|
HC NASOPHARYNGOSCOPY DILAT EUSTACHIAN TUBE UNI
|
Facility
|
OP
|
$16,728.00
|
|
|
Service Code
|
CPT 69705
|
| Hospital Charge Code |
76100519
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,084.94 |
| Max. Negotiated Rate |
$19,075.37 |
| Rate for Payer: Aetna American Axle |
$10,873.20
|
| Rate for Payer: Aetna Commercial |
$14,218.80
|
| Rate for Payer: Aetna Medicare |
$6,134.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,873.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,373.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,373.18
|
| Rate for Payer: BCBS Complete |
$3,239.48
|
| Rate for Payer: BCBS MAPPO |
$5,898.54
|
| Rate for Payer: BCBS Trust/PPO |
$4,995.40
|
| Rate for Payer: BCN Commercial |
$4,995.40
|
| Rate for Payer: BCN Medicare Advantage |
$5,898.54
|
| Rate for Payer: Cash Price |
$13,382.40
|
| Rate for Payer: Cash Price |
$13,382.40
|
| Rate for Payer: Cash Price |
$13,382.40
|
| Rate for Payer: Cofinity Advantage |
$11,709.60
|
| Rate for Payer: Cofinity Commercial |
$14,386.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,382.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,898.54
|
| Rate for Payer: Healthscope Commercial |
$15,055.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11,709.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12,546.00
|
| Rate for Payer: Mclaren Medicaid |
$5,898.54
|
| Rate for Payer: Mclaren Medicare |
$5,898.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,193.47
|
| Rate for Payer: Meridian Medicaid |
$6,193.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,783.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,488.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,218.80
|
| Rate for Payer: Nomi Health Commercial |
$17,695.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12,546.00
|
| Rate for Payer: PACE Medicare |
$5,603.61
|
| Rate for Payer: PACE SWMI |
$5,898.54
|
| Rate for Payer: PHP Commercial |
$14,218.80
|
| Rate for Payer: PHP Medicare Advantage |
$5,898.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,084.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$19,075.37
|
| Rate for Payer: Priority Health Medicare |
$5,898.54
|
| Rate for Payer: Priority Health SBD |
$10,538.64
|
| Rate for Payer: Priority Health Tiered Network |
$15,260.30
|
| Rate for Payer: Railroad Medicare Medicare |
$5,898.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,873.20
|
| Rate for Payer: UHC Core |
$8,715.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,898.54
|
| Rate for Payer: UHC Exchange |
$6,574.10
|
| Rate for Payer: UHC Medicaid |
$3,084.94
|
| Rate for Payer: UHCCP Medicaid |
$3,084.94
|
| Rate for Payer: UMR Bronson Commercial |
$6,189.36
|
| Rate for Payer: VA VA |
$5,898.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12,546.00
|
|
|
HC NASOTRACHEAL SUCTION
|
Facility
|
IP
|
$284.50
|
|
|
Service Code
|
CPT 31720
|
| Hospital Charge Code |
41000001
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$125.18 |
| Max. Negotiated Rate |
$256.05 |
| Rate for Payer: Aetna American Axle |
$184.93
|
| Rate for Payer: Aetna Commercial |
$241.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.93
|
| Rate for Payer: Cash Price |
$227.60
|
| Rate for Payer: Cofinity Advantage |
$199.15
|
| Rate for Payer: Cofinity Commercial |
$244.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.60
|
| Rate for Payer: Healthscope Commercial |
$256.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$199.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$213.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$213.38
|
| Rate for Payer: PHP Commercial |
$241.82
|
| Rate for Payer: Priority Health SBD |
$179.24
|
| Rate for Payer: UMR Bronson Commercial |
$125.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$213.38
|
|
|
HC NASOTRACHEAL SUCTION
|
Facility
|
OP
|
$284.50
|
|
|
Service Code
|
CPT 31720
|
| Hospital Charge Code |
41000001
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$105.27 |
| Max. Negotiated Rate |
$705.61 |
| Rate for Payer: Aetna American Axle |
$184.93
|
| Rate for Payer: Aetna Commercial |
$241.82
|
| Rate for Payer: Aetna Medicare |
$226.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$272.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$272.74
|
| Rate for Payer: BCBS Complete |
$119.83
|
| Rate for Payer: BCBS MAPPO |
$218.19
|
| Rate for Payer: BCBS Trust/PPO |
$182.88
|
| Rate for Payer: BCN Commercial |
$182.88
|
| Rate for Payer: BCN Medicare Advantage |
$218.19
|
| Rate for Payer: Cash Price |
$227.60
|
| Rate for Payer: Cash Price |
$227.60
|
| Rate for Payer: Cash Price |
$227.60
|
| Rate for Payer: Cofinity Advantage |
$199.15
|
| Rate for Payer: Cofinity Commercial |
$244.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$218.19
|
| Rate for Payer: Healthscope Commercial |
$256.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$199.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$213.38
|
| Rate for Payer: Mclaren Medicaid |
$218.19
|
| Rate for Payer: Mclaren Medicare |
$218.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$229.10
|
| Rate for Payer: Meridian Medicaid |
$229.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$250.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$240.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.82
|
| Rate for Payer: Nomi Health Commercial |
$654.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$213.38
|
| Rate for Payer: PACE Medicare |
$207.28
|
| Rate for Payer: PACE SWMI |
$218.19
|
| Rate for Payer: PHP Commercial |
$241.82
|
| Rate for Payer: PHP Medicare Advantage |
$218.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$114.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$705.61
|
| Rate for Payer: Priority Health Medicare |
$218.19
|
| Rate for Payer: Priority Health SBD |
$179.24
|
| Rate for Payer: Priority Health Tiered Network |
$564.49
|
| Rate for Payer: Railroad Medicare Medicare |
$218.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$184.93
|
| Rate for Payer: UHC Core |
$148.22
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$218.19
|
| Rate for Payer: UHC Exchange |
$111.81
|
| Rate for Payer: UHC Medicaid |
$114.11
|
| Rate for Payer: UHCCP Medicaid |
$114.11
|
| Rate for Payer: UMR Bronson Commercial |
$105.27
|
| Rate for Payer: VA VA |
$218.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$213.38
|
|
|
HC NCCU OBSERVATION PER HOUR
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200021
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$70.40 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Aetna American Axle |
$104.00
|
| Rate for Payer: Aetna Commercial |
$136.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cofinity Advantage |
$112.00
|
| Rate for Payer: Cofinity Commercial |
$137.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.00
|
| Rate for Payer: Healthscope Commercial |
$144.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$112.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$120.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.00
|
| Rate for Payer: PHP Commercial |
$136.00
|
| Rate for Payer: Priority Health SBD |
$100.80
|
| Rate for Payer: UMR Bronson Commercial |
$70.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$120.00
|
|
|
HC NCCU OBSERVATION PER HOUR
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200021
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$59.20 |
| Max. Negotiated Rate |
$1,608.00 |
| Rate for Payer: Aetna American Axle |
$104.00
|
| Rate for Payer: Aetna Commercial |
$136.00
|
| Rate for Payer: Aetna Medicare |
$80.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.00
|
| Rate for Payer: BCBS Complete |
$64.00
|
| Rate for Payer: BCBS Trust/PPO |
$107.13
|
| Rate for Payer: BCN Commercial |
$107.13
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cofinity Advantage |
$112.00
|
| Rate for Payer: Cofinity Commercial |
$137.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.00
|
| Rate for Payer: Healthscope Commercial |
$144.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$112.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$120.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$128.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.00
|
| Rate for Payer: PHP Commercial |
$136.00
|
| Rate for Payer: Priority Health SBD |
$100.80
|
| Rate for Payer: UHC Medicaid |
$1,608.00
|
| Rate for Payer: UHCCP Medicaid |
$850.00
|
| Rate for Payer: UMR Bronson Commercial |
$59.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$120.00
|
|
|
HC NCS 11-12 STUDIES INCL F&H WAVES
|
Facility
|
OP
|
$2,322.64
|
|
|
Service Code
|
CPT 95912
|
| Hospital Charge Code |
92200032
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$194.46 |
| Max. Negotiated Rate |
$2,090.38 |
| Rate for Payer: Aetna American Axle |
$1,509.72
|
| Rate for Payer: Aetna Commercial |
$1,974.24
|
| Rate for Payer: Aetna Medicare |
$386.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,509.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$464.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$464.77
|
| Rate for Payer: BCBS Complete |
$204.20
|
| Rate for Payer: BCBS MAPPO |
$371.82
|
| Rate for Payer: BCBS Trust/PPO |
$371.96
|
| Rate for Payer: BCN Commercial |
$371.96
|
| Rate for Payer: BCN Medicare Advantage |
$371.82
|
| Rate for Payer: Cash Price |
$1,858.11
|
| Rate for Payer: Cash Price |
$1,858.11
|
| Rate for Payer: Cofinity Advantage |
$1,625.85
|
| Rate for Payer: Cofinity Commercial |
$1,997.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,858.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$371.82
|
| Rate for Payer: Healthscope Commercial |
$2,090.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,625.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,741.98
|
| Rate for Payer: Mclaren Medicaid |
$371.82
|
| Rate for Payer: Mclaren Medicare |
$371.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$390.41
|
| Rate for Payer: Meridian Medicaid |
$390.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$427.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$409.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,974.24
|
| Rate for Payer: Nomi Health Commercial |
$1,115.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,741.98
|
| Rate for Payer: PACE Medicare |
$353.23
|
| Rate for Payer: PACE SWMI |
$371.82
|
| Rate for Payer: PHP Commercial |
$1,974.24
|
| Rate for Payer: PHP Medicare Advantage |
$371.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$194.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,202.41
|
| Rate for Payer: Priority Health Medicare |
$371.82
|
| Rate for Payer: Priority Health SBD |
$1,463.26
|
| Rate for Payer: Priority Health Tiered Network |
$961.93
|
| Rate for Payer: Railroad Medicare Medicare |
$371.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,509.72
|
| Rate for Payer: UHC Core |
$1,210.10
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$371.82
|
| Rate for Payer: UHC Exchange |
$912.80
|
| Rate for Payer: UHC Medicaid |
$194.46
|
| Rate for Payer: UHCCP Medicaid |
$194.46
|
| Rate for Payer: UMR Bronson Commercial |
$859.38
|
| Rate for Payer: VA VA |
$371.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,741.98
|
|
|
HC NCS 11-12 STUDIES INCL F&H WAVES
|
Facility
|
IP
|
$2,322.64
|
|
|
Service Code
|
CPT 95912
|
| Hospital Charge Code |
92200032
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$1,021.96 |
| Max. Negotiated Rate |
$2,090.38 |
| Rate for Payer: Aetna American Axle |
$1,509.72
|
| Rate for Payer: Aetna Commercial |
$1,974.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,509.72
|
| Rate for Payer: Cash Price |
$1,858.11
|
| Rate for Payer: Cofinity Advantage |
$1,625.85
|
| Rate for Payer: Cofinity Commercial |
$1,997.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,858.11
|
| Rate for Payer: Healthscope Commercial |
$2,090.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,625.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,741.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,974.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,741.98
|
| Rate for Payer: PHP Commercial |
$1,974.24
|
| Rate for Payer: Priority Health SBD |
$1,463.26
|
| Rate for Payer: UMR Bronson Commercial |
$1,021.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,741.98
|
|
|
HC NCS 1-2 STUDIES INCL F&H WAVES
|
Facility
|
IP
|
$504.23
|
|
|
Service Code
|
CPT 95907
|
| Hospital Charge Code |
92200027
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$221.86 |
| Max. Negotiated Rate |
$453.81 |
| Rate for Payer: Aetna American Axle |
$327.75
|
| Rate for Payer: Aetna Commercial |
$428.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$327.75
|
| Rate for Payer: Cash Price |
$403.38
|
| Rate for Payer: Cofinity Advantage |
$352.96
|
| Rate for Payer: Cofinity Commercial |
$433.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$403.38
|
| Rate for Payer: Healthscope Commercial |
$453.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$352.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$378.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$428.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$378.17
|
| Rate for Payer: PHP Commercial |
$428.60
|
| Rate for Payer: Priority Health SBD |
$317.66
|
| Rate for Payer: UMR Bronson Commercial |
$221.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$378.17
|
|
|
HC NCS 1-2 STUDIES INCL F&H WAVES
|
Facility
|
OP
|
$504.23
|
|
|
Service Code
|
CPT 95907
|
| Hospital Charge Code |
92200027
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$112.52 |
| Max. Negotiated Rate |
$695.77 |
| Rate for Payer: Aetna American Axle |
$327.75
|
| Rate for Payer: Aetna Commercial |
$428.60
|
| Rate for Payer: Aetna Medicare |
$223.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$327.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$268.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$268.94
|
| Rate for Payer: BCBS Complete |
$118.16
|
| Rate for Payer: BCBS MAPPO |
$215.15
|
| Rate for Payer: BCBS Trust/PPO |
$154.99
|
| Rate for Payer: BCN Commercial |
$154.99
|
| Rate for Payer: BCN Medicare Advantage |
$215.15
|
| Rate for Payer: Cash Price |
$403.38
|
| Rate for Payer: Cash Price |
$403.38
|
| Rate for Payer: Cofinity Advantage |
$352.96
|
| Rate for Payer: Cofinity Commercial |
$433.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$403.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$215.15
|
| Rate for Payer: Healthscope Commercial |
$453.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$352.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$378.17
|
| Rate for Payer: Mclaren Medicaid |
$215.15
|
| Rate for Payer: Mclaren Medicare |
$215.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$225.91
|
| Rate for Payer: Meridian Medicaid |
$225.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$247.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$236.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$428.60
|
| Rate for Payer: Nomi Health Commercial |
$645.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$378.17
|
| Rate for Payer: PACE Medicare |
$204.39
|
| Rate for Payer: PACE SWMI |
$215.15
|
| Rate for Payer: PHP Commercial |
$428.60
|
| Rate for Payer: PHP Medicare Advantage |
$215.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$112.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$695.77
|
| Rate for Payer: Priority Health Medicare |
$215.15
|
| Rate for Payer: Priority Health SBD |
$317.66
|
| Rate for Payer: Priority Health Tiered Network |
$556.62
|
| Rate for Payer: Railroad Medicare Medicare |
$215.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$327.75
|
| Rate for Payer: UHC Core |
$262.70
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$215.15
|
| Rate for Payer: UHC Exchange |
$198.16
|
| Rate for Payer: UHC Medicaid |
$112.52
|
| Rate for Payer: UHCCP Medicaid |
$112.52
|
| Rate for Payer: UMR Bronson Commercial |
$186.57
|
| Rate for Payer: VA VA |
$215.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$378.17
|
|
|
HC NCS 13 OR MORE STUDIES INCL F&H WAVES
|
Facility
|
IP
|
$3,013.52
|
|
|
Service Code
|
CPT 95913
|
| Hospital Charge Code |
92200033
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$1,325.95 |
| Max. Negotiated Rate |
$2,712.17 |
| Rate for Payer: Aetna American Axle |
$1,958.79
|
| Rate for Payer: Aetna Commercial |
$2,561.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,958.79
|
| Rate for Payer: Cash Price |
$2,410.82
|
| Rate for Payer: Cofinity Advantage |
$2,109.46
|
| Rate for Payer: Cofinity Commercial |
$2,591.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,410.82
|
| Rate for Payer: Healthscope Commercial |
$2,712.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,109.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,260.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,561.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,260.14
|
| Rate for Payer: PHP Commercial |
$2,561.49
|
| Rate for Payer: Priority Health SBD |
$1,898.52
|
| Rate for Payer: UMR Bronson Commercial |
$1,325.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,260.14
|
|
|
HC NCS 13 OR MORE STUDIES INCL F&H WAVES
|
Facility
|
OP
|
$3,013.52
|
|
|
Service Code
|
CPT 95913
|
| Hospital Charge Code |
92200033
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$194.46 |
| Max. Negotiated Rate |
$2,712.17 |
| Rate for Payer: Aetna American Axle |
$1,958.79
|
| Rate for Payer: Aetna Commercial |
$2,561.49
|
| Rate for Payer: Aetna Medicare |
$386.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,958.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$464.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$464.77
|
| Rate for Payer: BCBS Complete |
$204.20
|
| Rate for Payer: BCBS MAPPO |
$371.82
|
| Rate for Payer: BCBS Trust/PPO |
$425.50
|
| Rate for Payer: BCN Commercial |
$425.50
|
| Rate for Payer: BCN Medicare Advantage |
$371.82
|
| Rate for Payer: Cash Price |
$2,410.82
|
| Rate for Payer: Cash Price |
$2,410.82
|
| Rate for Payer: Cofinity Advantage |
$2,109.46
|
| Rate for Payer: Cofinity Commercial |
$2,591.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,410.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$371.82
|
| Rate for Payer: Healthscope Commercial |
$2,712.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,109.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,260.14
|
| Rate for Payer: Mclaren Medicaid |
$371.82
|
| Rate for Payer: Mclaren Medicare |
$371.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$390.41
|
| Rate for Payer: Meridian Medicaid |
$390.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$427.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$409.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,561.49
|
| Rate for Payer: Nomi Health Commercial |
$1,115.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,260.14
|
| Rate for Payer: PACE Medicare |
$353.23
|
| Rate for Payer: PACE SWMI |
$371.82
|
| Rate for Payer: PHP Commercial |
$2,561.49
|
| Rate for Payer: PHP Medicare Advantage |
$371.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$194.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,202.41
|
| Rate for Payer: Priority Health Medicare |
$371.82
|
| Rate for Payer: Priority Health SBD |
$1,898.52
|
| Rate for Payer: Priority Health Tiered Network |
$961.93
|
| Rate for Payer: Railroad Medicare Medicare |
$371.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,958.79
|
| Rate for Payer: UHC Core |
$1,570.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$371.82
|
| Rate for Payer: UHC Exchange |
$1,184.31
|
| Rate for Payer: UHC Medicaid |
$194.46
|
| Rate for Payer: UHCCP Medicaid |
$194.46
|
| Rate for Payer: UMR Bronson Commercial |
$1,115.00
|
| Rate for Payer: VA VA |
$371.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,260.14
|
|
|
HC NCS 3-4 STUDIES INCL F&H WAVES
|
Facility
|
IP
|
$931.70
|
|
|
Service Code
|
CPT 95908
|
| Hospital Charge Code |
92200028
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$409.95 |
| Max. Negotiated Rate |
$838.53 |
| Rate for Payer: Aetna American Axle |
$605.61
|
| Rate for Payer: Aetna Commercial |
$791.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$605.61
|
| Rate for Payer: Cash Price |
$745.36
|
| Rate for Payer: Cofinity Advantage |
$652.19
|
| Rate for Payer: Cofinity Commercial |
$801.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$745.36
|
| Rate for Payer: Healthscope Commercial |
$838.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$652.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$698.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$791.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$698.77
|
| Rate for Payer: PHP Commercial |
$791.95
|
| Rate for Payer: Priority Health SBD |
$586.97
|
| Rate for Payer: UMR Bronson Commercial |
$409.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$698.77
|
|
|
HC NCS 3-4 STUDIES INCL F&H WAVES
|
Facility
|
OP
|
$931.70
|
|
|
Service Code
|
CPT 95908
|
| Hospital Charge Code |
92200028
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$112.52 |
| Max. Negotiated Rate |
$838.53 |
| Rate for Payer: Aetna American Axle |
$605.61
|
| Rate for Payer: Aetna Commercial |
$791.95
|
| Rate for Payer: Aetna Medicare |
$223.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$605.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$268.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$268.94
|
| Rate for Payer: BCBS Complete |
$118.16
|
| Rate for Payer: BCBS MAPPO |
$215.15
|
| Rate for Payer: BCBS Trust/PPO |
$193.03
|
| Rate for Payer: BCN Commercial |
$193.03
|
| Rate for Payer: BCN Medicare Advantage |
$215.15
|
| Rate for Payer: Cash Price |
$745.36
|
| Rate for Payer: Cash Price |
$745.36
|
| Rate for Payer: Cofinity Advantage |
$652.19
|
| Rate for Payer: Cofinity Commercial |
$801.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$745.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$215.15
|
| Rate for Payer: Healthscope Commercial |
$838.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$652.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$698.77
|
| Rate for Payer: Mclaren Medicaid |
$215.15
|
| Rate for Payer: Mclaren Medicare |
$215.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$225.91
|
| Rate for Payer: Meridian Medicaid |
$225.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$247.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$236.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$791.95
|
| Rate for Payer: Nomi Health Commercial |
$645.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$698.77
|
| Rate for Payer: PACE Medicare |
$204.39
|
| Rate for Payer: PACE SWMI |
$215.15
|
| Rate for Payer: PHP Commercial |
$791.95
|
| Rate for Payer: PHP Medicare Advantage |
$215.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$112.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$695.77
|
| Rate for Payer: Priority Health Medicare |
$215.15
|
| Rate for Payer: Priority Health SBD |
$586.97
|
| Rate for Payer: Priority Health Tiered Network |
$556.62
|
| Rate for Payer: Railroad Medicare Medicare |
$215.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$605.61
|
| Rate for Payer: UHC Core |
$485.42
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$215.15
|
| Rate for Payer: UHC Exchange |
$366.16
|
| Rate for Payer: UHC Medicaid |
$112.52
|
| Rate for Payer: UHCCP Medicaid |
$112.52
|
| Rate for Payer: UMR Bronson Commercial |
$344.73
|
| Rate for Payer: VA VA |
$215.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$698.77
|
|
|
HC NCS 5-6 STUDIES INCL F&H WAVES
|
Facility
|
IP
|
$1,151.47
|
|
|
Service Code
|
CPT 95909
|
| Hospital Charge Code |
92200029
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$506.65 |
| Max. Negotiated Rate |
$1,036.32 |
| Rate for Payer: Aetna American Axle |
$748.46
|
| Rate for Payer: Aetna Commercial |
$978.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$748.46
|
| Rate for Payer: Cash Price |
$921.18
|
| Rate for Payer: Cofinity Advantage |
$806.03
|
| Rate for Payer: Cofinity Commercial |
$990.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$921.18
|
| Rate for Payer: Healthscope Commercial |
$1,036.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$806.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$863.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$978.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$863.60
|
| Rate for Payer: PHP Commercial |
$978.75
|
| Rate for Payer: Priority Health SBD |
$725.43
|
| Rate for Payer: UMR Bronson Commercial |
$506.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$863.60
|
|
|
HC NCS 5-6 STUDIES INCL F&H WAVES
|
Facility
|
OP
|
$1,151.47
|
|
|
Service Code
|
CPT 95909
|
| Hospital Charge Code |
92200029
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$112.52 |
| Max. Negotiated Rate |
$1,036.32 |
| Rate for Payer: Aetna American Axle |
$748.46
|
| Rate for Payer: Aetna Commercial |
$978.75
|
| Rate for Payer: Aetna Medicare |
$223.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$748.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$268.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$268.94
|
| Rate for Payer: BCBS Complete |
$118.16
|
| Rate for Payer: BCBS MAPPO |
$215.15
|
| Rate for Payer: BCBS Trust/PPO |
$232.47
|
| Rate for Payer: BCN Commercial |
$232.47
|
| Rate for Payer: BCN Medicare Advantage |
$215.15
|
| Rate for Payer: Cash Price |
$921.18
|
| Rate for Payer: Cash Price |
$921.18
|
| Rate for Payer: Cofinity Advantage |
$806.03
|
| Rate for Payer: Cofinity Commercial |
$990.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$921.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$215.15
|
| Rate for Payer: Healthscope Commercial |
$1,036.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$806.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$863.60
|
| Rate for Payer: Mclaren Medicaid |
$215.15
|
| Rate for Payer: Mclaren Medicare |
$215.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$225.91
|
| Rate for Payer: Meridian Medicaid |
$225.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$247.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$236.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$978.75
|
| Rate for Payer: Nomi Health Commercial |
$645.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$863.60
|
| Rate for Payer: PACE Medicare |
$204.39
|
| Rate for Payer: PACE SWMI |
$215.15
|
| Rate for Payer: PHP Commercial |
$978.75
|
| Rate for Payer: PHP Medicare Advantage |
$215.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$112.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$695.77
|
| Rate for Payer: Priority Health Medicare |
$215.15
|
| Rate for Payer: Priority Health SBD |
$725.43
|
| Rate for Payer: Priority Health Tiered Network |
$556.62
|
| Rate for Payer: Railroad Medicare Medicare |
$215.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$748.46
|
| Rate for Payer: UHC Core |
$599.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$215.15
|
| Rate for Payer: UHC Exchange |
$452.53
|
| Rate for Payer: UHC Medicaid |
$112.52
|
| Rate for Payer: UHCCP Medicaid |
$112.52
|
| Rate for Payer: UMR Bronson Commercial |
$426.04
|
| Rate for Payer: VA VA |
$215.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$863.60
|
|
|
HC NCS 7-8 STUDIES INCL F&H WAVES
|
Facility
|
IP
|
$1,487.04
|
|
|
Service Code
|
CPT 95910
|
| Hospital Charge Code |
92200030
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$654.30 |
| Max. Negotiated Rate |
$1,338.34 |
| Rate for Payer: Aetna American Axle |
$966.58
|
| Rate for Payer: Aetna Commercial |
$1,263.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$966.58
|
| Rate for Payer: Cash Price |
$1,189.63
|
| Rate for Payer: Cofinity Advantage |
$1,040.93
|
| Rate for Payer: Cofinity Commercial |
$1,278.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,189.63
|
| Rate for Payer: Healthscope Commercial |
$1,338.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,040.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,115.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,263.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,115.28
|
| Rate for Payer: PHP Commercial |
$1,263.98
|
| Rate for Payer: Priority Health SBD |
$936.84
|
| Rate for Payer: UMR Bronson Commercial |
$654.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,115.28
|
|
|
HC NCS 7-8 STUDIES INCL F&H WAVES
|
Facility
|
OP
|
$1,487.04
|
|
|
Service Code
|
CPT 95910
|
| Hospital Charge Code |
92200030
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$194.46 |
| Max. Negotiated Rate |
$1,338.34 |
| Rate for Payer: Aetna American Axle |
$966.58
|
| Rate for Payer: Aetna Commercial |
$1,263.98
|
| Rate for Payer: Aetna Medicare |
$386.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$966.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$464.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$464.77
|
| Rate for Payer: BCBS Complete |
$204.20
|
| Rate for Payer: BCBS MAPPO |
$371.82
|
| Rate for Payer: BCBS Trust/PPO |
$295.88
|
| Rate for Payer: BCN Commercial |
$295.88
|
| Rate for Payer: BCN Medicare Advantage |
$371.82
|
| Rate for Payer: Cash Price |
$1,189.63
|
| Rate for Payer: Cash Price |
$1,189.63
|
| Rate for Payer: Cofinity Advantage |
$1,040.93
|
| Rate for Payer: Cofinity Commercial |
$1,278.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,189.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$371.82
|
| Rate for Payer: Healthscope Commercial |
$1,338.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,040.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,115.28
|
| Rate for Payer: Mclaren Medicaid |
$371.82
|
| Rate for Payer: Mclaren Medicare |
$371.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$390.41
|
| Rate for Payer: Meridian Medicaid |
$390.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$427.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$409.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,263.98
|
| Rate for Payer: Nomi Health Commercial |
$1,115.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,115.28
|
| Rate for Payer: PACE Medicare |
$353.23
|
| Rate for Payer: PACE SWMI |
$371.82
|
| Rate for Payer: PHP Commercial |
$1,263.98
|
| Rate for Payer: PHP Medicare Advantage |
$371.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$194.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,202.41
|
| Rate for Payer: Priority Health Medicare |
$371.82
|
| Rate for Payer: Priority Health SBD |
$936.84
|
| Rate for Payer: Priority Health Tiered Network |
$961.93
|
| Rate for Payer: Railroad Medicare Medicare |
$371.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$966.58
|
| Rate for Payer: UHC Core |
$774.75
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$371.82
|
| Rate for Payer: UHC Exchange |
$584.41
|
| Rate for Payer: UHC Medicaid |
$194.46
|
| Rate for Payer: UHCCP Medicaid |
$194.46
|
| Rate for Payer: UMR Bronson Commercial |
$550.20
|
| Rate for Payer: VA VA |
$371.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,115.28
|
|
|
HC NCS 9-10 STUDIES INCL F&H WAVES
|
Facility
|
OP
|
$1,842.32
|
|
|
Service Code
|
CPT 95911
|
| Hospital Charge Code |
92200031
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$194.46 |
| Max. Negotiated Rate |
$1,658.09 |
| Rate for Payer: Aetna American Axle |
$1,197.51
|
| Rate for Payer: Aetna Commercial |
$1,565.97
|
| Rate for Payer: Aetna Medicare |
$386.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,197.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$464.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$464.77
|
| Rate for Payer: BCBS Complete |
$204.20
|
| Rate for Payer: BCBS MAPPO |
$371.82
|
| Rate for Payer: BCBS Trust/PPO |
$333.92
|
| Rate for Payer: BCN Commercial |
$333.92
|
| Rate for Payer: BCN Medicare Advantage |
$371.82
|
| Rate for Payer: Cash Price |
$1,473.86
|
| Rate for Payer: Cash Price |
$1,473.86
|
| Rate for Payer: Cofinity Advantage |
$1,289.62
|
| Rate for Payer: Cofinity Commercial |
$1,584.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,473.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$371.82
|
| Rate for Payer: Healthscope Commercial |
$1,658.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,289.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,381.74
|
| Rate for Payer: Mclaren Medicaid |
$371.82
|
| Rate for Payer: Mclaren Medicare |
$371.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$390.41
|
| Rate for Payer: Meridian Medicaid |
$390.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$427.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$409.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,565.97
|
| Rate for Payer: Nomi Health Commercial |
$1,115.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,381.74
|
| Rate for Payer: PACE Medicare |
$353.23
|
| Rate for Payer: PACE SWMI |
$371.82
|
| Rate for Payer: PHP Commercial |
$1,565.97
|
| Rate for Payer: PHP Medicare Advantage |
$371.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$194.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,202.41
|
| Rate for Payer: Priority Health Medicare |
$371.82
|
| Rate for Payer: Priority Health SBD |
$1,160.66
|
| Rate for Payer: Priority Health Tiered Network |
$961.93
|
| Rate for Payer: Railroad Medicare Medicare |
$371.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,197.51
|
| Rate for Payer: UHC Core |
$959.85
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$371.82
|
| Rate for Payer: UHC Exchange |
$724.03
|
| Rate for Payer: UHC Medicaid |
$194.46
|
| Rate for Payer: UHCCP Medicaid |
$194.46
|
| Rate for Payer: UMR Bronson Commercial |
$681.66
|
| Rate for Payer: VA VA |
$371.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,381.74
|
|
|
HC NCS 9-10 STUDIES INCL F&H WAVES
|
Facility
|
IP
|
$1,842.32
|
|
|
Service Code
|
CPT 95911
|
| Hospital Charge Code |
92200031
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$810.62 |
| Max. Negotiated Rate |
$1,658.09 |
| Rate for Payer: Aetna American Axle |
$1,197.51
|
| Rate for Payer: Aetna Commercial |
$1,565.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,197.51
|
| Rate for Payer: Cash Price |
$1,473.86
|
| Rate for Payer: Cofinity Advantage |
$1,289.62
|
| Rate for Payer: Cofinity Commercial |
$1,584.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,473.86
|
| Rate for Payer: Healthscope Commercial |
$1,658.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,289.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,381.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,565.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,381.74
|
| Rate for Payer: PHP Commercial |
$1,565.97
|
| Rate for Payer: Priority Health SBD |
$1,160.66
|
| Rate for Payer: UMR Bronson Commercial |
$810.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,381.74
|
|
|
HC NEEDLE 14 GAUGE LONG
|
Facility
|
IP
|
$112.36
|
|
| Hospital Charge Code |
27000674
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$49.44 |
| Max. Negotiated Rate |
$101.12 |
| Rate for Payer: Aetna American Axle |
$73.03
|
| Rate for Payer: Aetna Commercial |
$95.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.03
|
| Rate for Payer: Cash Price |
$89.89
|
| Rate for Payer: Cofinity Advantage |
$78.65
|
| Rate for Payer: Cofinity Commercial |
$96.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.89
|
| Rate for Payer: Healthscope Commercial |
$101.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$78.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$84.27
|
| Rate for Payer: PHP Commercial |
$95.51
|
| Rate for Payer: Priority Health SBD |
$70.79
|
| Rate for Payer: UMR Bronson Commercial |
$49.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.27
|
|
|
HC NEEDLE 14 GAUGE LONG
|
Facility
|
OP
|
$112.36
|
|
| Hospital Charge Code |
27000674
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$41.57 |
| Max. Negotiated Rate |
$101.12 |
| Rate for Payer: Aetna American Axle |
$73.03
|
| Rate for Payer: Aetna Commercial |
$95.51
|
| Rate for Payer: Aetna Medicare |
$56.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.03
|
| Rate for Payer: BCBS Complete |
$44.94
|
| Rate for Payer: Cash Price |
$89.89
|
| Rate for Payer: Cofinity Advantage |
$78.65
|
| Rate for Payer: Cofinity Commercial |
$96.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.89
|
| Rate for Payer: Healthscope Commercial |
$101.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$78.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$89.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$84.27
|
| Rate for Payer: PHP Commercial |
$95.51
|
| Rate for Payer: Priority Health SBD |
$70.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$73.03
|
| Rate for Payer: UHC Core |
$58.54
|
| Rate for Payer: UHC Exchange |
$44.16
|
| Rate for Payer: UMR Bronson Commercial |
$41.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.27
|
|
|
HC NEEDLE 1 EXTREMITY NON PARASPINAL
|
Facility
|
IP
|
$257.66
|
|
|
Service Code
|
CPT 95870
|
| Hospital Charge Code |
92200009
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$113.37 |
| Max. Negotiated Rate |
$231.89 |
| Rate for Payer: Aetna American Axle |
$167.48
|
| Rate for Payer: Aetna Commercial |
$219.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.48
|
| Rate for Payer: Cash Price |
$206.13
|
| Rate for Payer: Cofinity Advantage |
$180.36
|
| Rate for Payer: Cofinity Commercial |
$221.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.13
|
| Rate for Payer: Healthscope Commercial |
$231.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$180.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$193.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$193.25
|
| Rate for Payer: PHP Commercial |
$219.01
|
| Rate for Payer: Priority Health SBD |
$162.33
|
| Rate for Payer: UMR Bronson Commercial |
$113.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$193.25
|
|
|
HC NEEDLE 1 EXTREMITY NON PARASPINAL
|
Facility
|
OP
|
$257.66
|
|
|
Service Code
|
CPT 95870
|
| Hospital Charge Code |
92200009
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$69.33 |
| Max. Negotiated Rate |
$428.73 |
| Rate for Payer: Aetna American Axle |
$167.48
|
| Rate for Payer: Aetna Commercial |
$219.01
|
| Rate for Payer: Aetna Medicare |
$137.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$165.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$165.71
|
| Rate for Payer: BCBS Complete |
$72.81
|
| Rate for Payer: BCBS MAPPO |
$132.57
|
| Rate for Payer: BCBS Trust/PPO |
$256.41
|
| Rate for Payer: BCN Commercial |
$256.41
|
| Rate for Payer: BCN Medicare Advantage |
$132.57
|
| Rate for Payer: Cash Price |
$206.13
|
| Rate for Payer: Cash Price |
$206.13
|
| Rate for Payer: Cofinity Advantage |
$180.36
|
| Rate for Payer: Cofinity Commercial |
$221.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.57
|
| Rate for Payer: Healthscope Commercial |
$231.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$180.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$193.25
|
| Rate for Payer: Mclaren Medicaid |
$132.57
|
| Rate for Payer: Mclaren Medicare |
$132.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$139.20
|
| Rate for Payer: Meridian Medicaid |
$139.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$145.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.01
|
| Rate for Payer: Nomi Health Commercial |
$397.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$193.25
|
| Rate for Payer: PACE Medicare |
$125.94
|
| Rate for Payer: PACE SWMI |
$132.57
|
| Rate for Payer: PHP Commercial |
$219.01
|
| Rate for Payer: PHP Medicare Advantage |
$132.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$428.73
|
| Rate for Payer: Priority Health Medicare |
$132.57
|
| Rate for Payer: Priority Health SBD |
$162.33
|
| Rate for Payer: Priority Health Tiered Network |
$342.98
|
| Rate for Payer: Railroad Medicare Medicare |
$132.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$167.48
|
| Rate for Payer: UHC Core |
$134.24
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$132.57
|
| Rate for Payer: UHC Exchange |
$101.26
|
| Rate for Payer: UHC Medicaid |
$69.33
|
| Rate for Payer: UHCCP Medicaid |
$69.33
|
| Rate for Payer: UMR Bronson Commercial |
$95.33
|
| Rate for Payer: VA VA |
$132.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$193.25
|
|
|
HC NEEDLE BRACHYTHERAPY EACH
|
Facility
|
IP
|
$75.38
|
|
|
Service Code
|
HCPCS C1715
|
| Hospital Charge Code |
27200247
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$33.17 |
| Max. Negotiated Rate |
$67.84 |
| Rate for Payer: Aetna American Axle |
$49.00
|
| Rate for Payer: Aetna Commercial |
$64.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.00
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Cofinity Advantage |
$52.77
|
| Rate for Payer: Cofinity Commercial |
$64.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.30
|
| Rate for Payer: Healthscope Commercial |
$67.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.53
|
| Rate for Payer: PHP Commercial |
$64.07
|
| Rate for Payer: Priority Health SBD |
$47.49
|
| Rate for Payer: UMR Bronson Commercial |
$33.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.53
|
|
|
HC NEEDLE BRACHYTHERAPY EACH
|
Facility
|
OP
|
$75.38
|
|
|
Service Code
|
HCPCS C1715
|
| Hospital Charge Code |
27200247
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$67.84 |
| Rate for Payer: Aetna American Axle |
$49.00
|
| Rate for Payer: Aetna Commercial |
$64.07
|
| Rate for Payer: Aetna Medicare |
$37.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.00
|
| Rate for Payer: BCBS Complete |
$30.15
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Cofinity Advantage |
$52.77
|
| Rate for Payer: Cofinity Commercial |
$64.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.30
|
| Rate for Payer: Healthscope Commercial |
$67.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$60.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.53
|
| Rate for Payer: PHP Commercial |
$64.07
|
| Rate for Payer: Priority Health SBD |
$47.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.00
|
| Rate for Payer: UHC Core |
$39.27
|
| Rate for Payer: UHC Exchange |
$29.62
|
| Rate for Payer: UMR Bronson Commercial |
$27.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.53
|
|
