|
HC USTEKINUMAB AND AB CMPT
|
Facility
|
IP
|
$162.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100674
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$71.28 |
| Max. Negotiated Rate |
$145.80 |
| Rate for Payer: Aetna American Axle |
$105.30
|
| Rate for Payer: Aetna Commercial |
$137.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.30
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Cofinity Commercial |
$139.32
|
| Rate for Payer: Cofinity Commercial |
$113.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.60
|
| Rate for Payer: Healthscope Commercial |
$145.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$113.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$121.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$137.70
|
| Rate for Payer: PHP Commercial |
$137.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.40
|
| Rate for Payer: Priority Health SBD |
$102.06
|
| Rate for Payer: UMR Bronson Commercial |
$71.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$121.50
|
|
|
HC USTEKINUMAB AND ANTI-USTEK AB
|
Facility
|
OP
|
$148.00
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
30100708
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.72 |
| Max. Negotiated Rate |
$133.20 |
| Rate for Payer: Aetna American Axle |
$96.20
|
| Rate for Payer: Aetna Commercial |
$125.80
|
| Rate for Payer: Aetna Medicare |
$14.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.65
|
| Rate for Payer: BCBS Complete |
$8.11
|
| Rate for Payer: BCBS MAPPO |
$14.12
|
| Rate for Payer: BCBS Trust/PPO |
$12.70
|
| Rate for Payer: BCN Medicare Advantage |
$14.12
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Cofinity Commercial |
$103.60
|
| Rate for Payer: Cofinity Commercial |
$127.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.12
|
| Rate for Payer: Healthscope Commercial |
$133.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$103.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.00
|
| Rate for Payer: Mclaren Medicaid |
$7.72
|
| Rate for Payer: Mclaren Medicare |
$14.12
|
| Rate for Payer: Meridian Medicaid |
$8.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$125.80
|
| Rate for Payer: PACE Medicare |
$13.41
|
| Rate for Payer: PACE SWMI |
$14.12
|
| Rate for Payer: PHP Commercial |
$125.80
|
| Rate for Payer: PHP Medicare Advantage |
$14.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.84
|
| Rate for Payer: Priority Health Medicare |
$14.12
|
| Rate for Payer: Priority Health Narrow Network |
$9.47
|
| Rate for Payer: Priority Health SBD |
$93.24
|
| Rate for Payer: Railroad Medicare Medicare |
$14.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.94
|
| Rate for Payer: UHC Core |
$23.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.12
|
| Rate for Payer: UHC Exchange |
$14.12
|
| Rate for Payer: UHC Medicare Advantage |
$14.54
|
| Rate for Payer: UMR Bronson Commercial |
$54.76
|
| Rate for Payer: VA VA |
$14.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.00
|
|
|
HC USTEKINUMAB AND ANTI-USTEK AB
|
Facility
|
IP
|
$148.00
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
30100708
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$65.12 |
| Max. Negotiated Rate |
$133.20 |
| Rate for Payer: Aetna American Axle |
$96.20
|
| Rate for Payer: Aetna Commercial |
$125.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.20
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Cofinity Commercial |
$103.60
|
| Rate for Payer: Cofinity Commercial |
$127.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.40
|
| Rate for Payer: Healthscope Commercial |
$133.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$103.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$125.80
|
| Rate for Payer: PHP Commercial |
$125.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.60
|
| Rate for Payer: Priority Health SBD |
$93.24
|
| Rate for Payer: UMR Bronson Commercial |
$65.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.00
|
|
|
HC USTEKINUMAB AND ANTI-USTEK AB CMPT
|
Facility
|
OP
|
$162.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100709
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.20 |
| Max. Negotiated Rate |
$145.80 |
| Rate for Payer: Aetna American Axle |
$105.30
|
| Rate for Payer: Aetna Commercial |
$137.70
|
| Rate for Payer: Aetna Medicare |
$19.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.30
|
| Rate for Payer: BCBS Complete |
$10.71
|
| Rate for Payer: BCBS MAPPO |
$18.64
|
| Rate for Payer: BCBS Trust/PPO |
$16.76
|
| Rate for Payer: BCN Medicare Advantage |
$18.64
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Cofinity Commercial |
$139.32
|
| Rate for Payer: Cofinity Commercial |
$113.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.64
|
| Rate for Payer: Healthscope Commercial |
$145.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$113.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$121.50
|
| Rate for Payer: Mclaren Medicaid |
$10.20
|
| Rate for Payer: Mclaren Medicare |
$18.64
|
| Rate for Payer: Meridian Medicaid |
$10.71
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$137.70
|
| Rate for Payer: PACE Medicare |
$17.71
|
| Rate for Payer: PACE SWMI |
$18.64
|
| Rate for Payer: PHP Commercial |
$137.70
|
| Rate for Payer: PHP Medicare Advantage |
$18.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.40
|
| Rate for Payer: Priority Health Medicare |
$18.64
|
| Rate for Payer: Priority Health SBD |
$102.06
|
| Rate for Payer: Railroad Medicare Medicare |
$18.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.37
|
| Rate for Payer: UHC Core |
$22.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.64
|
| Rate for Payer: UHC Exchange |
$18.64
|
| Rate for Payer: UHC Medicare Advantage |
$19.20
|
| Rate for Payer: UMR Bronson Commercial |
$59.94
|
| Rate for Payer: VA VA |
$18.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$121.50
|
|
|
HC USTEKINUMAB AND ANTI-USTEK AB CMPT
|
Facility
|
IP
|
$162.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100709
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$71.28 |
| Max. Negotiated Rate |
$145.80 |
| Rate for Payer: Aetna American Axle |
$105.30
|
| Rate for Payer: Aetna Commercial |
$137.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.30
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Cofinity Commercial |
$113.40
|
| Rate for Payer: Cofinity Commercial |
$139.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.60
|
| Rate for Payer: Healthscope Commercial |
$145.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$113.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$121.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$137.70
|
| Rate for Payer: PHP Commercial |
$137.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.40
|
| Rate for Payer: Priority Health SBD |
$102.06
|
| Rate for Payer: UMR Bronson Commercial |
$71.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$121.50
|
|
|
HC US TRANSPLANTED KIDNEY
|
Facility
|
IP
|
$500.38
|
|
|
Service Code
|
CPT 76776
|
| Hospital Charge Code |
40200013
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$220.17 |
| Max. Negotiated Rate |
$450.34 |
| Rate for Payer: Aetna American Axle |
$325.25
|
| Rate for Payer: Aetna Commercial |
$425.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$325.25
|
| Rate for Payer: Cash Price |
$400.30
|
| Rate for Payer: Cofinity Commercial |
$350.27
|
| Rate for Payer: Cofinity Commercial |
$430.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$400.30
|
| Rate for Payer: Healthscope Commercial |
$450.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$350.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$375.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$425.32
|
| Rate for Payer: PHP Commercial |
$425.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$350.27
|
| Rate for Payer: Priority Health SBD |
$315.24
|
| Rate for Payer: UMR Bronson Commercial |
$220.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$375.28
|
|
|
HC US TRANSPLANTED KIDNEY
|
Facility
|
OP
|
$500.38
|
|
|
Service Code
|
CPT 76776
|
| Hospital Charge Code |
40200013
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$53.45 |
| Max. Negotiated Rate |
$450.34 |
| Rate for Payer: Aetna American Axle |
$325.25
|
| Rate for Payer: Aetna Commercial |
$425.32
|
| Rate for Payer: Aetna Medicare |
$101.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$325.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.15
|
| Rate for Payer: BCBS Complete |
$56.13
|
| Rate for Payer: BCBS MAPPO |
$97.72
|
| Rate for Payer: BCBS Trust/PPO |
$214.75
|
| Rate for Payer: BCN Medicare Advantage |
$97.72
|
| Rate for Payer: Cash Price |
$400.30
|
| Rate for Payer: Cash Price |
$400.30
|
| Rate for Payer: Cofinity Commercial |
$430.33
|
| Rate for Payer: Cofinity Commercial |
$350.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$400.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.72
|
| Rate for Payer: Healthscope Commercial |
$450.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$350.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$375.28
|
| Rate for Payer: Mclaren Medicaid |
$53.45
|
| Rate for Payer: Mclaren Medicare |
$97.72
|
| Rate for Payer: Meridian Medicaid |
$56.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$425.32
|
| Rate for Payer: PACE Medicare |
$92.83
|
| Rate for Payer: PACE SWMI |
$97.72
|
| Rate for Payer: PHP Commercial |
$425.32
|
| Rate for Payer: PHP Medicare Advantage |
$97.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$350.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$307.65
|
| Rate for Payer: Priority Health Medicare |
$97.72
|
| Rate for Payer: Priority Health Narrow Network |
$246.12
|
| Rate for Payer: Priority Health SBD |
$315.24
|
| Rate for Payer: Railroad Medicare Medicare |
$97.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$159.20
|
| Rate for Payer: UHC Core |
$367.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.72
|
| Rate for Payer: UHC Exchange |
$144.73
|
| Rate for Payer: UHC Medicare Advantage |
$100.65
|
| Rate for Payer: UMR Bronson Commercial |
$185.14
|
| Rate for Payer: VA VA |
$97.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$375.28
|
|
|
HC UVULECTOMY EXCISION UVULA
|
Facility
|
IP
|
$7,900.00
|
|
|
Service Code
|
CPT 42140
|
| Hospital Charge Code |
76100468
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,476.00 |
| Max. Negotiated Rate |
$7,110.00 |
| Rate for Payer: Aetna American Axle |
$5,135.00
|
| Rate for Payer: Aetna Commercial |
$6,715.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,135.00
|
| Rate for Payer: Cash Price |
$6,320.00
|
| Rate for Payer: Cofinity Commercial |
$5,530.00
|
| Rate for Payer: Cofinity Commercial |
$6,794.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,320.00
|
| Rate for Payer: Healthscope Commercial |
$7,110.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,530.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,925.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,715.00
|
| Rate for Payer: PHP Commercial |
$6,715.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,530.00
|
| Rate for Payer: Priority Health SBD |
$4,977.00
|
| Rate for Payer: UMR Bronson Commercial |
$3,476.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,925.00
|
|
|
HC UVULECTOMY EXCISION UVULA
|
Facility
|
OP
|
$7,900.00
|
|
|
Service Code
|
CPT 42140
|
| Hospital Charge Code |
76100468
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$162.08 |
| Max. Negotiated Rate |
$9,009.23 |
| Rate for Payer: Aetna American Axle |
$5,135.00
|
| Rate for Payer: Aetna Commercial |
$6,715.00
|
| Rate for Payer: Aetna Medicare |
$2,976.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,135.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,577.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,577.30
|
| Rate for Payer: BCBS Complete |
$1,643.84
|
| Rate for Payer: BCBS MAPPO |
$2,861.84
|
| Rate for Payer: BCBS Trust/PPO |
$1,629.30
|
| Rate for Payer: BCN Medicare Advantage |
$2,861.84
|
| Rate for Payer: Cash Price |
$6,320.00
|
| Rate for Payer: Cash Price |
$6,320.00
|
| Rate for Payer: Cofinity Commercial |
$6,794.00
|
| Rate for Payer: Cofinity Commercial |
$5,530.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,320.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,861.84
|
| Rate for Payer: Healthscope Commercial |
$7,110.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,530.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,925.00
|
| Rate for Payer: Mclaren Medicaid |
$1,565.43
|
| Rate for Payer: Mclaren Medicare |
$2,861.84
|
| Rate for Payer: Meridian Medicaid |
$1,643.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,004.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,291.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,715.00
|
| Rate for Payer: PACE Medicare |
$2,718.75
|
| Rate for Payer: PACE SWMI |
$2,861.84
|
| Rate for Payer: PHP Commercial |
$6,715.00
|
| Rate for Payer: PHP Medicare Advantage |
$2,861.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,565.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,530.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,009.23
|
| Rate for Payer: Priority Health Medicare |
$2,861.84
|
| Rate for Payer: Priority Health Narrow Network |
$7,207.38
|
| Rate for Payer: Priority Health SBD |
$4,977.00
|
| Rate for Payer: Railroad Medicare Medicare |
$2,861.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$178.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,861.84
|
| Rate for Payer: UHC Exchange |
$162.08
|
| Rate for Payer: UHC Medicare Advantage |
$2,947.70
|
| Rate for Payer: UMR Bronson Commercial |
$2,923.00
|
| Rate for Payer: VA VA |
$2,861.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,925.00
|
|
|
HC V5011 FITTING ORIENTATION CHECKING OF HEARING AID
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
CPT V5011
|
| Hospital Charge Code |
47000008
|
|
Hospital Revenue Code
|
470
|
| 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 V5011 FITTING ORIENTATION CHECKING OF HEARING AID
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
CPT V5011
|
| Hospital Charge Code |
47000008
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$22.20 |
| Max. Negotiated Rate |
$294.00 |
| 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: BCBS Complete |
$24.00
|
| 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: 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: UHC Core |
$294.00
|
| Rate for Payer: UMR Bronson Commercial |
$22.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.00
|
|
|
HC V5160 DISPENSING FEE BINAURAL
|
Facility
|
IP
|
$475.00
|
|
|
Service Code
|
CPT V5160
|
| Hospital Charge Code |
47000006
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$209.00 |
| Max. Negotiated Rate |
$427.50 |
| Rate for Payer: Aetna American Axle |
$308.75
|
| Rate for Payer: Aetna Commercial |
$403.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$308.75
|
| Rate for Payer: Cash Price |
$380.00
|
| Rate for Payer: Cofinity Commercial |
$332.50
|
| Rate for Payer: Cofinity Commercial |
$408.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$380.00
|
| Rate for Payer: Healthscope Commercial |
$427.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$332.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$356.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$403.75
|
| Rate for Payer: PHP Commercial |
$403.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$332.50
|
| Rate for Payer: Priority Health SBD |
$299.25
|
| Rate for Payer: UMR Bronson Commercial |
$209.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$356.25
|
|
|
HC V5160 DISPENSING FEE BINAURAL
|
Facility
|
OP
|
$475.00
|
|
|
Service Code
|
CPT V5160
|
| Hospital Charge Code |
47000006
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$175.75 |
| Max. Negotiated Rate |
$427.50 |
| Rate for Payer: Aetna American Axle |
$308.75
|
| Rate for Payer: Aetna Commercial |
$403.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$308.75
|
| Rate for Payer: BCBS Complete |
$190.00
|
| Rate for Payer: Cash Price |
$380.00
|
| Rate for Payer: Cash Price |
$380.00
|
| Rate for Payer: Cofinity Commercial |
$408.50
|
| Rate for Payer: Cofinity Commercial |
$332.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$380.00
|
| Rate for Payer: Healthscope Commercial |
$427.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$332.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$356.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$403.75
|
| Rate for Payer: PHP Commercial |
$403.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$332.50
|
| Rate for Payer: Priority Health SBD |
$299.25
|
| Rate for Payer: UHC Core |
$294.00
|
| Rate for Payer: UMR Bronson Commercial |
$175.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$356.25
|
|
|
HC V5241 DISPENSING FEE MONAURAL HEARING AID ANY TYPE
|
Facility
|
IP
|
$275.00
|
|
|
Service Code
|
CPT V5241
|
| Hospital Charge Code |
47000004
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$121.00 |
| Max. Negotiated Rate |
$247.50 |
| Rate for Payer: Aetna American Axle |
$178.75
|
| Rate for Payer: Aetna Commercial |
$233.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.75
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cofinity Commercial |
$192.50
|
| Rate for Payer: Cofinity Commercial |
$236.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.00
|
| Rate for Payer: Healthscope Commercial |
$247.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$192.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$233.75
|
| Rate for Payer: PHP Commercial |
$233.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.50
|
| Rate for Payer: Priority Health SBD |
$173.25
|
| Rate for Payer: UMR Bronson Commercial |
$121.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.25
|
|
|
HC V5241 DISPENSING FEE MONAURAL HEARING AID ANY TYPE
|
Facility
|
OP
|
$275.00
|
|
|
Service Code
|
CPT V5241
|
| Hospital Charge Code |
47000004
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$101.75 |
| Max. Negotiated Rate |
$294.00 |
| Rate for Payer: Aetna American Axle |
$178.75
|
| Rate for Payer: Aetna Commercial |
$233.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.75
|
| Rate for Payer: BCBS Complete |
$110.00
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cofinity Commercial |
$236.50
|
| Rate for Payer: Cofinity Commercial |
$192.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.00
|
| Rate for Payer: Healthscope Commercial |
$247.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$192.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$233.75
|
| Rate for Payer: PHP Commercial |
$233.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.50
|
| Rate for Payer: Priority Health SBD |
$173.25
|
| Rate for Payer: UHC Core |
$294.00
|
| Rate for Payer: UMR Bronson Commercial |
$101.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.25
|
|
|
HC V5264 EAR MOLD INSERT NOT DISPOSABLE ANY TYPE
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
CPT V5264
|
| Hospital Charge Code |
47000005
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$25.90 |
| Max. Negotiated Rate |
$294.00 |
| Rate for Payer: Aetna American Axle |
$45.50
|
| Rate for Payer: Aetna Commercial |
$59.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.50
|
| Rate for Payer: BCBS Complete |
$28.00
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cofinity Commercial |
$60.20
|
| Rate for Payer: Cofinity Commercial |
$49.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.00
|
| Rate for Payer: Healthscope Commercial |
$63.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.50
|
| Rate for Payer: PHP Commercial |
$59.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.00
|
| Rate for Payer: Priority Health SBD |
$44.10
|
| Rate for Payer: UHC Core |
$294.00
|
| Rate for Payer: UMR Bronson Commercial |
$25.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.50
|
|
|
HC V5264 EAR MOLD INSERT NOT DISPOSABLE ANY TYPE
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
CPT V5264
|
| Hospital Charge Code |
47000005
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$30.80 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Aetna American Axle |
$45.50
|
| Rate for Payer: Aetna Commercial |
$59.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.50
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cofinity Commercial |
$49.00
|
| Rate for Payer: Cofinity Commercial |
$60.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.00
|
| Rate for Payer: Healthscope Commercial |
$63.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.50
|
| Rate for Payer: PHP Commercial |
$59.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.00
|
| Rate for Payer: Priority Health SBD |
$44.10
|
| Rate for Payer: UMR Bronson Commercial |
$30.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.50
|
|
|
HC VACC AIIV4 NO PRSRV 0.5ML IM
|
Facility
|
IP
|
$178.26
|
|
|
Service Code
|
CPT 90694
|
| Hospital Charge Code |
63600224
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$78.43 |
| Max. Negotiated Rate |
$160.43 |
| Rate for Payer: Aetna American Axle |
$115.87
|
| Rate for Payer: Aetna Commercial |
$151.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.87
|
| Rate for Payer: Cash Price |
$142.61
|
| Rate for Payer: Cofinity Commercial |
$124.78
|
| Rate for Payer: Cofinity Commercial |
$153.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.61
|
| Rate for Payer: Healthscope Commercial |
$160.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$124.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$133.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$151.52
|
| Rate for Payer: PHP Commercial |
$151.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$124.78
|
| Rate for Payer: Priority Health SBD |
$112.30
|
| Rate for Payer: UMR Bronson Commercial |
$78.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$133.70
|
|
|
HC VACC AIIV4 NO PRSRV 0.5ML IM
|
Facility
|
OP
|
$178.26
|
|
|
Service Code
|
CPT 90694
|
| Hospital Charge Code |
63600224
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$61.89 |
| Max. Negotiated Rate |
$245.36 |
| Rate for Payer: Aetna American Axle |
$115.87
|
| Rate for Payer: Aetna Commercial |
$151.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.87
|
| Rate for Payer: BCBS Complete |
$71.30
|
| Rate for Payer: BCBS Trust/PPO |
$245.36
|
| Rate for Payer: Cash Price |
$142.61
|
| Rate for Payer: Cash Price |
$142.61
|
| Rate for Payer: Cofinity Commercial |
$153.30
|
| Rate for Payer: Cofinity Commercial |
$124.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.61
|
| Rate for Payer: Healthscope Commercial |
$160.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$124.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$133.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$151.52
|
| Rate for Payer: PHP Commercial |
$151.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$124.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$77.36
|
| Rate for Payer: Priority Health Narrow Network |
$61.89
|
| Rate for Payer: Priority Health SBD |
$112.30
|
| Rate for Payer: UMR Bronson Commercial |
$65.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$133.70
|
|
|
HC VACC CCIIV4 ABX FREE 0.5 ML IM
|
Facility
|
IP
|
$66.69
|
|
|
Service Code
|
CPT 90756
|
| Hospital Charge Code |
63600223
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.34 |
| Max. Negotiated Rate |
$60.02 |
| Rate for Payer: Aetna American Axle |
$43.35
|
| Rate for Payer: Aetna Commercial |
$56.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.35
|
| Rate for Payer: Cash Price |
$53.35
|
| Rate for Payer: Cofinity Commercial |
$46.68
|
| Rate for Payer: Cofinity Commercial |
$57.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.35
|
| Rate for Payer: Healthscope Commercial |
$60.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$56.69
|
| Rate for Payer: PHP Commercial |
$56.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.68
|
| Rate for Payer: Priority Health SBD |
$42.01
|
| Rate for Payer: UMR Bronson Commercial |
$29.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.02
|
|
|
HC VACC CCIIV4 ABX FREE 0.5 ML IM
|
Facility
|
OP
|
$66.69
|
|
|
Service Code
|
CPT 90756
|
| Hospital Charge Code |
63600223
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.68 |
| Max. Negotiated Rate |
$104.67 |
| Rate for Payer: Aetna American Axle |
$43.35
|
| Rate for Payer: Aetna Commercial |
$56.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.35
|
| Rate for Payer: BCBS Complete |
$26.68
|
| Rate for Payer: BCBS Trust/PPO |
$104.67
|
| Rate for Payer: Cash Price |
$53.35
|
| Rate for Payer: Cash Price |
$53.35
|
| Rate for Payer: Cofinity Commercial |
$46.68
|
| Rate for Payer: Cofinity Commercial |
$57.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.35
|
| Rate for Payer: Healthscope Commercial |
$60.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$56.69
|
| Rate for Payer: PHP Commercial |
$56.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$32.37
|
| Rate for Payer: Priority Health Narrow Network |
$25.90
|
| Rate for Payer: Priority Health SBD |
$42.01
|
| Rate for Payer: UMR Bronson Commercial |
$24.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.02
|
|
|
HC VACC CCIIV4 NO PRSV 0.5 ML IM
|
Facility
|
OP
|
$71.40
|
|
|
Service Code
|
CPT 90674
|
| Hospital Charge Code |
63600222
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.42 |
| Max. Negotiated Rate |
$107.77 |
| Rate for Payer: Aetna American Axle |
$46.41
|
| Rate for Payer: Aetna Commercial |
$60.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.41
|
| Rate for Payer: BCBS Complete |
$28.56
|
| Rate for Payer: BCBS Trust/PPO |
$107.77
|
| Rate for Payer: Cash Price |
$57.12
|
| Rate for Payer: Cash Price |
$57.12
|
| Rate for Payer: Cofinity Commercial |
$49.98
|
| Rate for Payer: Cofinity Commercial |
$61.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.12
|
| Rate for Payer: Healthscope Commercial |
$64.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$60.69
|
| Rate for Payer: PHP Commercial |
$60.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34.17
|
| Rate for Payer: Priority Health Narrow Network |
$27.34
|
| Rate for Payer: Priority Health SBD |
$44.98
|
| Rate for Payer: UMR Bronson Commercial |
$26.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.55
|
|
|
HC VACC CCIIV4 NO PRSV 0.5 ML IM
|
Facility
|
IP
|
$71.40
|
|
|
Service Code
|
CPT 90674
|
| Hospital Charge Code |
63600222
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.42 |
| Max. Negotiated Rate |
$64.26 |
| Rate for Payer: Aetna American Axle |
$46.41
|
| Rate for Payer: Aetna Commercial |
$60.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.41
|
| Rate for Payer: Cash Price |
$57.12
|
| Rate for Payer: Cofinity Commercial |
$49.98
|
| Rate for Payer: Cofinity Commercial |
$61.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.12
|
| Rate for Payer: Healthscope Commercial |
$64.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$60.69
|
| Rate for Payer: PHP Commercial |
$60.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.98
|
| Rate for Payer: Priority Health SBD |
$44.98
|
| Rate for Payer: UMR Bronson Commercial |
$31.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.55
|
|
|
HC VACC RSV PREF BIVALENT IM
|
Facility
|
IP
|
$823.05
|
|
|
Service Code
|
CPT 90678
|
| Hospital Charge Code |
63600226
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$362.14 |
| Max. Negotiated Rate |
$740.74 |
| Rate for Payer: Aetna American Axle |
$534.98
|
| Rate for Payer: Aetna Commercial |
$699.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$534.98
|
| Rate for Payer: Cash Price |
$658.44
|
| Rate for Payer: Cofinity Commercial |
$707.82
|
| Rate for Payer: Cofinity Commercial |
$576.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$658.44
|
| Rate for Payer: Healthscope Commercial |
$740.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$576.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$617.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$699.59
|
| Rate for Payer: PHP Commercial |
$699.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$576.14
|
| Rate for Payer: Priority Health SBD |
$518.52
|
| Rate for Payer: UMR Bronson Commercial |
$362.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$617.29
|
|
|
HC VACC RSV PREF BIVALENT IM
|
Facility
|
OP
|
$823.05
|
|
|
Service Code
|
CPT 90678
|
| Hospital Charge Code |
63600226
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$269.04 |
| Max. Negotiated Rate |
$1,100.58 |
| Rate for Payer: Aetna American Axle |
$534.98
|
| Rate for Payer: Aetna Commercial |
$699.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$534.98
|
| Rate for Payer: BCBS Complete |
$329.22
|
| Rate for Payer: BCBS Trust/PPO |
$1,100.58
|
| Rate for Payer: Cash Price |
$658.44
|
| Rate for Payer: Cash Price |
$658.44
|
| Rate for Payer: Cofinity Commercial |
$576.14
|
| Rate for Payer: Cofinity Commercial |
$707.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$658.44
|
| Rate for Payer: Healthscope Commercial |
$740.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$576.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$617.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$699.59
|
| Rate for Payer: PHP Commercial |
$699.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$576.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$336.30
|
| Rate for Payer: Priority Health Narrow Network |
$269.04
|
| Rate for Payer: Priority Health SBD |
$518.52
|
| Rate for Payer: UMR Bronson Commercial |
$304.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$617.29
|
|
