|
HC EUFLEXXA INJ PER DOSE
|
Facility
|
OP
|
$300.99
|
|
|
Service Code
|
HCPCS J7323
|
| Hospital Charge Code |
63600145
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$60.27 |
| Max. Negotiated Rate |
$316.54 |
| Rate for Payer: Aetna American Axle |
$195.64
|
| Rate for Payer: Aetna Commercial |
$255.84
|
| Rate for Payer: Aetna Medicare |
$116.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$195.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$140.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$140.56
|
| Rate for Payer: BCBS Complete |
$63.29
|
| Rate for Payer: BCBS MAPPO |
$112.45
|
| Rate for Payer: BCN Medicare Advantage |
$112.45
|
| Rate for Payer: Cash Price |
$240.79
|
| Rate for Payer: Cash Price |
$240.79
|
| Rate for Payer: Cofinity Commercial |
$258.85
|
| Rate for Payer: Cofinity Commercial |
$210.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$210.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$112.45
|
| Rate for Payer: Healthscope Commercial |
$270.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$210.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$225.74
|
| Rate for Payer: Mclaren Medicaid |
$60.27
|
| Rate for Payer: Mclaren Medicare |
$112.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$118.07
|
| Rate for Payer: Meridian Medicaid |
$63.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$129.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.84
|
| Rate for Payer: PACE Medicare |
$106.83
|
| Rate for Payer: PACE SWMI |
$112.45
|
| Rate for Payer: PHP Commercial |
$255.84
|
| Rate for Payer: PHP Medicare Advantage |
$112.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$60.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.64
|
| Rate for Payer: Priority Health Medicare |
$112.45
|
| Rate for Payer: Priority Health SBD |
$189.62
|
| Rate for Payer: Railroad Medicare Medicare |
$112.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$316.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$112.45
|
| Rate for Payer: UHC Exchange |
$214.90
|
| Rate for Payer: UHC Medicare Advantage |
$112.45
|
| Rate for Payer: UHCCP Medicaid |
$60.27
|
| Rate for Payer: UMR Bronson Commercial |
$111.37
|
| Rate for Payer: VA VA |
$112.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.74
|
|
|
HC EVACUATION SUBUNGUAL HEMATOMA
|
Facility
|
IP
|
$92.19
|
|
|
Service Code
|
CPT 11740
|
| Hospital Charge Code |
76100113
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$40.56 |
| Max. Negotiated Rate |
$82.97 |
| Rate for Payer: Aetna American Axle |
$59.92
|
| Rate for Payer: Aetna Commercial |
$78.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.92
|
| Rate for Payer: Cash Price |
$73.75
|
| Rate for Payer: Cofinity Commercial |
$64.53
|
| Rate for Payer: Cofinity Commercial |
$79.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$64.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.75
|
| Rate for Payer: Healthscope Commercial |
$82.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$64.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.36
|
| Rate for Payer: PHP Commercial |
$78.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.92
|
| Rate for Payer: Priority Health SBD |
$58.08
|
| Rate for Payer: UMR Bronson Commercial |
$40.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.14
|
|
|
HC EVACUATION SUBUNGUAL HEMATOMA
|
Facility
|
OP
|
$92.19
|
|
|
Service Code
|
CPT 11740
|
| Hospital Charge Code |
76100113
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$34.11 |
| Max. Negotiated Rate |
$353.86 |
| Rate for Payer: Aetna American Axle |
$59.92
|
| Rate for Payer: Aetna Commercial |
$78.36
|
| Rate for Payer: Aetna Medicare |
$130.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.14
|
| Rate for Payer: BCBS Complete |
$70.75
|
| Rate for Payer: BCBS MAPPO |
$125.71
|
| Rate for Payer: BCN Medicare Advantage |
$125.71
|
| Rate for Payer: Cash Price |
$73.75
|
| Rate for Payer: Cash Price |
$73.75
|
| Rate for Payer: Cofinity Commercial |
$79.28
|
| Rate for Payer: Cofinity Commercial |
$64.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$64.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.71
|
| Rate for Payer: Healthscope Commercial |
$82.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$64.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.14
|
| Rate for Payer: Mclaren Medicaid |
$67.38
|
| Rate for Payer: Mclaren Medicare |
$125.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.00
|
| Rate for Payer: Meridian Medicaid |
$70.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$144.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.36
|
| Rate for Payer: PACE Medicare |
$119.42
|
| Rate for Payer: PACE SWMI |
$125.71
|
| Rate for Payer: PHP Commercial |
$78.36
|
| Rate for Payer: PHP Medicare Advantage |
$125.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.92
|
| Rate for Payer: Priority Health Medicare |
$125.71
|
| Rate for Payer: Priority Health SBD |
$58.08
|
| Rate for Payer: Railroad Medicare Medicare |
$125.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$353.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.71
|
| Rate for Payer: UHC Exchange |
$240.24
|
| Rate for Payer: UHC Medicare Advantage |
$125.71
|
| Rate for Payer: UHCCP Medicaid |
$67.38
|
| Rate for Payer: UMR Bronson Commercial |
$34.11
|
| Rate for Payer: VA VA |
$125.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.14
|
|
|
HC EVAL APHASIA PER HR
|
Facility
|
IP
|
$261.73
|
|
|
Service Code
|
CPT 96105
|
| Hospital Charge Code |
44400013
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$115.16 |
| Max. Negotiated Rate |
$235.56 |
| Rate for Payer: Aetna American Axle |
$170.12
|
| Rate for Payer: Aetna Commercial |
$222.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.12
|
| Rate for Payer: Cash Price |
$209.38
|
| Rate for Payer: Cofinity Commercial |
$183.21
|
| Rate for Payer: Cofinity Commercial |
$225.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$183.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.38
|
| Rate for Payer: Healthscope Commercial |
$235.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$183.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$196.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.47
|
| Rate for Payer: PHP Commercial |
$222.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.12
|
| Rate for Payer: Priority Health SBD |
$164.89
|
| Rate for Payer: UMR Bronson Commercial |
$115.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$196.30
|
|
|
HC EVAL APHASIA PER HR
|
Facility
|
OP
|
$261.73
|
|
|
Service Code
|
CPT 96105
|
| Hospital Charge Code |
44400013
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$96.84 |
| Max. Negotiated Rate |
$294.00 |
| Rate for Payer: Aetna American Axle |
$170.12
|
| Rate for Payer: Aetna Commercial |
$222.47
|
| Rate for Payer: Aetna Medicare |
$130.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.12
|
| Rate for Payer: BCBS Complete |
$104.69
|
| Rate for Payer: Cash Price |
$209.38
|
| Rate for Payer: Cash Price |
$209.38
|
| Rate for Payer: Cofinity Commercial |
$225.09
|
| Rate for Payer: Cofinity Commercial |
$183.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$183.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.38
|
| Rate for Payer: Healthscope Commercial |
$235.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$183.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$196.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.47
|
| Rate for Payer: Nomi Health Commercial |
$135.00
|
| Rate for Payer: PHP Commercial |
$222.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.12
|
| Rate for Payer: Priority Health SBD |
$164.89
|
| Rate for Payer: UHC Core |
$294.00
|
| Rate for Payer: UMR Bronson Commercial |
$96.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$196.30
|
|
|
HC EVAL AUD FUNCJ CAND/PO SURG IMPLT DEV 1ST HR
|
Facility
|
OP
|
$438.00
|
|
|
Service Code
|
CPT 92626
|
| Hospital Charge Code |
47100017
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$81.79 |
| Max. Negotiated Rate |
$429.53 |
| Rate for Payer: Aetna American Axle |
$284.70
|
| Rate for Payer: Aetna Commercial |
$372.30
|
| Rate for Payer: Aetna Medicare |
$158.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$284.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$190.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$190.74
|
| Rate for Payer: BCBS Complete |
$85.88
|
| Rate for Payer: BCBS MAPPO |
$152.59
|
| Rate for Payer: BCN Medicare Advantage |
$152.59
|
| Rate for Payer: Cash Price |
$350.40
|
| Rate for Payer: Cash Price |
$350.40
|
| Rate for Payer: Cash Price |
$350.40
|
| Rate for Payer: Cofinity Commercial |
$306.60
|
| Rate for Payer: Cofinity Commercial |
$376.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$306.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$350.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$152.59
|
| Rate for Payer: Healthscope Commercial |
$394.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$306.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$328.50
|
| Rate for Payer: Mclaren Medicaid |
$81.79
|
| Rate for Payer: Mclaren Medicare |
$152.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$160.22
|
| Rate for Payer: Meridian Medicaid |
$85.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$175.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$372.30
|
| Rate for Payer: PACE Medicare |
$144.96
|
| Rate for Payer: PACE SWMI |
$152.59
|
| Rate for Payer: PHP Commercial |
$372.30
|
| Rate for Payer: PHP Medicare Advantage |
$152.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$81.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.70
|
| Rate for Payer: Priority Health Medicare |
$152.59
|
| Rate for Payer: Priority Health SBD |
$275.94
|
| Rate for Payer: Railroad Medicare Medicare |
$152.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$429.53
|
| Rate for Payer: UHC Core |
$294.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$152.59
|
| Rate for Payer: UHC Exchange |
$291.61
|
| Rate for Payer: UHC Medicare Advantage |
$152.59
|
| Rate for Payer: UHCCP Medicaid |
$81.79
|
| Rate for Payer: UMR Bronson Commercial |
$162.06
|
| Rate for Payer: VA VA |
$152.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$328.50
|
|
|
HC EVAL AUD FUNCJ CAND/PO SURG IMPLT DEV 1ST HR
|
Facility
|
IP
|
$438.00
|
|
|
Service Code
|
CPT 92626
|
| Hospital Charge Code |
47100017
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$192.72 |
| Max. Negotiated Rate |
$394.20 |
| Rate for Payer: Aetna American Axle |
$284.70
|
| Rate for Payer: Aetna Commercial |
$372.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$284.70
|
| Rate for Payer: Cash Price |
$350.40
|
| Rate for Payer: Cofinity Commercial |
$306.60
|
| Rate for Payer: Cofinity Commercial |
$376.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$306.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$350.40
|
| Rate for Payer: Healthscope Commercial |
$394.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$306.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$328.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$372.30
|
| Rate for Payer: PHP Commercial |
$372.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.70
|
| Rate for Payer: Priority Health SBD |
$275.94
|
| Rate for Payer: UMR Bronson Commercial |
$192.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$328.50
|
|
|
HC EVAL AUD FUNCJ CAND/PO SURG IMPLT DEV EA ADDL 15
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
CPT 92627
|
| Hospital Charge Code |
47100018
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$27.75 |
| Max. Negotiated Rate |
$294.00 |
| Rate for Payer: Aetna American Axle |
$48.75
|
| Rate for Payer: Aetna Commercial |
$63.75
|
| Rate for Payer: Aetna Medicare |
$37.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.75
|
| Rate for Payer: BCBS Complete |
$30.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cofinity Commercial |
$64.50
|
| Rate for Payer: Cofinity Commercial |
$52.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$52.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.00
|
| Rate for Payer: Healthscope Commercial |
$67.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.75
|
| Rate for Payer: PHP Commercial |
$63.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.75
|
| Rate for Payer: Priority Health SBD |
$47.25
|
| Rate for Payer: UHC Core |
$294.00
|
| Rate for Payer: UMR Bronson Commercial |
$27.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.25
|
|
|
HC EVAL AUD FUNCJ CAND/PO SURG IMPLT DEV EA ADDL 15
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
CPT 92627
|
| Hospital Charge Code |
47100018
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$33.00 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Aetna American Axle |
$48.75
|
| Rate for Payer: Aetna Commercial |
$63.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.75
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cofinity Commercial |
$52.50
|
| Rate for Payer: Cofinity Commercial |
$64.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$52.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.00
|
| Rate for Payer: Healthscope Commercial |
$67.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.75
|
| Rate for Payer: PHP Commercial |
$63.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.75
|
| Rate for Payer: Priority Health SBD |
$47.25
|
| Rate for Payer: UMR Bronson Commercial |
$33.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.25
|
|
|
HC EVAL CENTRAL AUDITORY FUNCJ W/REPRT EA 15 MIN
|
Facility
|
IP
|
$39.78
|
|
|
Service Code
|
CPT 92621
|
| Hospital Charge Code |
76100496
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$17.50 |
| Max. Negotiated Rate |
$35.80 |
| Rate for Payer: Aetna American Axle |
$25.86
|
| Rate for Payer: Aetna Commercial |
$33.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.86
|
| Rate for Payer: Cash Price |
$31.82
|
| Rate for Payer: Cofinity Commercial |
$27.85
|
| Rate for Payer: Cofinity Commercial |
$34.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.82
|
| Rate for Payer: Healthscope Commercial |
$35.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.81
|
| Rate for Payer: PHP Commercial |
$33.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.86
|
| Rate for Payer: Priority Health SBD |
$25.06
|
| Rate for Payer: UMR Bronson Commercial |
$17.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.84
|
|
|
HC EVAL CENTRAL AUDITORY FUNCJ W/REPRT EA 15 MIN
|
Facility
|
OP
|
$39.78
|
|
|
Service Code
|
CPT 92621
|
| Hospital Charge Code |
76100496
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$14.72 |
| Max. Negotiated Rate |
$294.00 |
| Rate for Payer: Aetna American Axle |
$25.86
|
| Rate for Payer: Aetna Commercial |
$33.81
|
| Rate for Payer: Aetna Medicare |
$19.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.86
|
| Rate for Payer: BCBS Complete |
$15.91
|
| Rate for Payer: Cash Price |
$31.82
|
| Rate for Payer: Cash Price |
$31.82
|
| Rate for Payer: Cofinity Commercial |
$34.21
|
| Rate for Payer: Cofinity Commercial |
$27.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.82
|
| Rate for Payer: Healthscope Commercial |
$35.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.81
|
| Rate for Payer: PHP Commercial |
$33.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.86
|
| Rate for Payer: Priority Health SBD |
$25.06
|
| Rate for Payer: UHC Core |
$294.00
|
| Rate for Payer: UMR Bronson Commercial |
$14.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.84
|
|
|
HC EVAL ORAL SPEECH ADDL 30 MIN
|
Facility
|
OP
|
$116.69
|
|
|
Service Code
|
CPT 92608
|
| Hospital Charge Code |
44400015
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$43.18 |
| Max. Negotiated Rate |
$294.00 |
| Rate for Payer: Aetna American Axle |
$75.85
|
| Rate for Payer: Aetna Commercial |
$99.19
|
| Rate for Payer: Aetna Medicare |
$58.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.85
|
| Rate for Payer: BCBS Complete |
$46.68
|
| Rate for Payer: Cash Price |
$93.35
|
| Rate for Payer: Cash Price |
$93.35
|
| Rate for Payer: Cofinity Commercial |
$81.68
|
| Rate for Payer: Cofinity Commercial |
$100.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$81.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.35
|
| Rate for Payer: Healthscope Commercial |
$105.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$81.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.19
|
| Rate for Payer: Nomi Health Commercial |
$135.00
|
| Rate for Payer: PHP Commercial |
$99.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.85
|
| Rate for Payer: Priority Health SBD |
$73.51
|
| Rate for Payer: UHC Core |
$294.00
|
| Rate for Payer: UMR Bronson Commercial |
$43.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.52
|
|
|
HC EVAL ORAL SPEECH ADDL 30 MIN
|
Facility
|
IP
|
$116.69
|
|
|
Service Code
|
CPT 92608
|
| Hospital Charge Code |
44400015
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$51.34 |
| Max. Negotiated Rate |
$105.02 |
| Rate for Payer: Aetna American Axle |
$75.85
|
| Rate for Payer: Aetna Commercial |
$99.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.85
|
| Rate for Payer: Cash Price |
$93.35
|
| Rate for Payer: Cofinity Commercial |
$100.35
|
| Rate for Payer: Cofinity Commercial |
$81.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$81.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.35
|
| Rate for Payer: Healthscope Commercial |
$105.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$81.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.19
|
| Rate for Payer: PHP Commercial |
$99.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.85
|
| Rate for Payer: Priority Health SBD |
$73.51
|
| Rate for Payer: UMR Bronson Commercial |
$51.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.52
|
|
|
HC EVAL ORAL SPEECH DEVICE
|
Facility
|
OP
|
$302.96
|
|
|
Service Code
|
CPT 92607
|
| Hospital Charge Code |
44400014
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$112.10 |
| Max. Negotiated Rate |
$294.00 |
| Rate for Payer: Aetna American Axle |
$196.92
|
| Rate for Payer: Aetna Commercial |
$257.52
|
| Rate for Payer: Aetna Medicare |
$151.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.92
|
| Rate for Payer: BCBS Complete |
$121.18
|
| Rate for Payer: Cash Price |
$242.37
|
| Rate for Payer: Cash Price |
$242.37
|
| Rate for Payer: Cofinity Commercial |
$260.55
|
| Rate for Payer: Cofinity Commercial |
$212.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$212.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.37
|
| Rate for Payer: Healthscope Commercial |
$272.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$212.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$227.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$257.52
|
| Rate for Payer: Nomi Health Commercial |
$135.00
|
| Rate for Payer: PHP Commercial |
$257.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.92
|
| Rate for Payer: Priority Health SBD |
$190.86
|
| Rate for Payer: UHC Core |
$294.00
|
| Rate for Payer: UMR Bronson Commercial |
$112.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$227.22
|
|
|
HC EVAL ORAL SPEECH DEVICE
|
Facility
|
IP
|
$302.96
|
|
|
Service Code
|
CPT 92607
|
| Hospital Charge Code |
44400014
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$133.30 |
| Max. Negotiated Rate |
$272.66 |
| Rate for Payer: Aetna American Axle |
$196.92
|
| Rate for Payer: Aetna Commercial |
$257.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.92
|
| Rate for Payer: Cash Price |
$242.37
|
| Rate for Payer: Cofinity Commercial |
$212.07
|
| Rate for Payer: Cofinity Commercial |
$260.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$212.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.37
|
| Rate for Payer: Healthscope Commercial |
$272.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$212.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$227.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$257.52
|
| Rate for Payer: PHP Commercial |
$257.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.92
|
| Rate for Payer: Priority Health SBD |
$190.86
|
| Rate for Payer: UMR Bronson Commercial |
$133.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$227.22
|
|
|
HC EVENT MONITOR
|
Facility
|
OP
|
$510.24
|
|
|
Service Code
|
CPT 93270
|
| Hospital Charge Code |
48000003
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$19.49 |
| Max. Negotiated Rate |
$816.00 |
| Rate for Payer: Aetna American Axle |
$331.66
|
| Rate for Payer: Aetna Commercial |
$433.70
|
| Rate for Payer: Aetna Medicare |
$37.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$331.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$45.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$45.46
|
| Rate for Payer: BCBS Complete |
$20.47
|
| Rate for Payer: BCBS MAPPO |
$36.37
|
| Rate for Payer: BCN Medicare Advantage |
$36.37
|
| Rate for Payer: Cash Price |
$408.19
|
| Rate for Payer: Cash Price |
$408.19
|
| Rate for Payer: Cash Price |
$408.19
|
| Rate for Payer: Cofinity Commercial |
$357.17
|
| Rate for Payer: Cofinity Commercial |
$438.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$357.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.37
|
| Rate for Payer: Healthscope Commercial |
$459.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$357.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$382.68
|
| Rate for Payer: Mclaren Medicaid |
$19.49
|
| Rate for Payer: Mclaren Medicare |
$36.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$38.19
|
| Rate for Payer: Meridian Medicaid |
$20.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$433.70
|
| Rate for Payer: PACE Medicare |
$34.55
|
| Rate for Payer: PACE SWMI |
$36.37
|
| Rate for Payer: PHP Commercial |
$433.70
|
| Rate for Payer: PHP Medicare Advantage |
$36.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.66
|
| Rate for Payer: Priority Health Medicare |
$36.37
|
| Rate for Payer: Priority Health SBD |
$321.45
|
| Rate for Payer: Railroad Medicare Medicare |
$36.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$102.38
|
| Rate for Payer: UHC Core |
$816.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$36.37
|
| Rate for Payer: UHC Exchange |
$69.51
|
| Rate for Payer: UHC Medicare Advantage |
$36.37
|
| Rate for Payer: UHCCP Medicaid |
$19.49
|
| Rate for Payer: UMR Bronson Commercial |
$188.79
|
| Rate for Payer: VA VA |
$36.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$382.68
|
|
|
HC EVENT MONITOR
|
Facility
|
IP
|
$510.24
|
|
|
Service Code
|
CPT 93270
|
| Hospital Charge Code |
48000003
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$224.51 |
| Max. Negotiated Rate |
$459.22 |
| Rate for Payer: Aetna American Axle |
$331.66
|
| Rate for Payer: Aetna Commercial |
$433.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$331.66
|
| Rate for Payer: Cash Price |
$408.19
|
| Rate for Payer: Cofinity Commercial |
$357.17
|
| Rate for Payer: Cofinity Commercial |
$438.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$357.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.19
|
| Rate for Payer: Healthscope Commercial |
$459.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$357.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$382.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$433.70
|
| Rate for Payer: PHP Commercial |
$433.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.66
|
| Rate for Payer: Priority Health SBD |
$321.45
|
| Rate for Payer: UMR Bronson Commercial |
$224.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$382.68
|
|
|
HC EVEROLIMUS
|
Facility
|
OP
|
$69.71
|
|
|
Service Code
|
CPT 80169
|
| Hospital Charge Code |
30100626
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.36 |
| Max. Negotiated Rate |
$62.74 |
| Rate for Payer: Aetna American Axle |
$45.31
|
| Rate for Payer: Aetna Commercial |
$59.25
|
| Rate for Payer: Aetna Medicare |
$14.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.16
|
| Rate for Payer: BCBS Complete |
$7.73
|
| Rate for Payer: BCBS MAPPO |
$13.73
|
| Rate for Payer: BCN Medicare Advantage |
$13.73
|
| Rate for Payer: Cash Price |
$55.77
|
| Rate for Payer: Cash Price |
$55.77
|
| Rate for Payer: Cofinity Commercial |
$59.95
|
| Rate for Payer: Cofinity Commercial |
$48.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$48.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.73
|
| Rate for Payer: Healthscope Commercial |
$62.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.28
|
| Rate for Payer: Mclaren Medicaid |
$7.36
|
| Rate for Payer: Mclaren Medicare |
$13.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.42
|
| Rate for Payer: Meridian Medicaid |
$7.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.25
|
| Rate for Payer: PACE Medicare |
$13.04
|
| Rate for Payer: PACE SWMI |
$13.73
|
| Rate for Payer: PHP Commercial |
$59.25
|
| Rate for Payer: PHP Medicare Advantage |
$13.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.31
|
| Rate for Payer: Priority Health Medicare |
$13.73
|
| Rate for Payer: Priority Health SBD |
$43.92
|
| Rate for Payer: Railroad Medicare Medicare |
$13.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.73
|
| Rate for Payer: UHC Exchange |
$26.24
|
| Rate for Payer: UHC Medicare Advantage |
$13.73
|
| Rate for Payer: UHCCP Medicaid |
$7.36
|
| Rate for Payer: UMR Bronson Commercial |
$25.79
|
| Rate for Payer: VA VA |
$13.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.28
|
|
|
HC EVEROLIMUS
|
Facility
|
IP
|
$69.71
|
|
|
Service Code
|
CPT 80169
|
| Hospital Charge Code |
30100626
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.67 |
| Max. Negotiated Rate |
$62.74 |
| Rate for Payer: Aetna American Axle |
$45.31
|
| Rate for Payer: Aetna Commercial |
$59.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.31
|
| Rate for Payer: Cash Price |
$55.77
|
| Rate for Payer: Cofinity Commercial |
$48.80
|
| Rate for Payer: Cofinity Commercial |
$59.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$48.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.77
|
| Rate for Payer: Healthscope Commercial |
$62.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.25
|
| Rate for Payer: PHP Commercial |
$59.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.31
|
| Rate for Payer: Priority Health SBD |
$43.92
|
| Rate for Payer: UMR Bronson Commercial |
$30.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.28
|
|
|
HC EVOKED AUDITORY TEST COMPLETE
|
Facility
|
OP
|
$286.62
|
|
|
Service Code
|
CPT 92588
|
| Hospital Charge Code |
76100506
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$106.05 |
| Max. Negotiated Rate |
$854.89 |
| Rate for Payer: Aetna American Axle |
$186.30
|
| Rate for Payer: Aetna Commercial |
$243.63
|
| Rate for Payer: Aetna Medicare |
$315.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$379.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$379.62
|
| Rate for Payer: BCBS Complete |
$170.92
|
| Rate for Payer: BCBS MAPPO |
$303.70
|
| Rate for Payer: BCN Medicare Advantage |
$303.70
|
| Rate for Payer: Cash Price |
$229.30
|
| Rate for Payer: Cash Price |
$229.30
|
| Rate for Payer: Cash Price |
$229.30
|
| Rate for Payer: Cofinity Commercial |
$200.63
|
| Rate for Payer: Cofinity Commercial |
$246.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$200.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$303.70
|
| Rate for Payer: Healthscope Commercial |
$257.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$200.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$214.97
|
| Rate for Payer: Mclaren Medicaid |
$162.78
|
| Rate for Payer: Mclaren Medicare |
$303.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$318.88
|
| Rate for Payer: Meridian Medicaid |
$170.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$349.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.63
|
| Rate for Payer: PACE Medicare |
$288.51
|
| Rate for Payer: PACE SWMI |
$303.70
|
| Rate for Payer: PHP Commercial |
$243.63
|
| Rate for Payer: PHP Medicare Advantage |
$303.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$162.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.30
|
| Rate for Payer: Priority Health Medicare |
$303.70
|
| Rate for Payer: Priority Health SBD |
$180.57
|
| Rate for Payer: Railroad Medicare Medicare |
$303.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$854.89
|
| Rate for Payer: UHC Core |
$294.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$303.70
|
| Rate for Payer: UHC Exchange |
$580.40
|
| Rate for Payer: UHC Medicare Advantage |
$303.70
|
| Rate for Payer: UHCCP Medicaid |
$162.78
|
| Rate for Payer: UMR Bronson Commercial |
$106.05
|
| Rate for Payer: VA VA |
$303.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$214.97
|
|
|
HC EVOKED AUDITORY TEST COMPLETE
|
Facility
|
IP
|
$286.62
|
|
|
Service Code
|
CPT 92588
|
| Hospital Charge Code |
76100506
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$126.11 |
| Max. Negotiated Rate |
$257.96 |
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.30
|
| Rate for Payer: Cash Price |
$229.30
|
| Rate for Payer: Cofinity Commercial |
$200.63
|
| Rate for Payer: Cofinity Commercial |
$246.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$200.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.30
|
| Rate for Payer: Healthscope Commercial |
$257.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$200.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$214.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.63
|
| Rate for Payer: PHP Commercial |
$243.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.30
|
| Rate for Payer: Priority Health SBD |
$180.57
|
| Rate for Payer: UMR Bronson Commercial |
$126.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$214.97
|
| Rate for Payer: Aetna American Axle |
$186.30
|
| Rate for Payer: Aetna Commercial |
$243.63
|
|
|
HC EVOKED AUDITORY TEST LIMITED
|
Facility
|
OP
|
$286.62
|
|
|
Service Code
|
CPT 92587
|
| Hospital Charge Code |
76100507
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$106.05 |
| Max. Negotiated Rate |
$854.89 |
| Rate for Payer: Aetna American Axle |
$186.30
|
| Rate for Payer: Aetna Commercial |
$243.63
|
| Rate for Payer: Aetna Medicare |
$315.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$379.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$379.62
|
| Rate for Payer: BCBS Complete |
$170.92
|
| Rate for Payer: BCBS MAPPO |
$303.70
|
| Rate for Payer: BCN Medicare Advantage |
$303.70
|
| Rate for Payer: Cash Price |
$229.30
|
| Rate for Payer: Cash Price |
$229.30
|
| Rate for Payer: Cash Price |
$229.30
|
| Rate for Payer: Cofinity Commercial |
$200.63
|
| Rate for Payer: Cofinity Commercial |
$246.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$200.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$303.70
|
| Rate for Payer: Healthscope Commercial |
$257.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$200.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$214.97
|
| Rate for Payer: Mclaren Medicaid |
$162.78
|
| Rate for Payer: Mclaren Medicare |
$303.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$318.88
|
| Rate for Payer: Meridian Medicaid |
$170.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$349.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.63
|
| Rate for Payer: PACE Medicare |
$288.51
|
| Rate for Payer: PACE SWMI |
$303.70
|
| Rate for Payer: PHP Commercial |
$243.63
|
| Rate for Payer: PHP Medicare Advantage |
$303.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$162.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.30
|
| Rate for Payer: Priority Health Medicare |
$303.70
|
| Rate for Payer: Priority Health SBD |
$180.57
|
| Rate for Payer: Railroad Medicare Medicare |
$303.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$854.89
|
| Rate for Payer: UHC Core |
$294.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$303.70
|
| Rate for Payer: UHC Exchange |
$580.40
|
| Rate for Payer: UHC Medicare Advantage |
$303.70
|
| Rate for Payer: UHCCP Medicaid |
$162.78
|
| Rate for Payer: UMR Bronson Commercial |
$106.05
|
| Rate for Payer: VA VA |
$303.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$214.97
|
|
|
HC EVOKED AUDITORY TEST LIMITED
|
Facility
|
IP
|
$286.62
|
|
|
Service Code
|
CPT 92587
|
| Hospital Charge Code |
76100507
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$126.11 |
| Max. Negotiated Rate |
$257.96 |
| Rate for Payer: Aetna American Axle |
$186.30
|
| Rate for Payer: Aetna Commercial |
$243.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.30
|
| Rate for Payer: Cash Price |
$229.30
|
| Rate for Payer: Cofinity Commercial |
$200.63
|
| Rate for Payer: Cofinity Commercial |
$246.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$200.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.30
|
| Rate for Payer: Healthscope Commercial |
$257.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$200.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$214.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.63
|
| Rate for Payer: PHP Commercial |
$243.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.30
|
| Rate for Payer: Priority Health SBD |
$180.57
|
| Rate for Payer: UMR Bronson Commercial |
$126.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$214.97
|
|
|
HC EVOKED OTOACOUSTIC EMISNS LIMITD
|
Facility
|
IP
|
$785.40
|
|
|
Service Code
|
CPT 92587
|
| Hospital Charge Code |
76100489
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$345.58 |
| Max. Negotiated Rate |
$706.86 |
| Rate for Payer: Aetna American Axle |
$510.51
|
| Rate for Payer: Aetna Commercial |
$667.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$510.51
|
| Rate for Payer: Cash Price |
$628.32
|
| Rate for Payer: Cofinity Commercial |
$549.78
|
| Rate for Payer: Cofinity Commercial |
$675.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$549.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$628.32
|
| Rate for Payer: Healthscope Commercial |
$706.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$549.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$589.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$667.59
|
| Rate for Payer: PHP Commercial |
$667.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$510.51
|
| Rate for Payer: Priority Health SBD |
$494.80
|
| Rate for Payer: UMR Bronson Commercial |
$345.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$589.05
|
|
|
HC EVOKED OTOACOUSTIC EMISNS LIMITD
|
Facility
|
OP
|
$785.40
|
|
|
Service Code
|
CPT 92587
|
| Hospital Charge Code |
76100489
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$162.78 |
| Max. Negotiated Rate |
$854.89 |
| Rate for Payer: Aetna American Axle |
$510.51
|
| Rate for Payer: Aetna Commercial |
$667.59
|
| Rate for Payer: Aetna Medicare |
$315.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$510.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$379.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$379.62
|
| Rate for Payer: BCBS Complete |
$170.92
|
| Rate for Payer: BCBS MAPPO |
$303.70
|
| Rate for Payer: BCN Medicare Advantage |
$303.70
|
| Rate for Payer: Cash Price |
$628.32
|
| Rate for Payer: Cash Price |
$628.32
|
| Rate for Payer: Cofinity Commercial |
$675.44
|
| Rate for Payer: Cofinity Commercial |
$549.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$549.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$628.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$303.70
|
| Rate for Payer: Healthscope Commercial |
$706.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$549.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$589.05
|
| Rate for Payer: Mclaren Medicaid |
$162.78
|
| Rate for Payer: Mclaren Medicare |
$303.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$318.88
|
| Rate for Payer: Meridian Medicaid |
$170.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$349.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$667.59
|
| Rate for Payer: PACE Medicare |
$288.51
|
| Rate for Payer: PACE SWMI |
$303.70
|
| Rate for Payer: PHP Commercial |
$667.59
|
| Rate for Payer: PHP Medicare Advantage |
$303.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$162.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$510.51
|
| Rate for Payer: Priority Health Medicare |
$303.70
|
| Rate for Payer: Priority Health SBD |
$494.80
|
| Rate for Payer: Railroad Medicare Medicare |
$303.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$854.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$303.70
|
| Rate for Payer: UHC Exchange |
$580.40
|
| Rate for Payer: UHC Medicare Advantage |
$303.70
|
| Rate for Payer: UHCCP Medicaid |
$162.78
|
| Rate for Payer: UMR Bronson Commercial |
$290.60
|
| Rate for Payer: VA VA |
$303.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$589.05
|
|
