclaren Medicare |
$23,925.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25,122.15
|
| Rate for Payer: Meridian Medicaid |
$13,465.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27,514.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15,078.58
|
| Rate for Payer: PACE Medicare |
$22,729.57
|
| Rate for Payer: PACE SWMI |
$23,925.86
|
| Rate for Payer: PHP Commercial |
$15,078.58
|
| Rate for Payer: PHP Medicare Advantage |
$23,925.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$12,824.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,530.67
|
| Rate for Payer: Priority Health Medicare |
$23,925.86
|
| Rate for Payer: Priority Health SBD |
$11,175.89
|
| Rate for Payer: Railroad Medicare Medicare |
$23,925.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67,348.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$23,925.86
|
| Rate for Payer: UHC Exchange |
$45,724.71
|
| Rate for Payer: UHC Medicare Advantage |
$23,925.86
|
| Rate for Payer: UHCCP Medicaid |
$12,824.26
|
| Rate for Payer: UMR Bronson Commercial |
$6,563.61
|
| Rate for Payer: VA VA |
$23,925.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13,304.62
|
|
|
HC EP+ABL ARRHYTHMIA
|
Facility
|
IP
|
$17,739.50
|
|
|
Service Code
|
CPT 93653
|
| Hospital Charge Code |
48100091
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$7,805.38 |
| Max. Negotiated Rate |
$15,965.55 |
| Rate for Payer: Aetna American Axle |
$11,530.67
|
| Rate for Payer: Aetna Commercial |
$15,078.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,530.67
|
| Rate for Payer: Cash Price |
$14,191.60
|
| Rate for Payer: Cofinity Commercial |
$12,417.65
|
| Rate for Payer: Cofinity Commercial |
$15,255.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$12,417.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,191.60
|
| Rate for Payer: Healthscope Commercial |
$15,965.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12,417.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13,304.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15,078.58
|
| Rate for Payer: PHP Commercial |
$15,078.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,530.67
|
| Rate for Payer: Priority Health SBD |
$11,175.89
|
| Rate for Payer: UMR Bronson Commercial |
$7,805.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13,304.62
|
|
|
HC EP+ABL VT
|
Facility
|
OP
|
$17,739.50
|
|
|
Service Code
|
CPT 93654
|
| Hospital Charge Code |
48100092
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$6,563.61 |
| Max. Negotiated Rate |
$67,348.90 |
| Rate for Payer: Aetna American Axle |
$11,530.67
|
| Rate for Payer: Aetna Commercial |
$15,078.58
|
| Rate for Payer: Aetna Medicare |
$24,882.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,530.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29,907.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29,907.33
|
| Rate for Payer: BCBS Complete |
$13,465.47
|
| Rate for Payer: BCBS MAPPO |
$23,925.86
|
| Rate for Payer: BCN Medicare Advantage |
$23,925.86
|
| Rate for Payer: Cash Price |
$14,191.60
|
| Rate for Payer: Cash Price |
$14,191.60
|
| Rate for Payer: Cofinity Commercial |
$15,255.97
|
| Rate for Payer: Cofinity Commercial |
$12,417.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$12,417.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,191.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23,925.86
|
| Rate for Payer: Healthscope Commercial |
$15,965.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12,417.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13,304.62
|
| Rate for Payer: Mclaren Medicaid |
$12,824.26
|
| Rate for Payer: Mclaren Medicare |
$23,925.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25,122.15
|
| Rate for Payer: Meridian Medicaid |
$13,465.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27,514.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15,078.58
|
| Rate for Payer: PACE Medicare |
$22,729.57
|
| Rate for Payer: PACE SWMI |
$23,925.86
|
| Rate for Payer: PHP Commercial |
$15,078.58
|
| Rate for Payer: PHP Medicare Advantage |
$23,925.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$12,824.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,530.67
|
| Rate for Payer: Priority Health Medicare |
$23,925.86
|
| Rate for Payer: Priority Health SBD |
$11,175.89
|
| Rate for Payer: Railroad Medicare Medicare |
$23,925.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67,348.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$23,925.86
|
| Rate for Payer: UHC Exchange |
$45,724.71
|
| Rate for Payer: UHC Medicare Advantage |
$23,925.86
|
| Rate for Payer: UHCCP Medicaid |
$12,824.26
|
| Rate for Payer: UMR Bronson Commercial |
$6,563.61
|
| Rate for Payer: VA VA |
$23,925.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13,304.62
|
|
|
HC EP+ABL VT
|
Facility
|
IP
|
$17,739.50
|
|
|
Service Code
|
CPT 93654
|
| Hospital Charge Code |
48100092
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$7,805.38 |
| Max. Negotiated Rate |
$15,965.55 |
| Rate for Payer: Aetna American Axle |
$11,530.67
|
| Rate for Payer: Aetna Commercial |
$15,078.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,530.67
|
| Rate for Payer: Cash Price |
$14,191.60
|
| Rate for Payer: Cofinity Commercial |
$12,417.65
|
| Rate for Payer: Cofinity Commercial |
$15,255.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$12,417.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,191.60
|
| Rate for Payer: Healthscope Commercial |
$15,965.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12,417.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13,304.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15,078.58
|
| Rate for Payer: PHP Commercial |
$15,078.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,530.67
|
| Rate for Payer: Priority Health SBD |
$11,175.89
|
| Rate for Payer: UMR Bronson Commercial |
$7,805.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13,304.62
|
|
|
HC EP AFTER DRUGS
|
Facility
|
IP
|
$7,423.93
|
|
|
Service Code
|
CPT 93623
|
| Hospital Charge Code |
48100039
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,266.53 |
| Max. Negotiated Rate |
$6,681.54 |
| Rate for Payer: Aetna American Axle |
$4,825.55
|
| Rate for Payer: Aetna Commercial |
$6,310.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,825.55
|
| Rate for Payer: Cash Price |
$5,939.14
|
| Rate for Payer: Cofinity Commercial |
$5,196.75
|
| Rate for Payer: Cofinity Commercial |
$6,384.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,196.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,939.14
|
| Rate for Payer: Healthscope Commercial |
$6,681.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,196.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,567.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,310.34
|
| Rate for Payer: PHP Commercial |
$6,310.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,825.55
|
| Rate for Payer: Priority Health SBD |
$4,677.08
|
| Rate for Payer: UMR Bronson Commercial |
$3,266.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,567.95
|
|
|
HC EP AFTER DRUGS
|
Facility
|
OP
|
$7,423.93
|
|
|
Service Code
|
CPT 93623
|
| Hospital Charge Code |
48100039
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,746.85 |
| Max. Negotiated Rate |
$6,681.54 |
| Rate for Payer: Aetna American Axle |
$4,825.55
|
| Rate for Payer: Aetna Commercial |
$6,310.34
|
| Rate for Payer: Aetna Medicare |
$3,711.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,825.55
|
| Rate for Payer: BCBS Complete |
$2,969.57
|
| Rate for Payer: Cash Price |
$5,939.14
|
| Rate for Payer: Cofinity Commercial |
$5,196.75
|
| Rate for Payer: Cofinity Commercial |
$6,384.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,196.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,939.14
|
| Rate for Payer: Healthscope Commercial |
$6,681.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,196.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,567.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,310.34
|
| Rate for Payer: PHP Commercial |
$6,310.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,825.55
|
| Rate for Payer: Priority Health SBD |
$4,677.08
|
| Rate for Payer: UMR Bronson Commercial |
$2,746.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,567.95
|
|
|
HC EP EVAL OF SQ ICD
|
Facility
|
IP
|
$3,342.81
|
|
|
Service Code
|
CPT 93644
|
| Hospital Charge Code |
48000027
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,470.84 |
| Max. Negotiated Rate |
$3,008.53 |
| Rate for Payer: Aetna American Axle |
$2,172.83
|
| Rate for Payer: Aetna Commercial |
$2,841.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,172.83
|
| Rate for Payer: Cash Price |
$2,674.25
|
| Rate for Payer: Cofinity Commercial |
$2,339.97
|
| Rate for Payer: Cofinity Commercial |
$2,874.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,339.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,674.25
|
| Rate for Payer: Healthscope Commercial |
$3,008.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,339.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,507.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,841.39
|
| Rate for Payer: PHP Commercial |
$2,841.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,172.83
|
| Rate for Payer: Priority Health SBD |
$2,105.97
|
| Rate for Payer: UMR Bronson Commercial |
$1,470.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,507.11
|
|
|
HC EP EVAL OF SQ ICD
|
Facility
|
OP
|
$3,342.81
|
|
|
Service Code
|
CPT 93644
|
| Hospital Charge Code |
48000027
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$816.00 |
| Max. Negotiated Rate |
$3,008.53 |
| Rate for Payer: Aetna American Axle |
$2,172.83
|
| Rate for Payer: Aetna Commercial |
$2,841.39
|
| Rate for Payer: Aetna Medicare |
$1,671.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,172.83
|
| Rate for Payer: BCBS Complete |
$1,337.12
|
| Rate for Payer: Cash Price |
$2,674.25
|
| Rate for Payer: Cash Price |
$2,674.25
|
| Rate for Payer: Cofinity Commercial |
$2,874.82
|
| Rate for Payer: Cofinity Commercial |
$2,339.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,339.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,674.25
|
| Rate for Payer: Healthscope Commercial |
$3,008.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,339.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,507.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,841.39
|
| Rate for Payer: PHP Commercial |
$2,841.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,172.83
|
| Rate for Payer: Priority Health SBD |
$2,105.97
|
| Rate for Payer: UHC Core |
$816.00
|
| Rate for Payer: UMR Bronson Commercial |
$1,236.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,507.11
|
|
|
HC EP EVALUATION OF GEN/LEADS
|
Facility
|
OP
|
$2,388.64
|
|
|
Service Code
|
CPT 93641
|
| Hospital Charge Code |
48100042
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$883.80 |
| Max. Negotiated Rate |
$2,149.78 |
| Rate for Payer: Aetna American Axle |
$1,552.62
|
| Rate for Payer: Aetna Commercial |
$2,030.34
|
| Rate for Payer: Aetna Medicare |
$1,194.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,552.62
|
| Rate for Payer: BCBS Complete |
$955.46
|
| Rate for Payer: Cash Price |
$1,910.91
|
| Rate for Payer: Cofinity Commercial |
$1,672.05
|
| Rate for Payer: Cofinity Commercial |
$2,054.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,672.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,910.91
|
| Rate for Payer: Healthscope Commercial |
$2,149.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,672.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,791.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,030.34
|
| Rate for Payer: PHP Commercial |
$2,030.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,552.62
|
| Rate for Payer: Priority Health SBD |
$1,504.84
|
| Rate for Payer: UMR Bronson Commercial |
$883.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,791.48
|
|
|
HC EP EVALUATION OF GEN/LEADS
|
Facility
|
IP
|
$2,388.64
|
|
|
Service Code
|
CPT 93641
|
| Hospital Charge Code |
48100042
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,051.00 |
| Max. Negotiated Rate |
$2,149.78 |
| Rate for Payer: Aetna American Axle |
$1,552.62
|
| Rate for Payer: Aetna Commercial |
$2,030.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,552.62
|
| Rate for Payer: Cash Price |
$1,910.91
|
| Rate for Payer: Cofinity Commercial |
$1,672.05
|
| Rate for Payer: Cofinity Commercial |
$2,054.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,672.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,910.91
|
| Rate for Payer: Healthscope Commercial |
$2,149.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,672.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,791.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,030.34
|
| Rate for Payer: PHP Commercial |
$2,030.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,552.62
|
| Rate for Payer: Priority Health SBD |
$1,504.84
|
| Rate for Payer: UMR Bronson Commercial |
$1,051.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,791.48
|
|
|
HC EP EVALUATION OF LEADS
|
Facility
|
OP
|
$2,189.46
|
|
|
Service Code
|
CPT 93640
|
| Hospital Charge Code |
48100041
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$810.10 |
| Max. Negotiated Rate |
$1,970.51 |
| Rate for Payer: Aetna American Axle |
$1,423.15
|
| Rate for Payer: Aetna Commercial |
$1,861.04
|
| Rate for Payer: Aetna Medicare |
$1,094.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,423.15
|
| Rate for Payer: BCBS Complete |
$875.78
|
| Rate for Payer: Cash Price |
$1,751.57
|
| Rate for Payer: Cofinity Commercial |
$1,532.62
|
| Rate for Payer: Cofinity Commercial |
$1,882.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,532.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,751.57
|
| Rate for Payer: Healthscope Commercial |
$1,970.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,532.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,642.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,861.04
|
| Rate for Payer: PHP Commercial |
$1,861.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,423.15
|
| Rate for Payer: Priority Health SBD |
$1,379.36
|
| Rate for Payer: UMR Bronson Commercial |
$810.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,642.10
|
|
|
HC EP EVALUATION OF LEADS
|
Facility
|
IP
|
$2,189.46
|
|
|
Service Code
|
CPT 93640
|
| Hospital Charge Code |
48100041
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$963.36 |
| Max. Negotiated Rate |
$1,970.51 |
| Rate for Payer: Aetna American Axle |
$1,423.15
|
| Rate for Payer: Aetna Commercial |
$1,861.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,423.15
|
| Rate for Payer: Cash Price |
$1,751.57
|
| Rate for Payer: Cofinity Commercial |
$1,532.62
|
| Rate for Payer: Cofinity Commercial |
$1,882.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,532.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,751.57
|
| Rate for Payer: Healthscope Commercial |
$1,970.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,532.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,642.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,861.04
|
| Rate for Payer: PHP Commercial |
$1,861.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,423.15
|
| Rate for Payer: Priority Health SBD |
$1,379.36
|
| Rate for Payer: UMR Bronson Commercial |
$963.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,642.10
|
|
|
HC EPIDURAL/LOCAL FLAT
|
Facility
|
IP
|
$675.00
|
|
| Hospital Charge Code |
37000023
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$297.00 |
| Max. Negotiated Rate |
$607.50 |
| Rate for Payer: Aetna American Axle |
$438.75
|
| Rate for Payer: Aetna Commercial |
$573.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$438.75
|
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Cofinity Commercial |
$472.50
|
| Rate for Payer: Cofinity Commercial |
$580.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$472.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$540.00
|
| Rate for Payer: Healthscope Commercial |
$607.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$472.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$506.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$573.75
|
| Rate for Payer: PHP Commercial |
$573.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$438.75
|
| Rate for Payer: Priority Health SBD |
$425.25
|
| Rate for Payer: UMR Bronson Commercial |
$297.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$506.25
|
|
|
HC EPIDURAL/LOCAL FLAT
|
Facility
|
OP
|
$675.00
|
|
| Hospital Charge Code |
37000023
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$249.75 |
| Max. Negotiated Rate |
$607.50 |
| Rate for Payer: Aetna American Axle |
$438.75
|
| Rate for Payer: Aetna Commercial |
$573.75
|
| Rate for Payer: Aetna Medicare |
$337.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$438.75
|
| Rate for Payer: BCBS Complete |
$270.00
|
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Cofinity Commercial |
$472.50
|
| Rate for Payer: Cofinity Commercial |
$580.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$472.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$540.00
|
| Rate for Payer: Healthscope Commercial |
$607.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$472.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$506.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$573.75
|
| Rate for Payer: PHP Commercial |
$573.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$438.75
|
| Rate for Payer: Priority Health SBD |
$425.25
|
| Rate for Payer: UMR Bronson Commercial |
$249.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$506.25
|
|
|
HC EPIDURAL PREP (OB)
|
Facility
|
IP
|
$646.09
|
|
| Hospital Charge Code |
37000003
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$284.28 |
| Max. Negotiated Rate |
$581.48 |
| Rate for Payer: Aetna American Axle |
$419.96
|
| Rate for Payer: Aetna Commercial |
$549.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$419.96
|
| Rate for Payer: Cash Price |
$516.87
|
| Rate for Payer: Cofinity Commercial |
$452.26
|
| Rate for Payer: Cofinity Commercial |
$555.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$452.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$516.87
|
| Rate for Payer: Healthscope Commercial |
$581.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$452.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$484.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$549.18
|
| Rate for Payer: PHP Commercial |
$549.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$419.96
|
| Rate for Payer: Priority Health SBD |
$407.04
|
| Rate for Payer: UMR Bronson Commercial |
$284.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$484.57
|
|
|
HC EPIDURAL PREP (OB)
|
Facility
|
OP
|
$646.09
|
|
| Hospital Charge Code |
37000003
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$239.05 |
| Max. Negotiated Rate |
$581.48 |
| Rate for Payer: Aetna American Axle |
$419.96
|
| Rate for Payer: Aetna Commercial |
$549.18
|
| Rate for Payer: Aetna Medicare |
$323.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$419.96
|
| Rate for Payer: BCBS Complete |
$258.44
|
| Rate for Payer: Cash Price |
$516.87
|
| Rate for Payer: Cofinity Commercial |
$452.26
|
| Rate for Payer: Cofinity Commercial |
$555.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$452.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$516.87
|
| Rate for Payer: Healthscope Commercial |
$581.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$452.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$484.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$549.18
|
| Rate for Payer: PHP Commercial |
$549.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$419.96
|
| Rate for Payer: Priority Health SBD |
$407.04
|
| Rate for Payer: UMR Bronson Commercial |
$239.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$484.57
|
|
|
HC EPIFIX (14 MM DISC) PER SQ CM
|
Facility
|
OP
|
$488.47
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600135
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$180.73 |
| Max. Negotiated Rate |
$439.62 |
| Rate for Payer: Aetna American Axle |
$317.51
|
| Rate for Payer: Aetna Commercial |
$415.20
|
| Rate for Payer: Aetna Medicare |
$244.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$317.51
|
| Rate for Payer: BCBS Complete |
$195.39
|
| Rate for Payer: Cash Price |
$390.78
|
| Rate for Payer: Cofinity Commercial |
$341.93
|
| Rate for Payer: Cofinity Commercial |
$420.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$341.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$390.78
|
| Rate for Payer: Healthscope Commercial |
$439.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$341.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$366.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$415.20
|
| Rate for Payer: PHP Commercial |
$415.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$317.51
|
| Rate for Payer: Priority Health SBD |
$307.74
|
| Rate for Payer: UMR Bronson Commercial |
$180.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$366.35
|
|
|
HC EPIFIX (14 MM DISC) PER SQ CM
|
Facility
|
IP
|
$488.47
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600135
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$214.93 |
| Max. Negotiated Rate |
$439.62 |
| Rate for Payer: Aetna American Axle |
$317.51
|
| Rate for Payer: Aetna Commercial |
$415.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$317.51
|
| Rate for Payer: Cash Price |
$390.78
|
| Rate for Payer: Cofinity Commercial |
$341.93
|
| Rate for Payer: Cofinity Commercial |
$420.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$341.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$390.78
|
| Rate for Payer: Healthscope Commercial |
$439.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$341.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$366.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$415.20
|
| Rate for Payer: PHP Commercial |
$415.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$317.51
|
| Rate for Payer: Priority Health SBD |
$307.74
|
| Rate for Payer: UMR Bronson Commercial |
$214.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$366.35
|
|
|
HC EPIFIX (18 MM DISC) PER SQ CM
|
Facility
|
OP
|
$709.55
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600136
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$262.53 |
| Max. Negotiated Rate |
$638.60 |
| Rate for Payer: Aetna American Axle |
$461.21
|
| Rate for Payer: Aetna Commercial |
$603.12
|
| Rate for Payer: Aetna Medicare |
$354.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$461.21
|
| Rate for Payer: BCBS Complete |
$283.82
|
| Rate for Payer: Cash Price |
$567.64
|
| Rate for Payer: Cofinity Commercial |
$496.69
|
| Rate for Payer: Cofinity Commercial |
$610.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$496.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$567.64
|
| Rate for Payer: Healthscope Commercial |
$638.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$496.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$532.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$603.12
|
| Rate for Payer: PHP Commercial |
$603.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$461.21
|
| Rate for Payer: Priority Health SBD |
$447.02
|
| Rate for Payer: UMR Bronson Commercial |
$262.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$532.16
|
|
|
HC EPIFIX (18 MM DISC) PER SQ CM
|
Facility
|
IP
|
$709.55
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600136
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$312.20 |
| Max. Negotiated Rate |
$638.60 |
| Rate for Payer: Aetna American Axle |
$461.21
|
| Rate for Payer: Aetna Commercial |
$603.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$461.21
|
| Rate for Payer: Cash Price |
$567.64
|
| Rate for Payer: Cofinity Commercial |
$496.69
|
| Rate for Payer: Cofinity Commercial |
$610.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$496.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$567.64
|
| Rate for Payer: Healthscope Commercial |
$638.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$496.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$532.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$603.12
|
| Rate for Payer: PHP Commercial |
$603.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$461.21
|
| Rate for Payer: Priority Health SBD |
$447.02
|
| Rate for Payer: UMR Bronson Commercial |
$312.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$532.16
|
|
|
HC EPIFIX 2X2 PER SQ CM
|
Facility
|
IP
|
$691.87
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600130
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$304.42 |
| Max. Negotiated Rate |
$622.68 |
| Rate for Payer: Aetna American Axle |
$449.72
|
| Rate for Payer: Aetna Commercial |
$588.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$449.72
|
| Rate for Payer: Cash Price |
$553.50
|
| Rate for Payer: Cofinity Commercial |
$484.31
|
| Rate for Payer: Cofinity Commercial |
$595.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$484.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$553.50
|
| Rate for Payer: Healthscope Commercial |
$622.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$484.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$518.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$588.09
|
| Rate for Payer: PHP Commercial |
$588.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$449.72
|
| Rate for Payer: Priority Health SBD |
$435.88
|
| Rate for Payer: UMR Bronson Commercial |
$304.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$518.90
|
|
|
HC EPIFIX 2X2 PER SQ CM
|
Facility
|
OP
|
$691.87
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600130
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$255.99 |
| Max. Negotiated Rate |
$622.68 |
| Rate for Payer: Aetna American Axle |
$449.72
|
| Rate for Payer: Aetna Commercial |
$588.09
|
| Rate for Payer: Aetna Medicare |
$345.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$449.72
|
| Rate for Payer: BCBS Complete |
$276.75
|
| Rate for Payer: Cash Price |
$553.50
|
| Rate for Payer: Cofinity Commercial |
$484.31
|
| Rate for Payer: Cofinity Commercial |
$595.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$484.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$553.50
|
| Rate for Payer: Healthscope Commercial |
$622.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$484.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$518.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$588.09
|
| Rate for Payer: PHP Commercial |
$588.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$449.72
|
| Rate for Payer: Priority Health SBD |
$435.88
|
| Rate for Payer: UMR Bronson Commercial |
$255.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$518.90
|
|
|
HC EPIFIX 2X3 PER SQ CM
|
Facility
|
OP
|
$495.92
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600131
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$183.49 |
| Max. Negotiated Rate |
$446.33 |
| Rate for Payer: Aetna American Axle |
$322.35
|
| Rate for Payer: Aetna Commercial |
$421.53
|
| Rate for Payer: Aetna Medicare |
$247.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$322.35
|
| Rate for Payer: BCBS Complete |
$198.37
|
| Rate for Payer: Cash Price |
$396.74
|
| Rate for Payer: Cofinity Commercial |
$347.14
|
| Rate for Payer: Cofinity Commercial |
$426.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$347.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$396.74
|
| Rate for Payer: Healthscope Commercial |
$446.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$347.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$371.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$421.53
|
| Rate for Payer: PHP Commercial |
$421.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$322.35
|
| Rate for Payer: Priority Health SBD |
$312.43
|
| Rate for Payer: UMR Bronson Commercial |
$183.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$371.94
|
|
|
HC EPIFIX 2X3 PER SQ CM
|
Facility
|
IP
|
$495.92
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600131
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$218.20 |
| Max. Negotiated Rate |
$446.33 |
| Rate for Payer: Aetna American Axle |
$322.35
|
| Rate for Payer: Aetna Commercial |
$421.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$322.35
|
| Rate for Payer: Cash Price |
$396.74
|
| Rate for Payer: Cofinity Commercial |
$347.14
|
| Rate for Payer: Cofinity Commercial |
$426.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$347.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$396.74
|
| Rate for Payer: Healthscope Commercial |
$446.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$347.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$371.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$421.53
|
| Rate for Payer: PHP Commercial |
$421.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$322.35
|
| Rate for Payer: Priority Health SBD |
$312.43
|
| Rate for Payer: UMR Bronson Commercial |
$218.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$371.94
|
|
