|
HC FOOD ALLERGY PROFILE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200070
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.17 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna American Axle |
$16.50
|
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health SBD |
$16.00
|
| Rate for Payer: UMR Bronson Commercial |
$11.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.04
|
|
|
HC FOOD ALLERGY PROFILE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200070
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna American Axle |
$16.50
|
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$5.04
|
| Rate for Payer: BCN Commercial |
$5.04
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.04
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$7.83
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.37
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$4.30
|
| Rate for Payer: Priority Health SBD |
$16.00
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$5.22
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.80
|
| Rate for Payer: UMR Bronson Commercial |
$9.39
|
| Rate for Payer: VA VA |
$5.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.04
|
|
|
HC FOREARM/ARM CUFFS FREE MOTIO
|
Facility
|
IP
|
$650.25
|
|
|
Service Code
|
HCPCS L3720
|
| Hospital Charge Code |
27400049
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$286.11 |
| Max. Negotiated Rate |
$585.22 |
| Rate for Payer: Aetna American Axle |
$422.66
|
| Rate for Payer: Aetna Commercial |
$552.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$422.66
|
| Rate for Payer: Cash Price |
$520.20
|
| Rate for Payer: Cofinity Commercial |
$455.18
|
| Rate for Payer: Cofinity Commercial |
$559.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$455.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$520.20
|
| Rate for Payer: Healthscope Commercial |
$585.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$455.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$487.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$552.71
|
| Rate for Payer: PHP Commercial |
$552.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$422.66
|
| Rate for Payer: Priority Health SBD |
$409.66
|
| Rate for Payer: UMR Bronson Commercial |
$286.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$487.69
|
|
|
HC FOREARM/ARM CUFFS FREE MOTIO
|
Facility
|
OP
|
$650.25
|
|
|
Service Code
|
HCPCS L3720
|
| Hospital Charge Code |
27400049
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$240.59 |
| Max. Negotiated Rate |
$1,936.32 |
| Rate for Payer: Aetna American Axle |
$422.66
|
| Rate for Payer: Aetna Commercial |
$552.71
|
| Rate for Payer: Aetna Medicare |
$325.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$422.66
|
| Rate for Payer: BCBS Complete |
$260.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,936.32
|
| Rate for Payer: BCN Commercial |
$1,936.32
|
| Rate for Payer: Cash Price |
$520.20
|
| Rate for Payer: Cash Price |
$520.20
|
| Rate for Payer: Cofinity Commercial |
$455.18
|
| Rate for Payer: Cofinity Commercial |
$559.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$455.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$520.20
|
| Rate for Payer: Healthscope Commercial |
$585.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$455.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$487.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$552.71
|
| Rate for Payer: PHP Commercial |
$552.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$422.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$749.24
|
| Rate for Payer: Priority Health Narrow Network |
$599.39
|
| Rate for Payer: Priority Health SBD |
$409.66
|
| Rate for Payer: UMR Bronson Commercial |
$240.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$487.69
|
|
|
HC FOREIGN BODY REMOVAL
|
Facility
|
IP
|
$459.55
|
|
| Hospital Charge Code |
45000042
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$202.20 |
| Max. Negotiated Rate |
$413.60 |
| Rate for Payer: Aetna American Axle |
$298.71
|
| Rate for Payer: Aetna Commercial |
$390.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$298.71
|
| Rate for Payer: Cash Price |
$367.64
|
| Rate for Payer: Cofinity Commercial |
$321.68
|
| Rate for Payer: Cofinity Commercial |
$395.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$321.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$367.64
|
| Rate for Payer: Healthscope Commercial |
$413.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$321.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$344.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$390.62
|
| Rate for Payer: PHP Commercial |
$390.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$298.71
|
| Rate for Payer: Priority Health SBD |
$289.52
|
| Rate for Payer: UMR Bronson Commercial |
$202.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$344.66
|
|
|
HC FOREIGN BODY REMOVAL
|
Facility
|
OP
|
$459.55
|
|
| Hospital Charge Code |
45000042
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$170.03 |
| Max. Negotiated Rate |
$413.60 |
| Rate for Payer: Aetna American Axle |
$298.71
|
| Rate for Payer: Aetna Commercial |
$390.62
|
| Rate for Payer: Aetna Medicare |
$229.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$298.71
|
| Rate for Payer: BCBS Complete |
$183.82
|
| Rate for Payer: Cash Price |
$367.64
|
| Rate for Payer: Cofinity Commercial |
$321.68
|
| Rate for Payer: Cofinity Commercial |
$395.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$321.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$367.64
|
| Rate for Payer: Healthscope Commercial |
$413.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$321.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$344.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$390.62
|
| Rate for Payer: PHP Commercial |
$390.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$298.71
|
| Rate for Payer: Priority Health SBD |
$289.52
|
| Rate for Payer: UMR Bronson Commercial |
$170.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$344.66
|
|
|
HC FOREIGN BODY REMOVAL
|
Facility
|
IP
|
$281.59
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
76100068
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$123.90 |
| Max. Negotiated Rate |
$253.43 |
| Rate for Payer: Aetna American Axle |
$183.03
|
| Rate for Payer: Aetna Commercial |
$239.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$183.03
|
| Rate for Payer: Cash Price |
$225.27
|
| Rate for Payer: Cofinity Commercial |
$197.11
|
| Rate for Payer: Cofinity Commercial |
$242.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$197.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.27
|
| Rate for Payer: Healthscope Commercial |
$253.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$197.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$211.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.35
|
| Rate for Payer: PHP Commercial |
$239.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.03
|
| Rate for Payer: Priority Health SBD |
$177.40
|
| Rate for Payer: UMR Bronson Commercial |
$123.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$211.19
|
|
|
HC FOREIGN BODY REMOVAL
|
Facility
|
OP
|
$281.59
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
76100068
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$1,230.33 |
| Rate for Payer: Aetna American Axle |
$183.03
|
| Rate for Payer: Aetna Commercial |
$239.35
|
| Rate for Payer: Aetna Medicare |
$407.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$183.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.31
|
| Rate for Payer: BCBS Complete |
$220.31
|
| Rate for Payer: BCBS MAPPO |
$391.45
|
| Rate for Payer: BCBS Trust/PPO |
$418.44
|
| Rate for Payer: BCN Commercial |
$418.44
|
| Rate for Payer: BCN Medicare Advantage |
$391.45
|
| Rate for Payer: Cash Price |
$225.27
|
| Rate for Payer: Cash Price |
$225.27
|
| Rate for Payer: Cash Price |
$225.27
|
| Rate for Payer: Cofinity Commercial |
$242.17
|
| Rate for Payer: Cofinity Commercial |
$197.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$197.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$391.45
|
| Rate for Payer: Healthscope Commercial |
$253.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$197.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$211.19
|
| Rate for Payer: Mclaren Medicaid |
$209.82
|
| Rate for Payer: Mclaren Medicare |
$391.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.02
|
| Rate for Payer: Meridian Medicaid |
$220.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.35
|
| Rate for Payer: Nomi Health Commercial |
$822.04
|
| Rate for Payer: PACE Medicare |
$371.88
|
| Rate for Payer: PACE SWMI |
$391.45
|
| Rate for Payer: PHP Commercial |
$239.35
|
| Rate for Payer: PHP Medicare Advantage |
$391.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,230.33
|
| Rate for Payer: Priority Health Medicare |
$391.45
|
| Rate for Payer: Priority Health Narrow Network |
$984.26
|
| Rate for Payer: Priority Health SBD |
$177.40
|
| Rate for Payer: Railroad Medicare Medicare |
$391.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$110.00
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.45
|
| Rate for Payer: UHC Exchange |
$100.00
|
| Rate for Payer: UHC Medicare Advantage |
$391.45
|
| Rate for Payer: UHCCP Medicaid |
$209.82
|
| Rate for Payer: UMR Bronson Commercial |
$104.19
|
| Rate for Payer: VA VA |
$391.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$211.19
|
|
|
HC FOREIGN BODY REMOVAL EAR
|
Facility
|
OP
|
$216.75
|
|
|
Service Code
|
CPT 69200
|
| Hospital Charge Code |
45000060
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$45.55 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna American Axle |
$140.89
|
| Rate for Payer: Aetna Commercial |
$184.24
|
| Rate for Payer: Aetna Medicare |
$131.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$140.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.86
|
| Rate for Payer: BCBS Complete |
$71.08
|
| Rate for Payer: BCBS MAPPO |
$126.29
|
| Rate for Payer: BCBS Trust/PPO |
$116.61
|
| Rate for Payer: BCN Commercial |
$116.61
|
| Rate for Payer: BCN Medicare Advantage |
$126.29
|
| Rate for Payer: Cash Price |
$173.40
|
| Rate for Payer: Cash Price |
$173.40
|
| Rate for Payer: Cash Price |
$173.40
|
| Rate for Payer: Cofinity Commercial |
$151.72
|
| Rate for Payer: Cofinity Commercial |
$186.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$151.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$126.29
|
| Rate for Payer: Healthscope Commercial |
$195.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$151.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$162.56
|
| Rate for Payer: Mclaren Medicaid |
$67.69
|
| Rate for Payer: Mclaren Medicare |
$126.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.60
|
| Rate for Payer: Meridian Medicaid |
$71.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$145.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.24
|
| Rate for Payer: Nomi Health Commercial |
$378.87
|
| Rate for Payer: PACE Medicare |
$119.98
|
| Rate for Payer: PACE SWMI |
$126.29
|
| Rate for Payer: PHP Commercial |
$184.24
|
| Rate for Payer: PHP Medicare Advantage |
$126.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$396.95
|
| Rate for Payer: Priority Health Medicare |
$126.29
|
| Rate for Payer: Priority Health Narrow Network |
$317.56
|
| Rate for Payer: Priority Health SBD |
$136.55
|
| Rate for Payer: Railroad Medicare Medicare |
$126.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.10
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$126.29
|
| Rate for Payer: UHC Exchange |
$45.55
|
| Rate for Payer: UHC Medicare Advantage |
$126.29
|
| Rate for Payer: UHCCP Medicaid |
$67.69
|
| Rate for Payer: UMR Bronson Commercial |
$80.20
|
| Rate for Payer: VA VA |
$126.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$162.56
|
|
|
HC FOREIGN BODY REMOVAL EAR
|
Facility
|
IP
|
$216.75
|
|
|
Service Code
|
CPT 69200
|
| Hospital Charge Code |
45000060
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$95.37 |
| Max. Negotiated Rate |
$195.08 |
| Rate for Payer: Aetna American Axle |
$140.89
|
| Rate for Payer: Aetna Commercial |
$184.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$140.89
|
| Rate for Payer: Cash Price |
$173.40
|
| Rate for Payer: Cofinity Commercial |
$151.72
|
| Rate for Payer: Cofinity Commercial |
$186.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$151.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.40
|
| Rate for Payer: Healthscope Commercial |
$195.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$151.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$162.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.24
|
| Rate for Payer: PHP Commercial |
$184.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.89
|
| Rate for Payer: Priority Health SBD |
$136.55
|
| Rate for Payer: UMR Bronson Commercial |
$95.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$162.56
|
|
|
HC FOREIGN BODY REMOVAL MUSCLE OR TENDON SHEATH SIMPLE
|
Facility
|
IP
|
$1,176.05
|
|
|
Service Code
|
CPT 20520
|
| Hospital Charge Code |
76100133
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$517.46 |
| Max. Negotiated Rate |
$1,058.44 |
| Rate for Payer: Aetna American Axle |
$764.43
|
| Rate for Payer: Aetna Commercial |
$999.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$764.43
|
| Rate for Payer: Cash Price |
$940.84
|
| Rate for Payer: Cofinity Commercial |
$1,011.40
|
| Rate for Payer: Cofinity Commercial |
$823.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$823.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$940.84
|
| Rate for Payer: Healthscope Commercial |
$1,058.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$823.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$882.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$999.64
|
| Rate for Payer: PHP Commercial |
$999.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$764.43
|
| Rate for Payer: Priority Health SBD |
$740.91
|
| Rate for Payer: UMR Bronson Commercial |
$517.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$882.04
|
|
|
HC FOREIGN BODY REMOVAL MUSCLE OR TENDON SHEATH SIMPLE
|
Facility
|
OP
|
$1,176.05
|
|
|
Service Code
|
CPT 20520
|
| Hospital Charge Code |
76100133
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$141.36 |
| Max. Negotiated Rate |
$4,989.41 |
| Rate for Payer: Aetna American Axle |
$764.43
|
| Rate for Payer: Aetna Commercial |
$999.64
|
| Rate for Payer: Aetna Medicare |
$1,650.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$764.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,984.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,984.35
|
| Rate for Payer: BCBS Complete |
$893.43
|
| Rate for Payer: BCBS MAPPO |
$1,587.48
|
| Rate for Payer: BCBS Trust/PPO |
$1,681.90
|
| Rate for Payer: BCN Commercial |
$1,681.90
|
| Rate for Payer: BCN Medicare Advantage |
$1,587.48
|
| Rate for Payer: Cash Price |
$940.84
|
| Rate for Payer: Cash Price |
$940.84
|
| Rate for Payer: Cash Price |
$940.84
|
| Rate for Payer: Cofinity Commercial |
$823.24
|
| Rate for Payer: Cofinity Commercial |
$1,011.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$823.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$940.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,587.48
|
| Rate for Payer: Healthscope Commercial |
$1,058.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$823.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$882.04
|
| Rate for Payer: Mclaren Medicaid |
$850.89
|
| Rate for Payer: Mclaren Medicare |
$1,587.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,666.85
|
| Rate for Payer: Meridian Medicaid |
$893.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,825.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$999.64
|
| Rate for Payer: Nomi Health Commercial |
$3,333.71
|
| Rate for Payer: PACE Medicare |
$1,508.11
|
| Rate for Payer: PACE SWMI |
$1,587.48
|
| Rate for Payer: PHP Commercial |
$999.64
|
| Rate for Payer: PHP Medicare Advantage |
$1,587.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$850.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$764.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,989.41
|
| Rate for Payer: Priority Health Medicare |
$1,587.48
|
| Rate for Payer: Priority Health Narrow Network |
$3,991.53
|
| Rate for Payer: Priority Health SBD |
$740.91
|
| Rate for Payer: Railroad Medicare Medicare |
$1,587.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$155.50
|
| Rate for Payer: UHC Core |
$981.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,587.48
|
| Rate for Payer: UHC Exchange |
$141.36
|
| Rate for Payer: UHC Medicare Advantage |
$1,587.48
|
| Rate for Payer: UHCCP Medicaid |
$850.89
|
| Rate for Payer: UMR Bronson Commercial |
$435.14
|
| Rate for Payer: VA VA |
$1,587.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$882.04
|
|
|
HC FOREIGN BODY REMOVAL NOSE
|
Facility
|
IP
|
$231.65
|
|
|
Service Code
|
CPT 30300
|
| Hospital Charge Code |
45000059
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$101.93 |
| Max. Negotiated Rate |
$208.48 |
| Rate for Payer: Aetna American Axle |
$150.57
|
| Rate for Payer: Aetna Commercial |
$196.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$150.57
|
| Rate for Payer: Cash Price |
$185.32
|
| Rate for Payer: Cofinity Commercial |
$162.16
|
| Rate for Payer: Cofinity Commercial |
$199.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$162.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$185.32
|
| Rate for Payer: Healthscope Commercial |
$208.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$162.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$173.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$196.90
|
| Rate for Payer: PHP Commercial |
$196.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.57
|
| Rate for Payer: Priority Health SBD |
$145.94
|
| Rate for Payer: UMR Bronson Commercial |
$101.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$173.74
|
|
|
HC FOREIGN BODY REMOVAL NOSE
|
Facility
|
OP
|
$231.65
|
|
|
Service Code
|
CPT 30300
|
| Hospital Charge Code |
45000059
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$67.69 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna American Axle |
$150.57
|
| Rate for Payer: Aetna Commercial |
$196.90
|
| Rate for Payer: Aetna Medicare |
$131.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$150.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.86
|
| Rate for Payer: BCBS Complete |
$71.08
|
| Rate for Payer: BCBS MAPPO |
$126.29
|
| Rate for Payer: BCBS Trust/PPO |
$75.48
|
| Rate for Payer: BCN Commercial |
$75.48
|
| Rate for Payer: BCN Medicare Advantage |
$126.29
|
| Rate for Payer: Cash Price |
$185.32
|
| Rate for Payer: Cash Price |
$185.32
|
| Rate for Payer: Cash Price |
$185.32
|
| Rate for Payer: Cofinity Commercial |
$162.16
|
| Rate for Payer: Cofinity Commercial |
$199.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$162.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$185.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$126.29
|
| Rate for Payer: Healthscope Commercial |
$208.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$162.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$173.74
|
| Rate for Payer: Mclaren Medicaid |
$67.69
|
| Rate for Payer: Mclaren Medicare |
$126.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.60
|
| Rate for Payer: Meridian Medicaid |
$71.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$145.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$196.90
|
| Rate for Payer: Nomi Health Commercial |
$378.87
|
| Rate for Payer: PACE Medicare |
$119.98
|
| Rate for Payer: PACE SWMI |
$126.29
|
| Rate for Payer: PHP Commercial |
$196.90
|
| Rate for Payer: PHP Medicare Advantage |
$126.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$396.95
|
| Rate for Payer: Priority Health Medicare |
$126.29
|
| Rate for Payer: Priority Health Narrow Network |
$317.56
|
| Rate for Payer: Priority Health SBD |
$145.94
|
| Rate for Payer: Railroad Medicare Medicare |
$126.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$127.07
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$126.29
|
| Rate for Payer: UHC Exchange |
$115.52
|
| Rate for Payer: UHC Medicare Advantage |
$126.29
|
| Rate for Payer: UHCCP Medicaid |
$67.69
|
| Rate for Payer: UMR Bronson Commercial |
$85.71
|
| Rate for Payer: VA VA |
$126.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$173.74
|
|
|
HC FOREIGN BODY RETRIEV (VASC)
|
Facility
|
OP
|
$3,897.02
|
|
|
Service Code
|
CPT 37197
|
| Hospital Charge Code |
36100375
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$287.58 |
| Max. Negotiated Rate |
$9,692.51 |
| Rate for Payer: Aetna American Axle |
$2,533.06
|
| Rate for Payer: Aetna Commercial |
$3,312.47
|
| Rate for Payer: Aetna Medicare |
$3,207.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,533.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,854.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,854.82
|
| Rate for Payer: BCBS Complete |
$1,735.60
|
| Rate for Payer: BCBS MAPPO |
$3,083.86
|
| Rate for Payer: BCBS Trust/PPO |
$2,317.94
|
| Rate for Payer: BCN Commercial |
$2,317.94
|
| Rate for Payer: BCN Medicare Advantage |
$3,083.86
|
| Rate for Payer: Cash Price |
$3,117.62
|
| Rate for Payer: Cash Price |
$3,117.62
|
| Rate for Payer: Cash Price |
$3,117.62
|
| Rate for Payer: Cofinity Commercial |
$3,351.44
|
| Rate for Payer: Cofinity Commercial |
$2,727.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,727.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,117.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,083.86
|
| Rate for Payer: Healthscope Commercial |
$3,507.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,727.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,922.76
|
| Rate for Payer: Mclaren Medicaid |
$1,652.95
|
| Rate for Payer: Mclaren Medicare |
$3,083.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,238.05
|
| Rate for Payer: Meridian Medicaid |
$1,735.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,546.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,312.47
|
| Rate for Payer: Nomi Health Commercial |
$6,476.11
|
| Rate for Payer: PACE Medicare |
$2,929.67
|
| Rate for Payer: PACE SWMI |
$3,083.86
|
| Rate for Payer: PHP Commercial |
$3,312.47
|
| Rate for Payer: PHP Medicare Advantage |
$3,083.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,652.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,533.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,692.51
|
| Rate for Payer: Priority Health Medicare |
$3,083.86
|
| Rate for Payer: Priority Health Narrow Network |
$7,754.01
|
| Rate for Payer: Priority Health SBD |
$2,455.12
|
| Rate for Payer: Railroad Medicare Medicare |
$3,083.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$316.34
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,083.86
|
| Rate for Payer: UHC Exchange |
$287.58
|
| Rate for Payer: UHC Medicare Advantage |
$3,083.86
|
| Rate for Payer: UHCCP Medicaid |
$1,652.95
|
| Rate for Payer: UMR Bronson Commercial |
$1,441.90
|
| Rate for Payer: VA VA |
$3,083.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,922.76
|
|
|
HC FOREIGN BODY RETRIEV (VASC)
|
Facility
|
IP
|
$3,897.02
|
|
|
Service Code
|
CPT 37197
|
| Hospital Charge Code |
36100375
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,714.69 |
| Max. Negotiated Rate |
$3,507.32 |
| Rate for Payer: Aetna American Axle |
$2,533.06
|
| Rate for Payer: Aetna Commercial |
$3,312.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,533.06
|
| Rate for Payer: Cash Price |
$3,117.62
|
| Rate for Payer: Cofinity Commercial |
$2,727.91
|
| Rate for Payer: Cofinity Commercial |
$3,351.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,727.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,117.62
|
| Rate for Payer: Healthscope Commercial |
$3,507.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,727.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,922.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,312.47
|
| Rate for Payer: PHP Commercial |
$3,312.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,533.06
|
| Rate for Payer: Priority Health SBD |
$2,455.12
|
| Rate for Payer: UMR Bronson Commercial |
$1,714.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,922.76
|
|
|
HC FORESKIN MANIP W LYSIS ADH AND STRETCH
|
Facility
|
OP
|
$366.59
|
|
|
Service Code
|
CPT 54450
|
| Hospital Charge Code |
76100269
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$54.88 |
| Max. Negotiated Rate |
$748.94 |
| Rate for Payer: Aetna American Axle |
$238.28
|
| Rate for Payer: Aetna Commercial |
$311.60
|
| Rate for Payer: Aetna Medicare |
$247.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$238.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$297.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$297.86
|
| Rate for Payer: BCBS Complete |
$134.11
|
| Rate for Payer: BCBS MAPPO |
$238.29
|
| Rate for Payer: BCBS Trust/PPO |
$181.82
|
| Rate for Payer: BCN Commercial |
$181.82
|
| Rate for Payer: BCN Medicare Advantage |
$238.29
|
| Rate for Payer: Cash Price |
$293.27
|
| Rate for Payer: Cash Price |
$293.27
|
| Rate for Payer: Cash Price |
$293.27
|
| Rate for Payer: Cofinity Commercial |
$315.27
|
| Rate for Payer: Cofinity Commercial |
$256.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$256.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$293.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$238.29
|
| Rate for Payer: Healthscope Commercial |
$329.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$256.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$274.94
|
| Rate for Payer: Mclaren Medicaid |
$127.72
|
| Rate for Payer: Mclaren Medicare |
$238.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$250.20
|
| Rate for Payer: Meridian Medicaid |
$134.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$274.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.60
|
| Rate for Payer: Nomi Health Commercial |
$500.41
|
| Rate for Payer: PACE Medicare |
$226.38
|
| Rate for Payer: PACE SWMI |
$238.29
|
| Rate for Payer: PHP Commercial |
$311.60
|
| Rate for Payer: PHP Medicare Advantage |
$238.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$127.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$748.94
|
| Rate for Payer: Priority Health Medicare |
$238.29
|
| Rate for Payer: Priority Health Narrow Network |
$599.15
|
| Rate for Payer: Priority Health SBD |
$230.95
|
| Rate for Payer: Railroad Medicare Medicare |
$238.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.37
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$238.29
|
| Rate for Payer: UHC Exchange |
$54.88
|
| Rate for Payer: UHC Medicare Advantage |
$238.29
|
| Rate for Payer: UHCCP Medicaid |
$127.72
|
| Rate for Payer: UMR Bronson Commercial |
$135.64
|
| Rate for Payer: VA VA |
$238.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$274.94
|
|
|
HC FORESKIN MANIP W LYSIS ADH AND STRETCH
|
Facility
|
IP
|
$366.59
|
|
|
Service Code
|
CPT 54450
|
| Hospital Charge Code |
76100269
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$161.30 |
| Max. Negotiated Rate |
$329.93 |
| Rate for Payer: Aetna American Axle |
$238.28
|
| Rate for Payer: Aetna Commercial |
$311.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$238.28
|
| Rate for Payer: Cash Price |
$293.27
|
| Rate for Payer: Cofinity Commercial |
$256.61
|
| Rate for Payer: Cofinity Commercial |
$315.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$256.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$293.27
|
| Rate for Payer: Healthscope Commercial |
$329.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$256.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$274.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.60
|
| Rate for Payer: PHP Commercial |
$311.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.28
|
| Rate for Payer: Priority Health SBD |
$230.95
|
| Rate for Payer: UMR Bronson Commercial |
$161.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$274.94
|
|
|
HC FORMALDEHYDE ALLERGY SCREEN
|
Facility
|
IP
|
$24.13
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200017
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.62 |
| Max. Negotiated Rate |
$21.72 |
| Rate for Payer: Aetna American Axle |
$15.68
|
| Rate for Payer: Aetna Commercial |
$20.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.68
|
| Rate for Payer: Cash Price |
$19.30
|
| Rate for Payer: Cofinity Commercial |
$16.89
|
| Rate for Payer: Cofinity Commercial |
$20.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.30
|
| Rate for Payer: Healthscope Commercial |
$21.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.51
|
| Rate for Payer: PHP Commercial |
$20.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.68
|
| Rate for Payer: Priority Health SBD |
$15.20
|
| Rate for Payer: UMR Bronson Commercial |
$10.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.10
|
|
|
HC FORMALDEHYDE ALLERGY SCREEN
|
Facility
|
OP
|
$24.13
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200017
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$21.72 |
| Rate for Payer: Aetna American Axle |
$15.68
|
| Rate for Payer: Aetna Commercial |
$20.51
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$5.04
|
| Rate for Payer: BCN Commercial |
$5.04
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$19.30
|
| Rate for Payer: Cash Price |
$19.30
|
| Rate for Payer: Cofinity Commercial |
$20.75
|
| Rate for Payer: Cofinity Commercial |
$16.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$21.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.10
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.51
|
| Rate for Payer: Nomi Health Commercial |
$7.83
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$20.51
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.37
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$4.30
|
| Rate for Payer: Priority Health SBD |
$15.20
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$5.22
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.80
|
| Rate for Payer: UMR Bronson Commercial |
$8.93
|
| Rate for Payer: VA VA |
$5.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.10
|
|
|
HC FORMALDEHYDE ALLERGY SCREEN REF LAB
|
Facility
|
OP
|
$35.37
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200125
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$31.83 |
| Rate for Payer: Aetna American Axle |
$22.99
|
| Rate for Payer: Aetna Commercial |
$30.06
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$5.04
|
| Rate for Payer: BCN Commercial |
$5.04
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$28.30
|
| Rate for Payer: Cash Price |
$28.30
|
| Rate for Payer: Cofinity Commercial |
$30.42
|
| Rate for Payer: Cofinity Commercial |
$24.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$31.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.53
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.06
|
| Rate for Payer: Nomi Health Commercial |
$7.83
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$30.06
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.37
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$4.30
|
| Rate for Payer: Priority Health SBD |
$22.28
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$5.22
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.80
|
| Rate for Payer: UMR Bronson Commercial |
$13.09
|
| Rate for Payer: VA VA |
$5.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.53
|
|
|
HC FORMALDEHYDE ALLERGY SCREEN REF LAB
|
Facility
|
IP
|
$35.37
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200125
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.56 |
| Max. Negotiated Rate |
$31.83 |
| Rate for Payer: Aetna American Axle |
$22.99
|
| Rate for Payer: Aetna Commercial |
$30.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.99
|
| Rate for Payer: Cash Price |
$28.30
|
| Rate for Payer: Cofinity Commercial |
$24.76
|
| Rate for Payer: Cofinity Commercial |
$30.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.30
|
| Rate for Payer: Healthscope Commercial |
$31.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.06
|
| Rate for Payer: PHP Commercial |
$30.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.99
|
| Rate for Payer: Priority Health SBD |
$22.28
|
| Rate for Payer: UMR Bronson Commercial |
$15.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.53
|
|
|
HC FRACTURE/DISLOCATION TX LEVEL 1
|
Facility
|
OP
|
$690.61
|
|
| Hospital Charge Code |
45000044
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$255.53 |
| Max. Negotiated Rate |
$621.55 |
| Rate for Payer: Aetna American Axle |
$448.90
|
| Rate for Payer: Aetna Commercial |
$587.02
|
| Rate for Payer: Aetna Medicare |
$345.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$448.90
|
| Rate for Payer: BCBS Complete |
$276.24
|
| Rate for Payer: Cash Price |
$552.49
|
| Rate for Payer: Cofinity Commercial |
$483.43
|
| Rate for Payer: Cofinity Commercial |
$593.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$483.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$552.49
|
| Rate for Payer: Healthscope Commercial |
$621.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$483.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$517.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$587.02
|
| Rate for Payer: PHP Commercial |
$587.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$448.90
|
| Rate for Payer: Priority Health SBD |
$435.08
|
| Rate for Payer: UMR Bronson Commercial |
$255.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$517.96
|
|
|
HC FRACTURE/DISLOCATION TX LEVEL 1
|
Facility
|
IP
|
$690.61
|
|
| Hospital Charge Code |
45000044
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$303.87 |
| Max. Negotiated Rate |
$621.55 |
| Rate for Payer: Aetna American Axle |
$448.90
|
| Rate for Payer: Aetna Commercial |
$587.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$448.90
|
| Rate for Payer: Cash Price |
$552.49
|
| Rate for Payer: Cofinity Commercial |
$483.43
|
| Rate for Payer: Cofinity Commercial |
$593.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$483.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$552.49
|
| Rate for Payer: Healthscope Commercial |
$621.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$483.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$517.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$587.02
|
| Rate for Payer: PHP Commercial |
$587.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$448.90
|
| Rate for Payer: Priority Health SBD |
$435.08
|
| Rate for Payer: UMR Bronson Commercial |
$303.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$517.96
|
|
|
HC FRACTURE/DISLOCATION TX LEVEL II
|
Facility
|
IP
|
$3,041.50
|
|
| Hospital Charge Code |
45000104
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,338.26 |
| Max. Negotiated Rate |
$2,737.35 |
| Rate for Payer: Aetna American Axle |
$1,976.98
|
| Rate for Payer: Aetna Commercial |
$2,585.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,976.98
|
| Rate for Payer: Cash Price |
$2,433.20
|
| Rate for Payer: Cofinity Commercial |
$2,129.05
|
| Rate for Payer: Cofinity Commercial |
$2,615.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,129.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,433.20
|
| Rate for Payer: Healthscope Commercial |
$2,737.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,129.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,281.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,585.28
|
| Rate for Payer: PHP Commercial |
$2,585.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,976.98
|
| Rate for Payer: Priority Health SBD |
$1,916.14
|
| Rate for Payer: UMR Bronson Commercial |
$1,338.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,281.12
|
|
