|
HC TETANUS AND DIPTHERIA TOXOIDS ADSORDED (TD), PF, 7 YRS OR OLDER IM
|
Facility
|
OP
|
$38.76
|
|
|
Service Code
|
CPT 90714
|
| Hospital Charge Code |
63600083
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.34 |
| Max. Negotiated Rate |
$111.61 |
| Rate for Payer: Aetna American Axle |
$25.19
|
| Rate for Payer: Aetna Commercial |
$32.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.19
|
| Rate for Payer: BCBS Complete |
$15.50
|
| Rate for Payer: BCBS Trust/PPO |
$111.61
|
| Rate for Payer: Cash Price |
$31.01
|
| Rate for Payer: Cash Price |
$31.01
|
| Rate for Payer: Cofinity Commercial |
$27.13
|
| Rate for Payer: Cofinity Commercial |
$33.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.01
|
| Rate for Payer: Healthscope Commercial |
$34.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.95
|
| Rate for Payer: PHP Commercial |
$32.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.13
|
| Rate for Payer: Priority Health SBD |
$24.42
|
| Rate for Payer: UMR Bronson Commercial |
$14.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.07
|
|
|
HC TETANUS AND DIPTHERIA TOXOIDS ADSORDED (TD), PF, 7 YRS OR OLDER IM
|
Facility
|
IP
|
$38.76
|
|
|
Service Code
|
CPT 90714
|
| Hospital Charge Code |
63600083
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.05 |
| Max. Negotiated Rate |
$34.88 |
| Rate for Payer: Aetna American Axle |
$25.19
|
| Rate for Payer: Aetna Commercial |
$32.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.19
|
| Rate for Payer: Cash Price |
$31.01
|
| Rate for Payer: Cofinity Commercial |
$27.13
|
| Rate for Payer: Cofinity Commercial |
$33.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.01
|
| Rate for Payer: Healthscope Commercial |
$34.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.95
|
| Rate for Payer: PHP Commercial |
$32.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.13
|
| Rate for Payer: Priority Health SBD |
$24.42
|
| Rate for Payer: UMR Bronson Commercial |
$17.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.07
|
|
|
HC TETANUS ANTIBODIES
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
CPT 86774
|
| Hospital Charge Code |
30200320
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$54.00 |
| Rate for Payer: Aetna American Axle |
$39.00
|
| Rate for Payer: Aetna Commercial |
$51.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cofinity Commercial |
$42.00
|
| Rate for Payer: Cofinity Commercial |
$51.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.00
|
| Rate for Payer: Healthscope Commercial |
$54.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.00
|
| Rate for Payer: PHP Commercial |
$51.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.00
|
| Rate for Payer: Priority Health SBD |
$37.80
|
| Rate for Payer: UMR Bronson Commercial |
$26.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.00
|
|
|
HC TETANUS ANTIBODIES
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
CPT 86774
|
| Hospital Charge Code |
30200320
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.10 |
| Max. Negotiated Rate |
$54.00 |
| Rate for Payer: Aetna American Axle |
$39.00
|
| Rate for Payer: Aetna Commercial |
$51.00
|
| Rate for Payer: Aetna Medicare |
$15.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.50
|
| Rate for Payer: BCBS Complete |
$8.50
|
| Rate for Payer: BCBS MAPPO |
$14.80
|
| Rate for Payer: BCBS Trust/PPO |
$13.31
|
| Rate for Payer: BCN Medicare Advantage |
$14.80
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cofinity Commercial |
$42.00
|
| Rate for Payer: Cofinity Commercial |
$51.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.80
|
| Rate for Payer: Healthscope Commercial |
$54.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.00
|
| Rate for Payer: Mclaren Medicaid |
$8.10
|
| Rate for Payer: Mclaren Medicare |
$14.80
|
| Rate for Payer: Meridian Medicaid |
$8.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.00
|
| Rate for Payer: PACE Medicare |
$14.06
|
| Rate for Payer: PACE SWMI |
$14.80
|
| Rate for Payer: PHP Commercial |
$51.00
|
| Rate for Payer: PHP Medicare Advantage |
$14.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.23
|
| Rate for Payer: Priority Health Medicare |
$14.80
|
| Rate for Payer: Priority Health Narrow Network |
$14.58
|
| Rate for Payer: Priority Health SBD |
$37.80
|
| Rate for Payer: Railroad Medicare Medicare |
$14.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.76
|
| Rate for Payer: UHC Core |
$24.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.80
|
| Rate for Payer: UHC Exchange |
$14.80
|
| Rate for Payer: UHC Medicare Advantage |
$15.24
|
| Rate for Payer: UMR Bronson Commercial |
$22.20
|
| Rate for Payer: VA VA |
$14.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.00
|
|
|
HC TETANUS/DIPHTHERIA/PERTUSIS VACCINE
|
Facility
|
OP
|
$122.18
|
|
|
Service Code
|
CPT 90715
|
| Hospital Charge Code |
63600022
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$45.21 |
| Max. Negotiated Rate |
$128.39 |
| Rate for Payer: Aetna American Axle |
$79.42
|
| Rate for Payer: Aetna Commercial |
$103.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.42
|
| Rate for Payer: BCBS Complete |
$48.87
|
| Rate for Payer: BCBS Trust/PPO |
$128.39
|
| Rate for Payer: Cash Price |
$97.74
|
| Rate for Payer: Cash Price |
$97.74
|
| Rate for Payer: Cofinity Commercial |
$105.07
|
| Rate for Payer: Cofinity Commercial |
$85.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.74
|
| Rate for Payer: Healthscope Commercial |
$109.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$85.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$103.85
|
| Rate for Payer: PHP Commercial |
$103.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.53
|
| Rate for Payer: Priority Health SBD |
$76.97
|
| Rate for Payer: UMR Bronson Commercial |
$45.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.64
|
|
|
HC TETANUS/DIPHTHERIA/PERTUSIS VACCINE
|
Facility
|
IP
|
$122.18
|
|
|
Service Code
|
CPT 90715
|
| Hospital Charge Code |
63600022
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$53.76 |
| Max. Negotiated Rate |
$109.96 |
| Rate for Payer: Aetna American Axle |
$79.42
|
| Rate for Payer: Aetna Commercial |
$103.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.42
|
| Rate for Payer: Cash Price |
$97.74
|
| Rate for Payer: Cofinity Commercial |
$105.07
|
| Rate for Payer: Cofinity Commercial |
$85.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.74
|
| Rate for Payer: Healthscope Commercial |
$109.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$85.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$103.85
|
| Rate for Payer: PHP Commercial |
$103.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.53
|
| Rate for Payer: Priority Health SBD |
$76.97
|
| Rate for Payer: UMR Bronson Commercial |
$53.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.64
|
|
|
HC THC URINE CONFIRM
|
Facility
|
IP
|
$62.00
|
|
|
Service Code
|
CPT 80349
|
| Hospital Charge Code |
30100568
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.28 |
| Max. Negotiated Rate |
$55.80 |
| Rate for Payer: Aetna American Axle |
$40.30
|
| Rate for Payer: Aetna Commercial |
$52.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.30
|
| Rate for Payer: Cash Price |
$49.60
|
| Rate for Payer: Cofinity Commercial |
$43.40
|
| Rate for Payer: Cofinity Commercial |
$53.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.60
|
| Rate for Payer: Healthscope Commercial |
$55.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.70
|
| Rate for Payer: PHP Commercial |
$52.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.40
|
| Rate for Payer: Priority Health SBD |
$39.06
|
| Rate for Payer: UMR Bronson Commercial |
$27.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.50
|
|
|
HC THC URINE CONFIRM
|
Facility
|
OP
|
$62.00
|
|
|
Service Code
|
CPT 80349
|
| Hospital Charge Code |
30100568
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.94 |
| Max. Negotiated Rate |
$55.80 |
| Rate for Payer: Aetna American Axle |
$40.30
|
| Rate for Payer: Aetna Commercial |
$52.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.30
|
| Rate for Payer: BCBS Complete |
$24.80
|
| Rate for Payer: Cash Price |
$49.60
|
| Rate for Payer: Cash Price |
$49.60
|
| Rate for Payer: Cofinity Commercial |
$43.40
|
| Rate for Payer: Cofinity Commercial |
$53.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.60
|
| Rate for Payer: Healthscope Commercial |
$55.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.70
|
| Rate for Payer: PHP Commercial |
$52.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.40
|
| Rate for Payer: Priority Health SBD |
$39.06
|
| Rate for Payer: UHC Core |
$29.32
|
| Rate for Payer: UMR Bronson Commercial |
$22.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.50
|
|
|
HC THEOPHYLLINE LEVEL
|
Facility
|
IP
|
$90.40
|
|
|
Service Code
|
CPT 80198
|
| Hospital Charge Code |
30100048
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$39.78 |
| Max. Negotiated Rate |
$81.36 |
| Rate for Payer: Aetna American Axle |
$58.76
|
| Rate for Payer: Aetna Commercial |
$76.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.76
|
| Rate for Payer: Cash Price |
$72.32
|
| Rate for Payer: Cofinity Commercial |
$63.28
|
| Rate for Payer: Cofinity Commercial |
$77.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.32
|
| Rate for Payer: Healthscope Commercial |
$81.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$63.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.84
|
| Rate for Payer: PHP Commercial |
$76.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.28
|
| Rate for Payer: Priority Health SBD |
$56.95
|
| Rate for Payer: UMR Bronson Commercial |
$39.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.80
|
|
|
HC THEOPHYLLINE LEVEL
|
Facility
|
OP
|
$90.40
|
|
|
Service Code
|
CPT 80198
|
| Hospital Charge Code |
30100048
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.73 |
| Max. Negotiated Rate |
$81.36 |
| Rate for Payer: Aetna American Axle |
$58.76
|
| Rate for Payer: Aetna Commercial |
$76.84
|
| Rate for Payer: Aetna Medicare |
$14.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.68
|
| Rate for Payer: BCBS Complete |
$8.12
|
| Rate for Payer: BCBS MAPPO |
$14.14
|
| Rate for Payer: BCBS Trust/PPO |
$12.72
|
| Rate for Payer: BCN Medicare Advantage |
$14.14
|
| Rate for Payer: Cash Price |
$72.32
|
| Rate for Payer: Cash Price |
$72.32
|
| Rate for Payer: Cofinity Commercial |
$63.28
|
| Rate for Payer: Cofinity Commercial |
$77.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.14
|
| Rate for Payer: Healthscope Commercial |
$81.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$63.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.80
|
| Rate for Payer: Mclaren Medicaid |
$7.73
|
| Rate for Payer: Mclaren Medicare |
$14.14
|
| Rate for Payer: Meridian Medicaid |
$8.12
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.84
|
| Rate for Payer: PACE Medicare |
$13.43
|
| Rate for Payer: PACE SWMI |
$14.14
|
| Rate for Payer: PHP Commercial |
$76.84
|
| Rate for Payer: PHP Medicare Advantage |
$14.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.01
|
| Rate for Payer: Priority Health Medicare |
$14.14
|
| Rate for Payer: Priority Health Narrow Network |
$10.41
|
| Rate for Payer: Priority Health SBD |
$56.95
|
| Rate for Payer: Railroad Medicare Medicare |
$14.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.97
|
| Rate for Payer: UHC Core |
$23.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.14
|
| Rate for Payer: UHC Exchange |
$14.14
|
| Rate for Payer: UHC Medicare Advantage |
$14.56
|
| Rate for Payer: UMR Bronson Commercial |
$33.45
|
| Rate for Payer: VA VA |
$14.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.80
|
|
|
HC THERAPEUTIC ACTIVITIES EA 15 MIN
|
Facility
|
IP
|
$96.90
|
|
|
Service Code
|
CPT 97530
|
| Hospital Charge Code |
42000028
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$42.64 |
| Max. Negotiated Rate |
$87.21 |
| Rate for Payer: Aetna American Axle |
$62.98
|
| Rate for Payer: Aetna Commercial |
$82.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.98
|
| Rate for Payer: Cash Price |
$77.52
|
| Rate for Payer: Cofinity Commercial |
$67.83
|
| Rate for Payer: Cofinity Commercial |
$83.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.52
|
| Rate for Payer: Healthscope Commercial |
$87.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$67.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$82.36
|
| Rate for Payer: PHP Commercial |
$82.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.83
|
| Rate for Payer: Priority Health SBD |
$61.05
|
| Rate for Payer: UMR Bronson Commercial |
$42.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.68
|
|
|
HC THERAPEUTIC ACTIVITIES EA 15 MIN
|
Facility
|
OP
|
$96.90
|
|
|
Service Code
|
CPT 97530
|
| Hospital Charge Code |
42000028
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$23.20 |
| Max. Negotiated Rate |
$294.00 |
| Rate for Payer: Aetna American Axle |
$62.98
|
| Rate for Payer: Aetna Commercial |
$82.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.98
|
| Rate for Payer: BCBS Complete |
$38.76
|
| Rate for Payer: BCBS Trust/PPO |
$26.03
|
| Rate for Payer: Cash Price |
$77.52
|
| Rate for Payer: Cash Price |
$77.52
|
| Rate for Payer: Cash Price |
$77.52
|
| Rate for Payer: Cofinity Commercial |
$67.83
|
| Rate for Payer: Cofinity Commercial |
$83.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.52
|
| Rate for Payer: Healthscope Commercial |
$87.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$67.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$82.36
|
| Rate for Payer: PHP Commercial |
$82.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$29.00
|
| Rate for Payer: Priority Health Narrow Network |
$23.20
|
| Rate for Payer: Priority Health SBD |
$61.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.62
|
| Rate for Payer: UHC Core |
$294.00
|
| Rate for Payer: UHC Exchange |
$36.02
|
| Rate for Payer: UMR Bronson Commercial |
$35.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.68
|
|
|
HC THERAPEUTIC APHERESIS PLASMA PHERESIS
|
Facility
|
OP
|
$2,505.38
|
|
|
Service Code
|
CPT 36514
|
| Hospital Charge Code |
36100520
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$90.05 |
| Max. Negotiated Rate |
$4,293.39 |
| Rate for Payer: Aetna American Axle |
$1,628.50
|
| Rate for Payer: Aetna Commercial |
$2,129.57
|
| Rate for Payer: Aetna Medicare |
$1,418.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,628.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,704.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,704.79
|
| Rate for Payer: BCBS Complete |
$783.38
|
| Rate for Payer: BCBS MAPPO |
$1,363.83
|
| Rate for Payer: BCBS Trust/PPO |
$1,864.63
|
| Rate for Payer: BCN Medicare Advantage |
$1,363.83
|
| Rate for Payer: Cash Price |
$2,004.30
|
| Rate for Payer: Cash Price |
$2,004.30
|
| Rate for Payer: Cofinity Commercial |
$2,154.63
|
| Rate for Payer: Cofinity Commercial |
$1,753.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,004.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,363.83
|
| Rate for Payer: Healthscope Commercial |
$2,254.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,753.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,879.04
|
| Rate for Payer: Mclaren Medicaid |
$746.02
|
| Rate for Payer: Mclaren Medicare |
$1,363.83
|
| Rate for Payer: Meridian Medicaid |
$783.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,432.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,568.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,129.57
|
| Rate for Payer: PACE Medicare |
$1,295.64
|
| Rate for Payer: PACE SWMI |
$1,363.83
|
| Rate for Payer: PHP Commercial |
$2,129.57
|
| Rate for Payer: PHP Medicare Advantage |
$1,363.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$746.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,753.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,293.39
|
| Rate for Payer: Priority Health Medicare |
$1,363.83
|
| Rate for Payer: Priority Health Narrow Network |
$3,434.71
|
| Rate for Payer: Priority Health SBD |
$1,578.39
|
| Rate for Payer: Railroad Medicare Medicare |
$1,363.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$99.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,363.83
|
| Rate for Payer: UHC Exchange |
$90.05
|
| Rate for Payer: UHC Medicare Advantage |
$1,404.74
|
| Rate for Payer: UMR Bronson Commercial |
$926.99
|
| Rate for Payer: VA VA |
$1,363.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,879.04
|
|
|
HC THERAPEUTIC APHERESIS PLASMA PHERESIS
|
Facility
|
IP
|
$2,505.38
|
|
|
Service Code
|
CPT 36514
|
| Hospital Charge Code |
36100520
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,102.37 |
| Max. Negotiated Rate |
$2,254.84 |
| Rate for Payer: Aetna American Axle |
$1,628.50
|
| Rate for Payer: Aetna Commercial |
$2,129.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,628.50
|
| Rate for Payer: Cash Price |
$2,004.30
|
| Rate for Payer: Cofinity Commercial |
$2,154.63
|
| Rate for Payer: Cofinity Commercial |
$1,753.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,004.30
|
| Rate for Payer: Healthscope Commercial |
$2,254.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,753.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,879.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,129.57
|
| Rate for Payer: PHP Commercial |
$2,129.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,753.77
|
| Rate for Payer: Priority Health SBD |
$1,578.39
|
| Rate for Payer: UMR Bronson Commercial |
$1,102.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,879.04
|
|
|
HC THERAPEUTIC APHERESIS RED BLOOD CELLS
|
Facility
|
IP
|
$2,432.40
|
|
|
Service Code
|
CPT 36512
|
| Hospital Charge Code |
76100326
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,070.26 |
| Max. Negotiated Rate |
$2,189.16 |
| Rate for Payer: Aetna American Axle |
$1,581.06
|
| Rate for Payer: Aetna Commercial |
$2,067.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,581.06
|
| Rate for Payer: Cash Price |
$1,945.92
|
| Rate for Payer: Cofinity Commercial |
$2,091.86
|
| Rate for Payer: Cofinity Commercial |
$1,702.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,945.92
|
| Rate for Payer: Healthscope Commercial |
$2,189.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,702.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,824.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,067.54
|
| Rate for Payer: PHP Commercial |
$2,067.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,702.68
|
| Rate for Payer: Priority Health SBD |
$1,532.41
|
| Rate for Payer: UMR Bronson Commercial |
$1,070.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,824.30
|
|
|
HC THERAPEUTIC APHERESIS RED BLOOD CELLS
|
Facility
|
OP
|
$2,432.40
|
|
|
Service Code
|
CPT 36512
|
| Hospital Charge Code |
76100326
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$102.16 |
| Max. Negotiated Rate |
$4,293.39 |
| Rate for Payer: Aetna American Axle |
$1,581.06
|
| Rate for Payer: Aetna Commercial |
$2,067.54
|
| Rate for Payer: Aetna Medicare |
$1,418.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,581.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,704.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,704.79
|
| Rate for Payer: BCBS Complete |
$783.38
|
| Rate for Payer: BCBS MAPPO |
$1,363.83
|
| Rate for Payer: BCBS Trust/PPO |
$1,085.89
|
| Rate for Payer: BCN Medicare Advantage |
$1,363.83
|
| Rate for Payer: Cash Price |
$1,945.92
|
| Rate for Payer: Cash Price |
$1,945.92
|
| Rate for Payer: Cofinity Commercial |
$1,702.68
|
| Rate for Payer: Cofinity Commercial |
$2,091.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,945.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,363.83
|
| Rate for Payer: Healthscope Commercial |
$2,189.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,702.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,824.30
|
| Rate for Payer: Mclaren Medicaid |
$746.02
|
| Rate for Payer: Mclaren Medicare |
$1,363.83
|
| Rate for Payer: Meridian Medicaid |
$783.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,432.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,568.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,067.54
|
| Rate for Payer: PACE Medicare |
$1,295.64
|
| Rate for Payer: PACE SWMI |
$1,363.83
|
| Rate for Payer: PHP Commercial |
$2,067.54
|
| Rate for Payer: PHP Medicare Advantage |
$1,363.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$746.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,702.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,293.39
|
| Rate for Payer: Priority Health Medicare |
$1,363.83
|
| Rate for Payer: Priority Health Narrow Network |
$3,434.71
|
| Rate for Payer: Priority Health SBD |
$1,532.41
|
| Rate for Payer: Railroad Medicare Medicare |
$1,363.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$112.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,363.83
|
| Rate for Payer: UHC Exchange |
$102.16
|
| Rate for Payer: UHC Medicare Advantage |
$1,404.74
|
| Rate for Payer: UMR Bronson Commercial |
$899.99
|
| Rate for Payer: VA VA |
$1,363.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,824.30
|
|
|
HC THERAPEUTIC APHERESIS WHITE BLOOD CELL
|
Facility
|
OP
|
$2,432.40
|
|
|
Service Code
|
CPT 36511
|
| Hospital Charge Code |
76100327
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$107.40 |
| Max. Negotiated Rate |
$4,293.39 |
| Rate for Payer: Aetna American Axle |
$1,581.06
|
| Rate for Payer: Aetna Commercial |
$2,067.54
|
| Rate for Payer: Aetna Medicare |
$1,418.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,581.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,704.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,704.79
|
| Rate for Payer: BCBS Complete |
$783.38
|
| Rate for Payer: BCBS MAPPO |
$1,363.83
|
| Rate for Payer: BCBS Trust/PPO |
$881.68
|
| Rate for Payer: BCN Medicare Advantage |
$1,363.83
|
| Rate for Payer: Cash Price |
$1,945.92
|
| Rate for Payer: Cash Price |
$1,945.92
|
| Rate for Payer: Cofinity Commercial |
$1,702.68
|
| Rate for Payer: Cofinity Commercial |
$2,091.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,945.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,363.83
|
| Rate for Payer: Healthscope Commercial |
$2,189.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,702.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,824.30
|
| Rate for Payer: Mclaren Medicaid |
$746.02
|
| Rate for Payer: Mclaren Medicare |
$1,363.83
|
| Rate for Payer: Meridian Medicaid |
$783.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,432.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,568.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,067.54
|
| Rate for Payer: PACE Medicare |
$1,295.64
|
| Rate for Payer: PACE SWMI |
$1,363.83
|
| Rate for Payer: PHP Commercial |
$2,067.54
|
| Rate for Payer: PHP Medicare Advantage |
$1,363.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$746.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,702.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,293.39
|
| Rate for Payer: Priority Health Medicare |
$1,363.83
|
| Rate for Payer: Priority Health Narrow Network |
$3,434.71
|
| Rate for Payer: Priority Health SBD |
$1,532.41
|
| Rate for Payer: Railroad Medicare Medicare |
$1,363.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$118.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,363.83
|
| Rate for Payer: UHC Exchange |
$107.40
|
| Rate for Payer: UHC Medicare Advantage |
$1,404.74
|
| Rate for Payer: UMR Bronson Commercial |
$899.99
|
| Rate for Payer: VA VA |
$1,363.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,824.30
|
|
|
HC THERAPEUTIC APHERESIS WHITE BLOOD CELL
|
Facility
|
IP
|
$2,432.40
|
|
|
Service Code
|
CPT 36511
|
| Hospital Charge Code |
76100327
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,070.26 |
| Max. Negotiated Rate |
$2,189.16 |
| Rate for Payer: Aetna American Axle |
$1,581.06
|
| Rate for Payer: Aetna Commercial |
$2,067.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,581.06
|
| Rate for Payer: Cash Price |
$1,945.92
|
| Rate for Payer: Cofinity Commercial |
$1,702.68
|
| Rate for Payer: Cofinity Commercial |
$2,091.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,945.92
|
| Rate for Payer: Healthscope Commercial |
$2,189.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,702.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,824.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,067.54
|
| Rate for Payer: PHP Commercial |
$2,067.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,702.68
|
| Rate for Payer: Priority Health SBD |
$1,532.41
|
| Rate for Payer: UMR Bronson Commercial |
$1,070.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,824.30
|
|
|
HC THERAPEUTIC EX EACH 15 MIN
|
Facility
|
IP
|
$112.20
|
|
|
Service Code
|
CPT 97110
|
| Hospital Charge Code |
42000020
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$49.37 |
| Max. Negotiated Rate |
$100.98 |
| Rate for Payer: Aetna American Axle |
$72.93
|
| Rate for Payer: Aetna Commercial |
$95.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.93
|
| Rate for Payer: Cash Price |
$89.76
|
| Rate for Payer: Cofinity Commercial |
$78.54
|
| Rate for Payer: Cofinity Commercial |
$96.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.76
|
| Rate for Payer: Healthscope Commercial |
$100.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$78.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$95.37
|
| Rate for Payer: PHP Commercial |
$95.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.54
|
| Rate for Payer: Priority Health SBD |
$70.69
|
| Rate for Payer: UMR Bronson Commercial |
$49.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.15
|
|
|
HC THERAPEUTIC EX EACH 15 MIN
|
Facility
|
OP
|
$112.20
|
|
|
Service Code
|
CPT 97110
|
| Hospital Charge Code |
42000020
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$20.64 |
| Max. Negotiated Rate |
$294.00 |
| Rate for Payer: Aetna American Axle |
$72.93
|
| Rate for Payer: Aetna Commercial |
$95.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.93
|
| Rate for Payer: BCBS Complete |
$44.88
|
| Rate for Payer: BCBS Trust/PPO |
$20.64
|
| Rate for Payer: Cash Price |
$89.76
|
| Rate for Payer: Cash Price |
$89.76
|
| Rate for Payer: Cash Price |
$89.76
|
| Rate for Payer: Cofinity Commercial |
$78.54
|
| Rate for Payer: Cofinity Commercial |
$96.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.76
|
| Rate for Payer: Healthscope Commercial |
$100.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$78.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$95.37
|
| Rate for Payer: PHP Commercial |
$95.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$28.00
|
| Rate for Payer: Priority Health Narrow Network |
$22.40
|
| Rate for Payer: Priority Health SBD |
$70.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.69
|
| Rate for Payer: UHC Core |
$294.00
|
| Rate for Payer: UHC Exchange |
$28.81
|
| Rate for Payer: UMR Bronson Commercial |
$41.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.15
|
|
|
HC THERAPEUTIC PHLEBOTOMY
|
Facility
|
OP
|
$846.31
|
|
|
Service Code
|
CPT 99195
|
| Hospital Charge Code |
76100010
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$62.11 |
| Max. Negotiated Rate |
$761.68 |
| Rate for Payer: Aetna American Axle |
$550.10
|
| Rate for Payer: Aetna Commercial |
$719.36
|
| Rate for Payer: Aetna Medicare |
$118.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$550.10
|
| 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 |
$475.88
|
| Rate for Payer: BCN Medicare Advantage |
$113.55
|
| Rate for Payer: Cash Price |
$677.05
|
| Rate for Payer: Cash Price |
$677.05
|
| Rate for Payer: Cofinity Commercial |
$727.83
|
| Rate for Payer: Cofinity Commercial |
$592.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$677.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$113.55
|
| Rate for Payer: Healthscope Commercial |
$761.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$592.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$634.73
|
| 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 |
$719.36
|
| Rate for Payer: PACE Medicare |
$107.87
|
| Rate for Payer: PACE SWMI |
$113.55
|
| Rate for Payer: PHP Commercial |
$719.36
|
| 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 |
$592.42
|
| 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 |
$533.18
|
| Rate for Payer: Railroad Medicare Medicare |
$113.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$103.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$113.55
|
| Rate for Payer: UHC Exchange |
$93.98
|
| Rate for Payer: UHC Medicare Advantage |
$116.96
|
| Rate for Payer: UMR Bronson Commercial |
$313.13
|
| Rate for Payer: VA VA |
$113.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$634.73
|
|
|
HC THERAPEUTIC PHLEBOTOMY
|
Facility
|
IP
|
$846.31
|
|
|
Service Code
|
CPT 99195
|
| Hospital Charge Code |
76100010
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$372.38 |
| Max. Negotiated Rate |
$761.68 |
| Rate for Payer: Aetna American Axle |
$550.10
|
| Rate for Payer: Aetna Commercial |
$719.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$550.10
|
| Rate for Payer: Cash Price |
$677.05
|
| Rate for Payer: Cofinity Commercial |
$592.42
|
| Rate for Payer: Cofinity Commercial |
$727.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$677.05
|
| Rate for Payer: Healthscope Commercial |
$761.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$592.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$634.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$719.36
|
| Rate for Payer: PHP Commercial |
$719.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$592.42
|
| Rate for Payer: Priority Health SBD |
$533.18
|
| Rate for Payer: UMR Bronson Commercial |
$372.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$634.73
|
|
|
HC THERASKIN PER SQ CM (116 SQ CM)
|
Facility
|
IP
|
$58.26
|
|
|
Service Code
|
HCPCS Q4121
|
| Hospital Charge Code |
63600219
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.63 |
| Max. Negotiated Rate |
$52.43 |
| Rate for Payer: Aetna American Axle |
$37.87
|
| Rate for Payer: Aetna Commercial |
$49.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.87
|
| Rate for Payer: Cash Price |
$46.61
|
| Rate for Payer: Cofinity Commercial |
$40.78
|
| Rate for Payer: Cofinity Commercial |
$50.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.61
|
| Rate for Payer: Healthscope Commercial |
$52.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$40.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$49.52
|
| Rate for Payer: PHP Commercial |
$49.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.78
|
| Rate for Payer: Priority Health SBD |
$36.70
|
| Rate for Payer: UMR Bronson Commercial |
$25.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.70
|
|
|
HC THERASKIN PER SQ CM (116 SQ CM)
|
Facility
|
OP
|
$58.26
|
|
|
Service Code
|
HCPCS Q4121
|
| Hospital Charge Code |
63600219
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.56 |
| Max. Negotiated Rate |
$52.43 |
| Rate for Payer: Aetna American Axle |
$37.87
|
| Rate for Payer: Aetna Commercial |
$49.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.87
|
| Rate for Payer: BCBS Complete |
$23.30
|
| Rate for Payer: BCBS Trust/PPO |
$37.12
|
| Rate for Payer: Cash Price |
$46.61
|
| Rate for Payer: Cash Price |
$46.61
|
| Rate for Payer: Cofinity Commercial |
$40.78
|
| Rate for Payer: Cofinity Commercial |
$50.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.61
|
| Rate for Payer: Healthscope Commercial |
$52.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$40.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$49.52
|
| Rate for Payer: PHP Commercial |
$49.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.78
|
| Rate for Payer: Priority Health SBD |
$36.70
|
| Rate for Payer: UMR Bronson Commercial |
$21.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.70
|
|
|
HC THERASKIN PER SQ CM (13 SQ CM)
|
Facility
|
IP
|
$180.52
|
|
|
Service Code
|
CPT Q4121
|
| Hospital Charge Code |
63600064
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$79.43 |
| Max. Negotiated Rate |
$162.47 |
| Rate for Payer: Aetna American Axle |
$117.34
|
| Rate for Payer: Aetna Commercial |
$153.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.34
|
| Rate for Payer: Cash Price |
$144.42
|
| Rate for Payer: Cofinity Commercial |
$155.25
|
| Rate for Payer: Cofinity Commercial |
$126.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.42
|
| Rate for Payer: Healthscope Commercial |
$162.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$126.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$153.44
|
| Rate for Payer: PHP Commercial |
$153.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.36
|
| Rate for Payer: Priority Health SBD |
$113.73
|
| Rate for Payer: UMR Bronson Commercial |
$79.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.39
|
|
