|
HC PUNCTURE ASPIRATION OF ABSCESS
|
Facility
|
OP
|
$269.89
|
|
|
Service Code
|
CPT 10160
|
| Hospital Charge Code |
36100004
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$95.29 |
| Max. Negotiated Rate |
$1,115.78 |
| Rate for Payer: Aetna American Axle |
$175.43
|
| Rate for Payer: Aetna Commercial |
$229.41
|
| Rate for Payer: Aetna Medicare |
$368.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$443.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$443.04
|
| Rate for Payer: BCBS Complete |
$203.58
|
| Rate for Payer: BCBS MAPPO |
$354.43
|
| Rate for Payer: BCBS Trust/PPO |
$277.63
|
| Rate for Payer: BCN Medicare Advantage |
$354.43
|
| Rate for Payer: Cash Price |
$215.91
|
| Rate for Payer: Cash Price |
$215.91
|
| Rate for Payer: Cofinity Commercial |
$232.11
|
| Rate for Payer: Cofinity Commercial |
$188.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.43
|
| Rate for Payer: Healthscope Commercial |
$242.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$188.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$202.42
|
| Rate for Payer: Mclaren Medicaid |
$193.87
|
| Rate for Payer: Mclaren Medicare |
$354.43
|
| Rate for Payer: Meridian Medicaid |
$203.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$372.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$407.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$229.41
|
| Rate for Payer: PACE Medicare |
$336.71
|
| Rate for Payer: PACE SWMI |
$354.43
|
| Rate for Payer: PHP Commercial |
$229.41
|
| Rate for Payer: PHP Medicare Advantage |
$354.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$193.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,115.78
|
| Rate for Payer: Priority Health Medicare |
$354.43
|
| Rate for Payer: Priority Health Narrow Network |
$892.62
|
| Rate for Payer: Priority Health SBD |
$170.03
|
| Rate for Payer: Railroad Medicare Medicare |
$354.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$104.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$354.43
|
| Rate for Payer: UHC Exchange |
$95.29
|
| Rate for Payer: UHC Medicare Advantage |
$365.06
|
| Rate for Payer: UMR Bronson Commercial |
$99.86
|
| Rate for Payer: VA VA |
$354.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$202.42
|
|
|
HC PUNCTURE CERVICAL
|
Facility
|
OP
|
$762.46
|
|
|
Service Code
|
CPT 61050
|
| Hospital Charge Code |
36100268
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$77.60 |
| Max. Negotiated Rate |
$828.79 |
| Rate for Payer: Aetna American Axle |
$495.60
|
| Rate for Payer: Aetna Commercial |
$648.09
|
| Rate for Payer: Aetna Medicare |
$273.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$495.60
|
| 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 |
$655.63
|
| Rate for Payer: BCN Medicare Advantage |
$263.27
|
| Rate for Payer: Cash Price |
$609.97
|
| Rate for Payer: Cash Price |
$609.97
|
| Rate for Payer: Cofinity Commercial |
$533.72
|
| Rate for Payer: Cofinity Commercial |
$655.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$609.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$263.27
|
| Rate for Payer: Healthscope Commercial |
$686.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$533.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$571.84
|
| 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 |
$648.09
|
| Rate for Payer: PACE Medicare |
$250.11
|
| Rate for Payer: PACE SWMI |
$263.27
|
| Rate for Payer: PHP Commercial |
$648.09
|
| 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 |
$533.72
|
| 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 |
$480.35
|
| Rate for Payer: Railroad Medicare Medicare |
$263.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$85.36
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$263.27
|
| Rate for Payer: UHC Exchange |
$77.60
|
| Rate for Payer: UHC Medicare Advantage |
$271.17
|
| Rate for Payer: UMR Bronson Commercial |
$282.11
|
| Rate for Payer: VA VA |
$263.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$571.84
|
|
|
HC PUNCTURE CERVICAL
|
Facility
|
IP
|
$762.46
|
|
|
Service Code
|
CPT 61050
|
| Hospital Charge Code |
36100268
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$335.48 |
| Max. Negotiated Rate |
$686.21 |
| Rate for Payer: Aetna American Axle |
$495.60
|
| Rate for Payer: Aetna Commercial |
$648.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$495.60
|
| Rate for Payer: Cash Price |
$609.97
|
| Rate for Payer: Cofinity Commercial |
$533.72
|
| Rate for Payer: Cofinity Commercial |
$655.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$609.97
|
| Rate for Payer: Healthscope Commercial |
$686.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$533.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$571.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$648.09
|
| Rate for Payer: PHP Commercial |
$648.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$533.72
|
| Rate for Payer: Priority Health SBD |
$480.35
|
| Rate for Payer: UMR Bronson Commercial |
$335.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$571.84
|
|
|
HC PUNCTURE WITH INJECTION CERVICAL
|
Facility
|
IP
|
$762.46
|
|
|
Service Code
|
CPT 61055
|
| Hospital Charge Code |
36100269
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$335.48 |
| Max. Negotiated Rate |
$686.21 |
| Rate for Payer: Aetna American Axle |
$495.60
|
| Rate for Payer: Aetna Commercial |
$648.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$495.60
|
| Rate for Payer: Cash Price |
$609.97
|
| Rate for Payer: Cofinity Commercial |
$655.72
|
| Rate for Payer: Cofinity Commercial |
$533.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$609.97
|
| Rate for Payer: Healthscope Commercial |
$686.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$533.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$571.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$648.09
|
| Rate for Payer: PHP Commercial |
$648.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$533.72
|
| Rate for Payer: Priority Health SBD |
$480.35
|
| Rate for Payer: UMR Bronson Commercial |
$335.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$571.84
|
|
|
HC PUNCTURE WITH INJECTION CERVICAL
|
Facility
|
OP
|
$762.46
|
|
|
Service Code
|
CPT 61055
|
| Hospital Charge Code |
36100269
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$114.28 |
| Max. Negotiated Rate |
$828.79 |
| Rate for Payer: Aetna American Axle |
$495.60
|
| Rate for Payer: Aetna Commercial |
$648.09
|
| Rate for Payer: Aetna Medicare |
$273.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$495.60
|
| 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 |
$473.51
|
| Rate for Payer: BCN Medicare Advantage |
$263.27
|
| Rate for Payer: Cash Price |
$609.97
|
| Rate for Payer: Cash Price |
$609.97
|
| Rate for Payer: Cofinity Commercial |
$655.72
|
| Rate for Payer: Cofinity Commercial |
$533.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$609.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$263.27
|
| Rate for Payer: Healthscope Commercial |
$686.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$533.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$571.84
|
| 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 |
$648.09
|
| Rate for Payer: PACE Medicare |
$250.11
|
| Rate for Payer: PACE SWMI |
$263.27
|
| Rate for Payer: PHP Commercial |
$648.09
|
| 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 |
$533.72
|
| 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 |
$480.35
|
| Rate for Payer: Railroad Medicare Medicare |
$263.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$125.71
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$263.27
|
| Rate for Payer: UHC Exchange |
$114.28
|
| Rate for Payer: UHC Medicare Advantage |
$271.17
|
| Rate for Payer: UMR Bronson Commercial |
$282.11
|
| Rate for Payer: VA VA |
$263.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$571.84
|
|
|
HC PURAPLY AM (1.6 SQ CM DISC) PER SQ CM
|
Facility
|
OP
|
$722.93
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600128
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$105.34 |
| Max. Negotiated Rate |
$650.64 |
| Rate for Payer: Aetna American Axle |
$469.90
|
| Rate for Payer: Aetna Commercial |
$614.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$469.90
|
| Rate for Payer: BCBS Complete |
$289.17
|
| Rate for Payer: BCBS Trust/PPO |
$105.34
|
| Rate for Payer: Cash Price |
$578.34
|
| Rate for Payer: Cash Price |
$578.34
|
| Rate for Payer: Cofinity Commercial |
$506.05
|
| Rate for Payer: Cofinity Commercial |
$621.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$578.34
|
| Rate for Payer: Healthscope Commercial |
$650.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$506.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$542.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$614.49
|
| Rate for Payer: PHP Commercial |
$614.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$506.05
|
| Rate for Payer: Priority Health SBD |
$455.45
|
| Rate for Payer: UMR Bronson Commercial |
$267.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$542.20
|
|
|
HC PURAPLY AM (1.6 SQ CM DISC) PER SQ CM
|
Facility
|
IP
|
$722.93
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600128
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$318.09 |
| Max. Negotiated Rate |
$650.64 |
| Rate for Payer: Aetna American Axle |
$469.90
|
| Rate for Payer: Aetna Commercial |
$614.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$469.90
|
| Rate for Payer: Cash Price |
$578.34
|
| Rate for Payer: Cofinity Commercial |
$506.05
|
| Rate for Payer: Cofinity Commercial |
$621.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$578.34
|
| Rate for Payer: Healthscope Commercial |
$650.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$506.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$542.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$614.49
|
| Rate for Payer: PHP Commercial |
$614.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$506.05
|
| Rate for Payer: Priority Health SBD |
$455.45
|
| Rate for Payer: UMR Bronson Commercial |
$318.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$542.20
|
|
|
HC PURAPLY AM 2X2 PER SQ CM
|
Facility
|
OP
|
$502.03
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600115
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$105.34 |
| Max. Negotiated Rate |
$451.83 |
| Rate for Payer: Aetna American Axle |
$326.32
|
| Rate for Payer: Aetna Commercial |
$426.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$326.32
|
| Rate for Payer: BCBS Complete |
$200.81
|
| Rate for Payer: BCBS Trust/PPO |
$105.34
|
| Rate for Payer: Cash Price |
$401.62
|
| Rate for Payer: Cash Price |
$401.62
|
| Rate for Payer: Cofinity Commercial |
$351.42
|
| Rate for Payer: Cofinity Commercial |
$431.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$401.62
|
| Rate for Payer: Healthscope Commercial |
$451.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$351.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$376.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$426.73
|
| Rate for Payer: PHP Commercial |
$426.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$351.42
|
| Rate for Payer: Priority Health SBD |
$316.28
|
| Rate for Payer: UMR Bronson Commercial |
$185.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$376.52
|
|
|
HC PURAPLY AM 2X2 PER SQ CM
|
Facility
|
IP
|
$502.03
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600115
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$220.89 |
| Max. Negotiated Rate |
$451.83 |
| Rate for Payer: Aetna American Axle |
$326.32
|
| Rate for Payer: Aetna Commercial |
$426.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$326.32
|
| Rate for Payer: Cash Price |
$401.62
|
| Rate for Payer: Cofinity Commercial |
$351.42
|
| Rate for Payer: Cofinity Commercial |
$431.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$401.62
|
| Rate for Payer: Healthscope Commercial |
$451.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$351.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$376.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$426.73
|
| Rate for Payer: PHP Commercial |
$426.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$351.42
|
| Rate for Payer: Priority Health SBD |
$316.28
|
| Rate for Payer: UMR Bronson Commercial |
$220.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$376.52
|
|
|
HC PURAPLY AM 2X4 PER SQ CM
|
Facility
|
IP
|
$317.95
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600116
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$139.90 |
| Max. Negotiated Rate |
$286.16 |
| Rate for Payer: Aetna American Axle |
$206.67
|
| Rate for Payer: Aetna Commercial |
$270.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$206.67
|
| Rate for Payer: Cash Price |
$254.36
|
| Rate for Payer: Cofinity Commercial |
$222.56
|
| Rate for Payer: Cofinity Commercial |
$273.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$254.36
|
| Rate for Payer: Healthscope Commercial |
$286.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$222.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$238.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$270.26
|
| Rate for Payer: PHP Commercial |
$270.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$222.56
|
| Rate for Payer: Priority Health SBD |
$200.31
|
| Rate for Payer: UMR Bronson Commercial |
$139.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$238.46
|
|
|
HC PURAPLY AM 2X4 PER SQ CM
|
Facility
|
OP
|
$317.95
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600116
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$105.34 |
| Max. Negotiated Rate |
$286.16 |
| Rate for Payer: Aetna American Axle |
$206.67
|
| Rate for Payer: Aetna Commercial |
$270.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$206.67
|
| Rate for Payer: BCBS Complete |
$127.18
|
| Rate for Payer: BCBS Trust/PPO |
$105.34
|
| Rate for Payer: Cash Price |
$254.36
|
| Rate for Payer: Cash Price |
$254.36
|
| Rate for Payer: Cofinity Commercial |
$222.56
|
| Rate for Payer: Cofinity Commercial |
$273.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$254.36
|
| Rate for Payer: Healthscope Commercial |
$286.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$222.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$238.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$270.26
|
| Rate for Payer: PHP Commercial |
$270.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$222.56
|
| Rate for Payer: Priority Health SBD |
$200.31
|
| Rate for Payer: UMR Bronson Commercial |
$117.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$238.46
|
|
|
HC PURAPLY AM 3X4 PER SQ CM
|
Facility
|
OP
|
$265.63
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600185
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$98.28 |
| Max. Negotiated Rate |
$239.07 |
| Rate for Payer: Aetna American Axle |
$172.66
|
| Rate for Payer: Aetna Commercial |
$225.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.66
|
| Rate for Payer: BCBS Complete |
$106.25
|
| Rate for Payer: BCBS Trust/PPO |
$105.34
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cofinity Commercial |
$185.94
|
| Rate for Payer: Cofinity Commercial |
$228.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.50
|
| Rate for Payer: Healthscope Commercial |
$239.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$185.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$199.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$225.79
|
| Rate for Payer: PHP Commercial |
$225.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$185.94
|
| Rate for Payer: Priority Health SBD |
$167.35
|
| Rate for Payer: UMR Bronson Commercial |
$98.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$199.22
|
|
|
HC PURAPLY AM 3X4 PER SQ CM
|
Facility
|
IP
|
$265.63
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600185
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$116.88 |
| Max. Negotiated Rate |
$239.07 |
| Rate for Payer: Aetna American Axle |
$172.66
|
| Rate for Payer: Aetna Commercial |
$225.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.66
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cofinity Commercial |
$185.94
|
| Rate for Payer: Cofinity Commercial |
$228.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.50
|
| Rate for Payer: Healthscope Commercial |
$239.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$185.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$199.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$225.79
|
| Rate for Payer: PHP Commercial |
$225.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$185.94
|
| Rate for Payer: Priority Health SBD |
$167.35
|
| Rate for Payer: UMR Bronson Commercial |
$116.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$199.22
|
|
|
HC PURAPLY AM 4X3 PER SQ CM EXTRA FENESTRATED
|
Facility
|
OP
|
$280.50
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600183
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$103.78 |
| Max. Negotiated Rate |
$252.45 |
| Rate for Payer: Aetna American Axle |
$182.32
|
| Rate for Payer: Aetna Commercial |
$238.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.32
|
| Rate for Payer: BCBS Complete |
$112.20
|
| Rate for Payer: BCBS Trust/PPO |
$105.34
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cofinity Commercial |
$196.35
|
| Rate for Payer: Cofinity Commercial |
$241.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.40
|
| Rate for Payer: Healthscope Commercial |
$252.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$196.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$238.42
|
| Rate for Payer: PHP Commercial |
$238.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.35
|
| Rate for Payer: Priority Health SBD |
$176.72
|
| Rate for Payer: UMR Bronson Commercial |
$103.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.38
|
|
|
HC PURAPLY AM 4X3 PER SQ CM EXTRA FENESTRATED
|
Facility
|
IP
|
$280.50
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600183
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$123.42 |
| Max. Negotiated Rate |
$252.45 |
| Rate for Payer: Aetna American Axle |
$182.32
|
| Rate for Payer: Aetna Commercial |
$238.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.32
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cofinity Commercial |
$196.35
|
| Rate for Payer: Cofinity Commercial |
$241.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.40
|
| Rate for Payer: Healthscope Commercial |
$252.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$196.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$238.42
|
| Rate for Payer: PHP Commercial |
$238.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.35
|
| Rate for Payer: Priority Health SBD |
$176.72
|
| Rate for Payer: UMR Bronson Commercial |
$123.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.38
|
|
|
HC PURAPLY AM 4X4 PER SQ CM
|
Facility
|
IP
|
$220.32
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600186
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$96.94 |
| Max. Negotiated Rate |
$198.29 |
| Rate for Payer: Aetna American Axle |
$143.21
|
| Rate for Payer: Aetna Commercial |
$187.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.21
|
| Rate for Payer: Cash Price |
$176.26
|
| Rate for Payer: Cofinity Commercial |
$154.22
|
| Rate for Payer: Cofinity Commercial |
$189.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.26
|
| Rate for Payer: Healthscope Commercial |
$198.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$154.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$165.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$187.27
|
| Rate for Payer: PHP Commercial |
$187.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.22
|
| Rate for Payer: Priority Health SBD |
$138.80
|
| Rate for Payer: UMR Bronson Commercial |
$96.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$165.24
|
|
|
HC PURAPLY AM 4X4 PER SQ CM
|
Facility
|
OP
|
$220.32
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600186
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$81.52 |
| Max. Negotiated Rate |
$198.29 |
| Rate for Payer: Aetna American Axle |
$143.21
|
| Rate for Payer: Aetna Commercial |
$187.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.21
|
| Rate for Payer: BCBS Complete |
$88.13
|
| Rate for Payer: BCBS Trust/PPO |
$105.34
|
| Rate for Payer: Cash Price |
$176.26
|
| Rate for Payer: Cash Price |
$176.26
|
| Rate for Payer: Cofinity Commercial |
$154.22
|
| Rate for Payer: Cofinity Commercial |
$189.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.26
|
| Rate for Payer: Healthscope Commercial |
$198.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$154.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$165.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$187.27
|
| Rate for Payer: PHP Commercial |
$187.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.22
|
| Rate for Payer: Priority Health SBD |
$138.80
|
| Rate for Payer: UMR Bronson Commercial |
$81.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$165.24
|
|
|
HC PURAPLY AM 4X4 PER SQ CM EXTRA FENESTRATED
|
Facility
|
OP
|
$220.32
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600184
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$81.52 |
| Max. Negotiated Rate |
$198.29 |
| Rate for Payer: Aetna American Axle |
$143.21
|
| Rate for Payer: Aetna Commercial |
$187.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.21
|
| Rate for Payer: BCBS Complete |
$88.13
|
| Rate for Payer: BCBS Trust/PPO |
$105.34
|
| Rate for Payer: Cash Price |
$176.26
|
| Rate for Payer: Cash Price |
$176.26
|
| Rate for Payer: Cofinity Commercial |
$154.22
|
| Rate for Payer: Cofinity Commercial |
$189.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.26
|
| Rate for Payer: Healthscope Commercial |
$198.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$154.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$165.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$187.27
|
| Rate for Payer: PHP Commercial |
$187.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.22
|
| Rate for Payer: Priority Health SBD |
$138.80
|
| Rate for Payer: UMR Bronson Commercial |
$81.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$165.24
|
|
|
HC PURAPLY AM 4X4 PER SQ CM EXTRA FENESTRATED
|
Facility
|
IP
|
$220.32
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600184
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$96.94 |
| Max. Negotiated Rate |
$198.29 |
| Rate for Payer: Aetna American Axle |
$143.21
|
| Rate for Payer: Aetna Commercial |
$187.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.21
|
| Rate for Payer: Cash Price |
$176.26
|
| Rate for Payer: Cofinity Commercial |
$154.22
|
| Rate for Payer: Cofinity Commercial |
$189.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.26
|
| Rate for Payer: Healthscope Commercial |
$198.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$154.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$165.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$187.27
|
| Rate for Payer: PHP Commercial |
$187.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.22
|
| Rate for Payer: Priority Health SBD |
$138.80
|
| Rate for Payer: UMR Bronson Commercial |
$96.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$165.24
|
|
|
HC PURAPLY AM 5X5 PER SQ CM
|
Facility
|
OP
|
$152.57
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600117
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$56.45 |
| Max. Negotiated Rate |
$137.31 |
| Rate for Payer: Aetna American Axle |
$99.17
|
| Rate for Payer: Aetna Commercial |
$129.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.17
|
| Rate for Payer: BCBS Complete |
$61.03
|
| Rate for Payer: BCBS Trust/PPO |
$105.34
|
| Rate for Payer: Cash Price |
$122.06
|
| Rate for Payer: Cash Price |
$122.06
|
| Rate for Payer: Cofinity Commercial |
$106.80
|
| Rate for Payer: Cofinity Commercial |
$131.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.06
|
| Rate for Payer: Healthscope Commercial |
$137.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$106.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$129.68
|
| Rate for Payer: PHP Commercial |
$129.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.80
|
| Rate for Payer: Priority Health SBD |
$96.12
|
| Rate for Payer: UMR Bronson Commercial |
$56.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.43
|
|
|
HC PURAPLY AM 5X5 PER SQ CM
|
Facility
|
IP
|
$152.57
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600117
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$67.13 |
| Max. Negotiated Rate |
$137.31 |
| Rate for Payer: Aetna American Axle |
$99.17
|
| Rate for Payer: Aetna Commercial |
$129.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.17
|
| Rate for Payer: Cash Price |
$122.06
|
| Rate for Payer: Cofinity Commercial |
$106.80
|
| Rate for Payer: Cofinity Commercial |
$131.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.06
|
| Rate for Payer: Healthscope Commercial |
$137.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$106.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$129.68
|
| Rate for Payer: PHP Commercial |
$129.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.80
|
| Rate for Payer: Priority Health SBD |
$96.12
|
| Rate for Payer: UMR Bronson Commercial |
$67.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.43
|
|
|
HC PURAPLY AM 6X9 PER SQ CM
|
Facility
|
OP
|
$174.42
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600118
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.54 |
| Max. Negotiated Rate |
$156.98 |
| Rate for Payer: Aetna American Axle |
$113.37
|
| Rate for Payer: Aetna Commercial |
$148.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.37
|
| Rate for Payer: BCBS Complete |
$69.77
|
| Rate for Payer: BCBS Trust/PPO |
$105.34
|
| Rate for Payer: Cash Price |
$139.54
|
| Rate for Payer: Cash Price |
$139.54
|
| Rate for Payer: Cofinity Commercial |
$150.00
|
| Rate for Payer: Cofinity Commercial |
$122.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.54
|
| Rate for Payer: Healthscope Commercial |
$156.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$122.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$130.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$148.26
|
| Rate for Payer: PHP Commercial |
$148.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.09
|
| Rate for Payer: Priority Health SBD |
$109.88
|
| Rate for Payer: UMR Bronson Commercial |
$64.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$130.82
|
|
|
HC PURAPLY AM 6X9 PER SQ CM
|
Facility
|
IP
|
$174.42
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600118
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$76.74 |
| Max. Negotiated Rate |
$156.98 |
| Rate for Payer: Aetna American Axle |
$113.37
|
| Rate for Payer: Aetna Commercial |
$148.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.37
|
| Rate for Payer: Cash Price |
$139.54
|
| Rate for Payer: Cofinity Commercial |
$122.09
|
| Rate for Payer: Cofinity Commercial |
$150.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.54
|
| Rate for Payer: Healthscope Commercial |
$156.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$122.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$130.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$148.26
|
| Rate for Payer: PHP Commercial |
$148.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.09
|
| Rate for Payer: Priority Health SBD |
$109.88
|
| Rate for Payer: UMR Bronson Commercial |
$76.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$130.82
|
|
|
HC PURE TONE AUDIOMETRY AIR
|
Facility
|
OP
|
$162.91
|
|
|
Service Code
|
CPT 92552
|
| Hospital Charge Code |
47100009
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$37.33 |
| Max. Negotiated Rate |
$357.43 |
| Rate for Payer: Aetna American Axle |
$105.89
|
| Rate for Payer: Aetna Commercial |
$138.47
|
| Rate for Payer: Aetna Medicare |
$118.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$141.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$141.94
|
| Rate for Payer: BCBS Complete |
$65.22
|
| Rate for Payer: BCBS MAPPO |
$113.55
|
| Rate for Payer: BCBS Trust/PPO |
$175.93
|
| Rate for Payer: BCN Medicare Advantage |
$113.55
|
| Rate for Payer: Cash Price |
$130.33
|
| Rate for Payer: Cash Price |
$130.33
|
| Rate for Payer: Cash Price |
$130.33
|
| Rate for Payer: Cofinity Commercial |
$140.10
|
| Rate for Payer: Cofinity Commercial |
$114.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$113.55
|
| Rate for Payer: Healthscope Commercial |
$146.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$114.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$122.18
|
| Rate for Payer: Mclaren Medicaid |
$62.11
|
| Rate for Payer: Mclaren Medicare |
$113.55
|
| Rate for Payer: Meridian Medicaid |
$65.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$119.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$130.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$138.47
|
| Rate for Payer: PACE Medicare |
$107.87
|
| Rate for Payer: PACE SWMI |
$113.55
|
| Rate for Payer: PHP Commercial |
$138.47
|
| Rate for Payer: PHP Medicare Advantage |
$113.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$62.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$357.43
|
| Rate for Payer: Priority Health Medicare |
$113.55
|
| Rate for Payer: Priority Health Narrow Network |
$285.94
|
| Rate for Payer: Priority Health SBD |
$102.63
|
| Rate for Payer: Railroad Medicare Medicare |
$113.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.06
|
| Rate for Payer: UHC Core |
$294.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$113.55
|
| Rate for Payer: UHC Exchange |
$37.33
|
| Rate for Payer: UHC Medicare Advantage |
$116.96
|
| Rate for Payer: UMR Bronson Commercial |
$60.28
|
| Rate for Payer: VA VA |
$113.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$122.18
|
|
|
HC PURE TONE AUDIOMETRY AIR
|
Facility
|
IP
|
$162.91
|
|
|
Service Code
|
CPT 92552
|
| Hospital Charge Code |
47100009
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$71.68 |
| Max. Negotiated Rate |
$146.62 |
| Rate for Payer: Aetna American Axle |
$105.89
|
| Rate for Payer: Aetna Commercial |
$138.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.89
|
| Rate for Payer: Cash Price |
$130.33
|
| Rate for Payer: Cofinity Commercial |
$114.04
|
| Rate for Payer: Cofinity Commercial |
$140.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.33
|
| Rate for Payer: Healthscope Commercial |
$146.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$114.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$122.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$138.47
|
| Rate for Payer: PHP Commercial |
$138.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.04
|
| Rate for Payer: Priority Health SBD |
$102.63
|
| Rate for Payer: UMR Bronson Commercial |
$71.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$122.18
|
|
