|
HC POST MASTECTOMY SLEEVE C
|
Facility
|
OP
|
$216.00
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000051
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$79.92 |
| Max. Negotiated Rate |
$194.40 |
| Rate for Payer: Aetna American Axle |
$140.40
|
| Rate for Payer: Aetna Commercial |
$183.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$140.40
|
| Rate for Payer: BCBS Complete |
$86.40
|
| Rate for Payer: BCBS Trust/PPO |
$161.76
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Cofinity Commercial |
$185.76
|
| Rate for Payer: Cofinity Commercial |
$151.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.80
|
| Rate for Payer: Healthscope Commercial |
$194.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$151.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$162.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$183.60
|
| Rate for Payer: PHP Commercial |
$183.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.20
|
| Rate for Payer: Priority Health SBD |
$136.08
|
| Rate for Payer: UMR Bronson Commercial |
$79.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$162.00
|
|
|
HC POST MASTECTOMY SLEEVE D
|
Facility
|
OP
|
$246.00
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000052
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$91.02 |
| Max. Negotiated Rate |
$221.40 |
| Rate for Payer: Aetna American Axle |
$159.90
|
| Rate for Payer: Aetna Commercial |
$209.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.90
|
| Rate for Payer: BCBS Complete |
$98.40
|
| Rate for Payer: BCBS Trust/PPO |
$161.76
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Cofinity Commercial |
$172.20
|
| Rate for Payer: Cofinity Commercial |
$211.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.80
|
| Rate for Payer: Healthscope Commercial |
$221.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$172.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$184.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$209.10
|
| Rate for Payer: PHP Commercial |
$209.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.20
|
| Rate for Payer: Priority Health SBD |
$154.98
|
| Rate for Payer: UMR Bronson Commercial |
$91.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$184.50
|
|
|
HC POST MASTECTOMY SLEEVE D
|
Facility
|
IP
|
$246.00
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000052
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$108.24 |
| Max. Negotiated Rate |
$221.40 |
| Rate for Payer: Aetna American Axle |
$159.90
|
| Rate for Payer: Aetna Commercial |
$209.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.90
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Cofinity Commercial |
$172.20
|
| Rate for Payer: Cofinity Commercial |
$211.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.80
|
| Rate for Payer: Healthscope Commercial |
$221.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$172.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$184.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$209.10
|
| Rate for Payer: PHP Commercial |
$209.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.20
|
| Rate for Payer: Priority Health SBD |
$154.98
|
| Rate for Payer: UMR Bronson Commercial |
$108.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$184.50
|
|
|
HC POST-OP
|
Facility
|
IP
|
$17.72
|
|
| Hospital Charge Code |
27000136
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$15.95 |
| Rate for Payer: Aetna American Axle |
$11.52
|
| Rate for Payer: Aetna Commercial |
$15.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.52
|
| Rate for Payer: Cash Price |
$14.18
|
| Rate for Payer: Cofinity Commercial |
$12.40
|
| Rate for Payer: Cofinity Commercial |
$15.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.18
|
| Rate for Payer: Healthscope Commercial |
$15.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.06
|
| Rate for Payer: PHP Commercial |
$15.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.40
|
| Rate for Payer: Priority Health SBD |
$11.16
|
| Rate for Payer: UMR Bronson Commercial |
$7.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.29
|
|
|
HC POST-OP
|
Facility
|
OP
|
$17.72
|
|
| Hospital Charge Code |
27000136
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.56 |
| Max. Negotiated Rate |
$15.95 |
| Rate for Payer: Aetna American Axle |
$11.52
|
| Rate for Payer: Aetna Commercial |
$15.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.52
|
| Rate for Payer: BCBS Complete |
$7.09
|
| Rate for Payer: Cash Price |
$14.18
|
| Rate for Payer: Cofinity Commercial |
$12.40
|
| Rate for Payer: Cofinity Commercial |
$15.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.18
|
| Rate for Payer: Healthscope Commercial |
$15.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.06
|
| Rate for Payer: PHP Commercial |
$15.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.40
|
| Rate for Payer: Priority Health SBD |
$11.16
|
| Rate for Payer: UMR Bronson Commercial |
$6.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.29
|
|
|
HC POST TIBIAL NEUROSTIMULATION PERC NEEDLE ELECTRODE
|
Facility
|
IP
|
$378.64
|
|
|
Service Code
|
CPT 64566
|
| Hospital Charge Code |
76100208
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$166.60 |
| Max. Negotiated Rate |
$340.78 |
| Rate for Payer: Aetna American Axle |
$246.12
|
| Rate for Payer: Aetna Commercial |
$321.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$246.12
|
| Rate for Payer: Cash Price |
$302.91
|
| Rate for Payer: Cofinity Commercial |
$265.05
|
| Rate for Payer: Cofinity Commercial |
$325.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$302.91
|
| Rate for Payer: Healthscope Commercial |
$340.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$265.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$283.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$321.84
|
| Rate for Payer: PHP Commercial |
$321.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.05
|
| Rate for Payer: Priority Health SBD |
$238.54
|
| Rate for Payer: UMR Bronson Commercial |
$166.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$283.98
|
|
|
HC POST TIBIAL NEUROSTIMULATION PERC NEEDLE ELECTRODE
|
Facility
|
OP
|
$378.64
|
|
|
Service Code
|
CPT 64566
|
| Hospital Charge Code |
76100208
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$29.47 |
| Max. Negotiated Rate |
$828.79 |
| Rate for Payer: Aetna American Axle |
$246.12
|
| Rate for Payer: Aetna Commercial |
$321.84
|
| Rate for Payer: Aetna Medicare |
$273.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$246.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$329.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$329.09
|
| Rate for Payer: BCBS Complete |
$151.22
|
| Rate for Payer: BCBS MAPPO |
$263.27
|
| Rate for Payer: BCBS Trust/PPO |
$140.93
|
| Rate for Payer: BCN Medicare Advantage |
$263.27
|
| Rate for Payer: Cash Price |
$302.91
|
| Rate for Payer: Cash Price |
$302.91
|
| Rate for Payer: Cofinity Commercial |
$265.05
|
| Rate for Payer: Cofinity Commercial |
$325.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$302.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$263.27
|
| Rate for Payer: Healthscope Commercial |
$340.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$265.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$283.98
|
| Rate for Payer: Mclaren Medicaid |
$144.01
|
| Rate for Payer: Mclaren Medicare |
$263.27
|
| Rate for Payer: Meridian Medicaid |
$151.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$276.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$302.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$321.84
|
| Rate for Payer: PACE Medicare |
$250.11
|
| Rate for Payer: PACE SWMI |
$263.27
|
| Rate for Payer: PHP Commercial |
$321.84
|
| Rate for Payer: PHP Medicare Advantage |
$263.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$144.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$828.79
|
| Rate for Payer: Priority Health Medicare |
$263.27
|
| Rate for Payer: Priority Health Narrow Network |
$663.03
|
| Rate for Payer: Priority Health SBD |
$238.54
|
| Rate for Payer: Railroad Medicare Medicare |
$263.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$263.27
|
| Rate for Payer: UHC Exchange |
$29.47
|
| Rate for Payer: UHC Medicare Advantage |
$271.17
|
| Rate for Payer: UMR Bronson Commercial |
$140.10
|
| Rate for Payer: VA VA |
$263.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$283.98
|
|
|
HC POTASSIUM LEVEL
|
Facility
|
OP
|
$20.40
|
|
|
Service Code
|
CPT 84132
|
| Hospital Charge Code |
30100396
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.60 |
| Max. Negotiated Rate |
$18.36 |
| Rate for Payer: Aetna American Axle |
$13.26
|
| Rate for Payer: Aetna Commercial |
$17.34
|
| Rate for Payer: Aetna Medicare |
$4.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.95
|
| Rate for Payer: BCBS Complete |
$2.73
|
| Rate for Payer: BCBS MAPPO |
$4.76
|
| Rate for Payer: BCN Medicare Advantage |
$4.76
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cofinity Commercial |
$14.28
|
| Rate for Payer: Cofinity Commercial |
$17.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.76
|
| Rate for Payer: Healthscope Commercial |
$18.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.30
|
| Rate for Payer: Mclaren Medicaid |
$2.60
|
| Rate for Payer: Mclaren Medicare |
$4.76
|
| Rate for Payer: Meridian Medicaid |
$2.73
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.34
|
| Rate for Payer: PACE Medicare |
$4.52
|
| Rate for Payer: PACE SWMI |
$4.76
|
| Rate for Payer: PHP Commercial |
$17.34
|
| Rate for Payer: PHP Medicare Advantage |
$4.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6.31
|
| Rate for Payer: Priority Health Medicare |
$4.76
|
| Rate for Payer: Priority Health Narrow Network |
$5.05
|
| Rate for Payer: Priority Health SBD |
$12.85
|
| Rate for Payer: Railroad Medicare Medicare |
$4.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.71
|
| Rate for Payer: UHC Core |
$7.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.76
|
| Rate for Payer: UHC Exchange |
$4.76
|
| Rate for Payer: UHC Medicare Advantage |
$4.90
|
| Rate for Payer: UMR Bronson Commercial |
$7.55
|
| Rate for Payer: VA VA |
$4.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.30
|
|
|
HC POTASSIUM LEVEL
|
Facility
|
IP
|
$20.40
|
|
|
Service Code
|
CPT 84132
|
| Hospital Charge Code |
30100396
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.98 |
| Max. Negotiated Rate |
$18.36 |
| Rate for Payer: Aetna American Axle |
$13.26
|
| Rate for Payer: Aetna Commercial |
$17.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.26
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cofinity Commercial |
$14.28
|
| Rate for Payer: Cofinity Commercial |
$17.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.32
|
| Rate for Payer: Healthscope Commercial |
$18.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.34
|
| Rate for Payer: PHP Commercial |
$17.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.28
|
| Rate for Payer: Priority Health SBD |
$12.85
|
| Rate for Payer: UMR Bronson Commercial |
$8.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.30
|
|
|
HC POTASSIUM OTHER SOURCE
|
Facility
|
IP
|
$20.80
|
|
|
Service Code
|
CPT 84999
|
| Hospital Charge Code |
30100556
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.15 |
| Max. Negotiated Rate |
$18.72 |
| Rate for Payer: Aetna American Axle |
$13.52
|
| Rate for Payer: Aetna Commercial |
$17.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.52
|
| Rate for Payer: Cash Price |
$16.64
|
| Rate for Payer: Cofinity Commercial |
$14.56
|
| Rate for Payer: Cofinity Commercial |
$17.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.64
|
| Rate for Payer: Healthscope Commercial |
$18.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.68
|
| Rate for Payer: PHP Commercial |
$17.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.56
|
| Rate for Payer: Priority Health SBD |
$13.10
|
| Rate for Payer: UMR Bronson Commercial |
$9.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.60
|
|
|
HC POTASSIUM OTHER SOURCE
|
Facility
|
OP
|
$20.80
|
|
|
Service Code
|
CPT 84999
|
| Hospital Charge Code |
30100556
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.70 |
| Max. Negotiated Rate |
$18.72 |
| Rate for Payer: Aetna American Axle |
$13.52
|
| Rate for Payer: Aetna Commercial |
$17.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.52
|
| Rate for Payer: BCBS Complete |
$8.32
|
| Rate for Payer: BCBS Trust/PPO |
$11.96
|
| Rate for Payer: Cash Price |
$16.64
|
| Rate for Payer: Cash Price |
$16.64
|
| Rate for Payer: Cofinity Commercial |
$14.56
|
| Rate for Payer: Cofinity Commercial |
$17.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.64
|
| Rate for Payer: Healthscope Commercial |
$18.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.68
|
| Rate for Payer: PHP Commercial |
$17.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.56
|
| Rate for Payer: Priority Health SBD |
$13.10
|
| Rate for Payer: UMR Bronson Commercial |
$7.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.60
|
|
|
HC POTASSIUM URINE
|
Facility
|
OP
|
$36.20
|
|
|
Service Code
|
CPT 84133
|
| Hospital Charge Code |
30100397
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.59 |
| Max. Negotiated Rate |
$32.58 |
| Rate for Payer: Aetna American Axle |
$23.53
|
| Rate for Payer: Aetna Commercial |
$30.77
|
| Rate for Payer: Aetna Medicare |
$4.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.91
|
| Rate for Payer: BCBS Complete |
$2.72
|
| Rate for Payer: BCBS MAPPO |
$4.73
|
| Rate for Payer: BCBS Trust/PPO |
$4.26
|
| Rate for Payer: BCN Medicare Advantage |
$4.73
|
| Rate for Payer: Cash Price |
$28.96
|
| Rate for Payer: Cash Price |
$28.96
|
| Rate for Payer: Cofinity Commercial |
$25.34
|
| Rate for Payer: Cofinity Commercial |
$31.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.73
|
| Rate for Payer: Healthscope Commercial |
$32.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.15
|
| Rate for Payer: Mclaren Medicaid |
$2.59
|
| Rate for Payer: Mclaren Medicare |
$4.73
|
| Rate for Payer: Meridian Medicaid |
$2.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.77
|
| Rate for Payer: PACE Medicare |
$4.49
|
| Rate for Payer: PACE SWMI |
$4.73
|
| Rate for Payer: PHP Commercial |
$30.77
|
| Rate for Payer: PHP Medicare Advantage |
$4.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.91
|
| Rate for Payer: Priority Health Medicare |
$4.73
|
| Rate for Payer: Priority Health Narrow Network |
$4.73
|
| Rate for Payer: Priority Health SBD |
$22.81
|
| Rate for Payer: Railroad Medicare Medicare |
$4.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.68
|
| Rate for Payer: UHC Core |
$7.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.73
|
| Rate for Payer: UHC Exchange |
$4.73
|
| Rate for Payer: UHC Medicare Advantage |
$4.87
|
| Rate for Payer: UMR Bronson Commercial |
$13.39
|
| Rate for Payer: VA VA |
$4.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.15
|
|
|
HC POTASSIUM URINE
|
Facility
|
IP
|
$36.20
|
|
|
Service Code
|
CPT 84133
|
| Hospital Charge Code |
30100397
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.93 |
| Max. Negotiated Rate |
$32.58 |
| Rate for Payer: Aetna American Axle |
$23.53
|
| Rate for Payer: Aetna Commercial |
$30.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.53
|
| Rate for Payer: Cash Price |
$28.96
|
| Rate for Payer: Cofinity Commercial |
$25.34
|
| Rate for Payer: Cofinity Commercial |
$31.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.96
|
| Rate for Payer: Healthscope Commercial |
$32.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.77
|
| Rate for Payer: PHP Commercial |
$30.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.34
|
| Rate for Payer: Priority Health SBD |
$22.81
|
| Rate for Payer: UMR Bronson Commercial |
$15.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.15
|
|
|
HC POUCH 1 PIECE OPEN END W/WAFER
|
Facility
|
IP
|
$10.00
|
|
| Hospital Charge Code |
27000022
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: Aetna American Axle |
$6.50
|
| Rate for Payer: Aetna Commercial |
$8.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.50
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cofinity Commercial |
$7.00
|
| Rate for Payer: Cofinity Commercial |
$8.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.00
|
| Rate for Payer: Healthscope Commercial |
$9.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.50
|
| Rate for Payer: PHP Commercial |
$8.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.00
|
| Rate for Payer: Priority Health SBD |
$6.30
|
| Rate for Payer: UMR Bronson Commercial |
$4.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.50
|
|
|
HC POUCH 1 PIECE OPEN END W/WAFER
|
Facility
|
OP
|
$10.00
|
|
| Hospital Charge Code |
27000022
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.70 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: Aetna American Axle |
$6.50
|
| Rate for Payer: Aetna Commercial |
$8.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.50
|
| Rate for Payer: BCBS Complete |
$4.00
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cofinity Commercial |
$7.00
|
| Rate for Payer: Cofinity Commercial |
$8.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.00
|
| Rate for Payer: Healthscope Commercial |
$9.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.50
|
| Rate for Payer: PHP Commercial |
$8.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.00
|
| Rate for Payer: Priority Health SBD |
$6.30
|
| Rate for Payer: UMR Bronson Commercial |
$3.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.50
|
|
|
HC POUCH 2-PIECE
|
Facility
|
IP
|
$16.94
|
|
| Hospital Charge Code |
27000137
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.45 |
| Max. Negotiated Rate |
$15.25 |
| Rate for Payer: Aetna American Axle |
$11.01
|
| Rate for Payer: Aetna Commercial |
$14.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.01
|
| Rate for Payer: Cash Price |
$13.55
|
| Rate for Payer: Cofinity Commercial |
$11.86
|
| Rate for Payer: Cofinity Commercial |
$14.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.55
|
| Rate for Payer: Healthscope Commercial |
$15.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.40
|
| Rate for Payer: PHP Commercial |
$14.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.86
|
| Rate for Payer: Priority Health SBD |
$10.67
|
| Rate for Payer: UMR Bronson Commercial |
$7.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.70
|
|
|
HC POUCH 2-PIECE
|
Facility
|
OP
|
$16.94
|
|
| Hospital Charge Code |
27000137
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.27 |
| Max. Negotiated Rate |
$15.25 |
| Rate for Payer: Aetna American Axle |
$11.01
|
| Rate for Payer: Aetna Commercial |
$14.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.01
|
| Rate for Payer: BCBS Complete |
$6.78
|
| Rate for Payer: Cash Price |
$13.55
|
| Rate for Payer: Cofinity Commercial |
$11.86
|
| Rate for Payer: Cofinity Commercial |
$14.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.55
|
| Rate for Payer: Healthscope Commercial |
$15.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.40
|
| Rate for Payer: PHP Commercial |
$14.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.86
|
| Rate for Payer: Priority Health SBD |
$10.67
|
| Rate for Payer: UMR Bronson Commercial |
$6.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.70
|
|
|
HC POUCH WOUND 11 X 5
|
Facility
|
IP
|
$110.66
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000619
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$48.69 |
| Max. Negotiated Rate |
$99.59 |
| Rate for Payer: Aetna American Axle |
$71.93
|
| Rate for Payer: Aetna Commercial |
$94.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.93
|
| Rate for Payer: Cash Price |
$88.53
|
| Rate for Payer: Cofinity Commercial |
$77.46
|
| Rate for Payer: Cofinity Commercial |
$95.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.53
|
| Rate for Payer: Healthscope Commercial |
$99.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$77.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$94.06
|
| Rate for Payer: PHP Commercial |
$94.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.46
|
| Rate for Payer: Priority Health SBD |
$69.72
|
| Rate for Payer: UMR Bronson Commercial |
$48.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.00
|
|
|
HC POUCH WOUND 11 X 5
|
Facility
|
OP
|
$110.66
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000619
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$19.62 |
| Max. Negotiated Rate |
$99.59 |
| Rate for Payer: Aetna American Axle |
$71.93
|
| Rate for Payer: Aetna Commercial |
$94.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.93
|
| Rate for Payer: BCBS Complete |
$44.26
|
| Rate for Payer: BCBS Trust/PPO |
$60.64
|
| Rate for Payer: Cash Price |
$88.53
|
| Rate for Payer: Cash Price |
$88.53
|
| Rate for Payer: Cofinity Commercial |
$95.17
|
| Rate for Payer: Cofinity Commercial |
$77.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.53
|
| Rate for Payer: Healthscope Commercial |
$99.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$77.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$94.06
|
| Rate for Payer: PHP Commercial |
$94.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.46
|
| Rate for Payer: Priority Health SBD |
$69.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.54
|
| Rate for Payer: UHC Exchange |
$19.62
|
| Rate for Payer: UMR Bronson Commercial |
$40.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.00
|
|
|
HC POUCH WOUND 1 X 1
|
Facility
|
OP
|
$29.85
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000623
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.04 |
| Max. Negotiated Rate |
$60.64 |
| Rate for Payer: Aetna American Axle |
$19.40
|
| Rate for Payer: Aetna Commercial |
$25.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.40
|
| Rate for Payer: BCBS Complete |
$11.94
|
| Rate for Payer: BCBS Trust/PPO |
$60.64
|
| Rate for Payer: Cash Price |
$23.88
|
| Rate for Payer: Cash Price |
$23.88
|
| Rate for Payer: Cofinity Commercial |
$20.90
|
| Rate for Payer: Cofinity Commercial |
$25.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.88
|
| Rate for Payer: Healthscope Commercial |
$26.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.37
|
| Rate for Payer: PHP Commercial |
$25.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.90
|
| Rate for Payer: Priority Health SBD |
$18.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.54
|
| Rate for Payer: UHC Exchange |
$19.62
|
| Rate for Payer: UMR Bronson Commercial |
$11.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.39
|
|
|
HC POUCH WOUND 1 X 1
|
Facility
|
IP
|
$29.85
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000623
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.13 |
| Max. Negotiated Rate |
$26.86 |
| Rate for Payer: Aetna American Axle |
$19.40
|
| Rate for Payer: Aetna Commercial |
$25.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.40
|
| Rate for Payer: Cash Price |
$23.88
|
| Rate for Payer: Cofinity Commercial |
$20.90
|
| Rate for Payer: Cofinity Commercial |
$25.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.88
|
| Rate for Payer: Healthscope Commercial |
$26.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.37
|
| Rate for Payer: PHP Commercial |
$25.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.90
|
| Rate for Payer: Priority Health SBD |
$18.81
|
| Rate for Payer: UMR Bronson Commercial |
$13.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.39
|
|
|
HC POUCH WOUND 2 X 3
|
Facility
|
IP
|
$39.02
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000622
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.17 |
| Max. Negotiated Rate |
$35.12 |
| Rate for Payer: Aetna American Axle |
$25.36
|
| Rate for Payer: Aetna Commercial |
$33.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.36
|
| Rate for Payer: Cash Price |
$31.22
|
| Rate for Payer: Cofinity Commercial |
$27.31
|
| Rate for Payer: Cofinity Commercial |
$33.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.22
|
| Rate for Payer: Healthscope Commercial |
$35.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$33.17
|
| Rate for Payer: PHP Commercial |
$33.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.31
|
| Rate for Payer: Priority Health SBD |
$24.58
|
| Rate for Payer: UMR Bronson Commercial |
$17.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.26
|
|
|
HC POUCH WOUND 2 X 3
|
Facility
|
OP
|
$39.02
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000622
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.44 |
| Max. Negotiated Rate |
$60.64 |
| Rate for Payer: Aetna American Axle |
$25.36
|
| Rate for Payer: Aetna Commercial |
$33.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.36
|
| Rate for Payer: BCBS Complete |
$15.61
|
| Rate for Payer: BCBS Trust/PPO |
$60.64
|
| Rate for Payer: Cash Price |
$31.22
|
| Rate for Payer: Cash Price |
$31.22
|
| Rate for Payer: Cofinity Commercial |
$27.31
|
| Rate for Payer: Cofinity Commercial |
$33.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.22
|
| Rate for Payer: Healthscope Commercial |
$35.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$33.17
|
| Rate for Payer: PHP Commercial |
$33.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.31
|
| Rate for Payer: Priority Health SBD |
$24.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.54
|
| Rate for Payer: UHC Exchange |
$19.62
|
| Rate for Payer: UMR Bronson Commercial |
$14.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.26
|
|
|
HC POUCH WOUND 6 X 4
|
Facility
|
OP
|
$55.62
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000621
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$19.62 |
| Max. Negotiated Rate |
$60.64 |
| Rate for Payer: Aetna American Axle |
$36.15
|
| Rate for Payer: Aetna Commercial |
$47.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.15
|
| Rate for Payer: BCBS Complete |
$22.25
|
| Rate for Payer: BCBS Trust/PPO |
$60.64
|
| Rate for Payer: Cash Price |
$44.50
|
| Rate for Payer: Cash Price |
$44.50
|
| Rate for Payer: Cofinity Commercial |
$47.83
|
| Rate for Payer: Cofinity Commercial |
$38.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.50
|
| Rate for Payer: Healthscope Commercial |
$50.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$38.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$47.28
|
| Rate for Payer: PHP Commercial |
$47.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.93
|
| Rate for Payer: Priority Health SBD |
$35.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.54
|
| Rate for Payer: UHC Exchange |
$19.62
|
| Rate for Payer: UMR Bronson Commercial |
$20.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.72
|
|
|
HC POUCH WOUND 6 X 4
|
Facility
|
IP
|
$55.62
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000621
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.47 |
| Max. Negotiated Rate |
$50.06 |
| Rate for Payer: Aetna American Axle |
$36.15
|
| Rate for Payer: Aetna Commercial |
$47.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.15
|
| Rate for Payer: Cash Price |
$44.50
|
| Rate for Payer: Cofinity Commercial |
$38.93
|
| Rate for Payer: Cofinity Commercial |
$47.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.50
|
| Rate for Payer: Healthscope Commercial |
$50.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$38.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$47.28
|
| Rate for Payer: PHP Commercial |
$47.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.93
|
| Rate for Payer: Priority Health SBD |
$35.04
|
| Rate for Payer: UMR Bronson Commercial |
$24.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.72
|
|
