|
HC NON OPEN HEART PLATELET MAPPING
|
Facility
|
OP
|
$1,155.32
|
|
| Hospital Charge Code |
27000389
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$427.47 |
| Max. Negotiated Rate |
$1,039.79 |
| Rate for Payer: Aetna American Axle |
$750.96
|
| Rate for Payer: Aetna Commercial |
$982.02
|
| Rate for Payer: Aetna Medicare |
$577.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$750.96
|
| Rate for Payer: BCBS Complete |
$462.13
|
| Rate for Payer: Cash Price |
$924.26
|
| Rate for Payer: Cofinity Advantage |
$808.72
|
| Rate for Payer: Cofinity Commercial |
$993.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$924.26
|
| Rate for Payer: Healthscope Commercial |
$1,039.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$808.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$866.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$924.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$982.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$866.49
|
| Rate for Payer: PHP Commercial |
$982.02
|
| Rate for Payer: Priority Health SBD |
$727.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$750.96
|
| Rate for Payer: UHC Core |
$601.92
|
| Rate for Payer: UHC Exchange |
$454.04
|
| Rate for Payer: UMR Bronson Commercial |
$427.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$866.49
|
|
|
HC NON OPEN HEART PLATELET MAPPING
|
Facility
|
IP
|
$1,155.32
|
|
| Hospital Charge Code |
27000389
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$508.34 |
| Max. Negotiated Rate |
$1,039.79 |
| Rate for Payer: Aetna American Axle |
$750.96
|
| Rate for Payer: Aetna Commercial |
$982.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$750.96
|
| Rate for Payer: Cash Price |
$924.26
|
| Rate for Payer: Cofinity Advantage |
$808.72
|
| Rate for Payer: Cofinity Commercial |
$993.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$924.26
|
| Rate for Payer: Healthscope Commercial |
$1,039.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$808.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$866.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$982.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$866.49
|
| Rate for Payer: PHP Commercial |
$982.02
|
| Rate for Payer: Priority Health SBD |
$727.85
|
| Rate for Payer: UMR Bronson Commercial |
$508.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$866.49
|
|
|
HC NON OPEN HEART TEG
|
Facility
|
OP
|
$942.80
|
|
| Hospital Charge Code |
27000197
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$348.84 |
| Max. Negotiated Rate |
$848.52 |
| Rate for Payer: Aetna American Axle |
$612.82
|
| Rate for Payer: Aetna Commercial |
$801.38
|
| Rate for Payer: Aetna Medicare |
$471.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$612.82
|
| Rate for Payer: BCBS Complete |
$377.12
|
| Rate for Payer: Cash Price |
$754.24
|
| Rate for Payer: Cofinity Advantage |
$659.96
|
| Rate for Payer: Cofinity Commercial |
$810.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$754.24
|
| Rate for Payer: Healthscope Commercial |
$848.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$659.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$707.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$754.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$801.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$707.10
|
| Rate for Payer: PHP Commercial |
$801.38
|
| Rate for Payer: Priority Health SBD |
$593.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$612.82
|
| Rate for Payer: UHC Core |
$491.20
|
| Rate for Payer: UHC Exchange |
$370.52
|
| Rate for Payer: UMR Bronson Commercial |
$348.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$707.10
|
|
|
HC NON OPEN HEART TEG
|
Facility
|
IP
|
$942.80
|
|
| Hospital Charge Code |
27000197
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$414.83 |
| Max. Negotiated Rate |
$848.52 |
| Rate for Payer: Aetna American Axle |
$612.82
|
| Rate for Payer: Aetna Commercial |
$801.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$612.82
|
| Rate for Payer: Cash Price |
$754.24
|
| Rate for Payer: Cofinity Advantage |
$659.96
|
| Rate for Payer: Cofinity Commercial |
$810.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$754.24
|
| Rate for Payer: Healthscope Commercial |
$848.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$659.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$707.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$801.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$707.10
|
| Rate for Payer: PHP Commercial |
$801.38
|
| Rate for Payer: Priority Health SBD |
$593.96
|
| Rate for Payer: UMR Bronson Commercial |
$414.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$707.10
|
|
|
HC NON-SELECTIVE DEBRIDEMENT
|
Facility
|
OP
|
$366.12
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
42000037
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$89.43 |
| Max. Negotiated Rate |
$646.50 |
| Rate for Payer: Aetna American Axle |
$237.98
|
| Rate for Payer: Aetna Commercial |
$311.20
|
| Rate for Payer: Aetna Medicare |
$207.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$237.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$249.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$249.89
|
| Rate for Payer: BCBS Complete |
$109.79
|
| Rate for Payer: BCBS MAPPO |
$199.91
|
| Rate for Payer: BCBS Trust/PPO |
$89.43
|
| Rate for Payer: BCN Commercial |
$89.43
|
| Rate for Payer: BCN Medicare Advantage |
$199.91
|
| Rate for Payer: Cash Price |
$292.90
|
| Rate for Payer: Cash Price |
$292.90
|
| Rate for Payer: Cash Price |
$292.90
|
| Rate for Payer: Cofinity Advantage |
$256.28
|
| Rate for Payer: Cofinity Commercial |
$314.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.91
|
| Rate for Payer: Healthscope Commercial |
$329.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$256.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$274.59
|
| Rate for Payer: Mclaren Medicaid |
$199.91
|
| Rate for Payer: Mclaren Medicare |
$199.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$209.91
|
| Rate for Payer: Meridian Medicaid |
$209.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$229.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$219.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.20
|
| Rate for Payer: Nomi Health Commercial |
$599.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$274.59
|
| Rate for Payer: PACE Medicare |
$189.91
|
| Rate for Payer: PACE SWMI |
$199.91
|
| Rate for Payer: PHP Commercial |
$311.20
|
| Rate for Payer: PHP Medicare Advantage |
$199.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$646.50
|
| Rate for Payer: Priority Health Medicare |
$199.91
|
| Rate for Payer: Priority Health SBD |
$230.66
|
| Rate for Payer: Priority Health Tiered Network |
$517.20
|
| Rate for Payer: Railroad Medicare Medicare |
$199.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$237.98
|
| Rate for Payer: UHC Core |
$190.75
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$199.91
|
| Rate for Payer: UHC Exchange |
$143.89
|
| Rate for Payer: UHC Medicaid |
$104.55
|
| Rate for Payer: UHCCP Medicaid |
$104.55
|
| Rate for Payer: UMR Bronson Commercial |
$135.46
|
| Rate for Payer: VA VA |
$199.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$274.59
|
|
|
HC NON-SELECTIVE DEBRIDEMENT
|
Facility
|
IP
|
$366.12
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
42000037
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$161.09 |
| Max. Negotiated Rate |
$329.51 |
| Rate for Payer: Aetna American Axle |
$237.98
|
| Rate for Payer: Aetna Commercial |
$311.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$237.98
|
| Rate for Payer: Cash Price |
$292.90
|
| Rate for Payer: Cofinity Advantage |
$256.28
|
| Rate for Payer: Cofinity Commercial |
$314.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.90
|
| Rate for Payer: Healthscope Commercial |
$329.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$256.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$274.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$274.59
|
| Rate for Payer: PHP Commercial |
$311.20
|
| Rate for Payer: Priority Health SBD |
$230.66
|
| Rate for Payer: UMR Bronson Commercial |
$161.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$274.59
|
|
|
HC NON-SELECTIVE THORACIC AORTA W ANGIO
|
Facility
|
OP
|
$4,034.29
|
|
|
Service Code
|
CPT 36221
|
| Hospital Charge Code |
36100376
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,492.69 |
| Max. Negotiated Rate |
$10,174.29 |
| Rate for Payer: Aetna American Axle |
$2,622.29
|
| Rate for Payer: Aetna Commercial |
$3,429.15
|
| Rate for Payer: Aetna Medicare |
$3,271.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,622.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,932.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,932.66
|
| Rate for Payer: BCBS Complete |
$1,727.85
|
| Rate for Payer: BCBS MAPPO |
$3,146.13
|
| Rate for Payer: BCBS Trust/PPO |
$2,663.55
|
| Rate for Payer: BCN Commercial |
$2,663.55
|
| Rate for Payer: BCN Medicare Advantage |
$3,146.13
|
| Rate for Payer: Cash Price |
$3,227.43
|
| Rate for Payer: Cash Price |
$3,227.43
|
| Rate for Payer: Cash Price |
$3,227.43
|
| Rate for Payer: Cofinity Advantage |
$2,824.00
|
| Rate for Payer: Cofinity Commercial |
$3,469.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,227.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,146.13
|
| Rate for Payer: Healthscope Commercial |
$3,630.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,824.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,025.72
|
| Rate for Payer: Mclaren Medicaid |
$3,146.13
|
| Rate for Payer: Mclaren Medicare |
$3,146.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,303.44
|
| Rate for Payer: Meridian Medicaid |
$3,303.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,618.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,460.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,429.15
|
| Rate for Payer: Nomi Health Commercial |
$9,438.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,025.72
|
| Rate for Payer: PACE Medicare |
$2,988.82
|
| Rate for Payer: PACE SWMI |
$3,146.13
|
| Rate for Payer: PHP Commercial |
$3,429.15
|
| Rate for Payer: PHP Medicare Advantage |
$3,146.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,174.29
|
| Rate for Payer: Priority Health Medicare |
$3,146.13
|
| Rate for Payer: Priority Health SBD |
$2,541.60
|
| Rate for Payer: Priority Health Tiered Network |
$8,139.43
|
| Rate for Payer: Railroad Medicare Medicare |
$3,146.13
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,146.13
|
| Rate for Payer: UHC Medicaid |
$1,645.43
|
| Rate for Payer: UHCCP Medicaid |
$1,645.43
|
| Rate for Payer: UMR Bronson Commercial |
$1,492.69
|
| Rate for Payer: VA VA |
$3,146.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,025.72
|
|
|
HC NON-SELECTIVE THORACIC AORTA W ANGIO
|
Facility
|
IP
|
$4,034.29
|
|
|
Service Code
|
CPT 36221
|
| Hospital Charge Code |
36100376
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,775.09 |
| Max. Negotiated Rate |
$3,630.86 |
| Rate for Payer: Aetna American Axle |
$2,622.29
|
| Rate for Payer: Aetna Commercial |
$3,429.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,622.29
|
| Rate for Payer: Cash Price |
$3,227.43
|
| Rate for Payer: Cofinity Advantage |
$2,824.00
|
| Rate for Payer: Cofinity Commercial |
$3,469.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,227.43
|
| Rate for Payer: Healthscope Commercial |
$3,630.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,824.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,025.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,429.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,025.72
|
| Rate for Payer: PHP Commercial |
$3,429.15
|
| Rate for Payer: Priority Health SBD |
$2,541.60
|
| Rate for Payer: UMR Bronson Commercial |
$1,775.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,025.72
|
|
|
HC NON-SELECTIVE VERTEBRAL ARTERY UNI
|
Facility
|
OP
|
$9,738.02
|
|
|
Service Code
|
CPT 36225
|
| Hospital Charge Code |
36100380
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,645.43 |
| Max. Negotiated Rate |
$10,174.29 |
| Rate for Payer: Aetna American Axle |
$6,329.71
|
| Rate for Payer: Aetna Commercial |
$8,277.32
|
| Rate for Payer: Aetna Medicare |
$3,271.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,329.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,932.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,932.66
|
| Rate for Payer: BCBS Complete |
$1,727.85
|
| Rate for Payer: BCBS MAPPO |
$3,146.13
|
| Rate for Payer: BCBS Trust/PPO |
$2,663.55
|
| Rate for Payer: BCN Commercial |
$2,663.55
|
| Rate for Payer: BCN Medicare Advantage |
$3,146.13
|
| Rate for Payer: Cash Price |
$7,790.42
|
| Rate for Payer: Cash Price |
$7,790.42
|
| Rate for Payer: Cash Price |
$7,790.42
|
| Rate for Payer: Cofinity Advantage |
$6,816.61
|
| Rate for Payer: Cofinity Commercial |
$8,374.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,790.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,146.13
|
| Rate for Payer: Healthscope Commercial |
$8,764.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,816.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,303.52
|
| Rate for Payer: Mclaren Medicaid |
$3,146.13
|
| Rate for Payer: Mclaren Medicare |
$3,146.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,303.44
|
| Rate for Payer: Meridian Medicaid |
$3,303.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,618.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,460.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,277.32
|
| Rate for Payer: Nomi Health Commercial |
$9,438.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,303.52
|
| Rate for Payer: PACE Medicare |
$2,988.82
|
| Rate for Payer: PACE SWMI |
$3,146.13
|
| Rate for Payer: PHP Commercial |
$8,277.32
|
| Rate for Payer: PHP Medicare Advantage |
$3,146.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,174.29
|
| Rate for Payer: Priority Health Medicare |
$3,146.13
|
| Rate for Payer: Priority Health SBD |
$6,134.95
|
| Rate for Payer: Priority Health Tiered Network |
$8,139.43
|
| Rate for Payer: Railroad Medicare Medicare |
$3,146.13
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,146.13
|
| Rate for Payer: UHC Medicaid |
$1,645.43
|
| Rate for Payer: UHCCP Medicaid |
$1,645.43
|
| Rate for Payer: UMR Bronson Commercial |
$3,603.07
|
| Rate for Payer: VA VA |
$3,146.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,303.52
|
|
|
HC NON-SELECTIVE VERTEBRAL ARTERY UNI
|
Facility
|
IP
|
$9,738.02
|
|
|
Service Code
|
CPT 36225
|
| Hospital Charge Code |
36100380
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,284.73 |
| Max. Negotiated Rate |
$8,764.22 |
| Rate for Payer: Aetna American Axle |
$6,329.71
|
| Rate for Payer: Aetna Commercial |
$8,277.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,329.71
|
| Rate for Payer: Cash Price |
$7,790.42
|
| Rate for Payer: Cofinity Advantage |
$6,816.61
|
| Rate for Payer: Cofinity Commercial |
$8,374.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,790.42
|
| Rate for Payer: Healthscope Commercial |
$8,764.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,816.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,303.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,277.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,303.52
|
| Rate for Payer: PHP Commercial |
$8,277.32
|
| Rate for Payer: Priority Health SBD |
$6,134.95
|
| Rate for Payer: UMR Bronson Commercial |
$4,284.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,303.52
|
|
|
HC NONSTRESS TEST
|
Facility
|
IP
|
$359.49
|
|
|
Service Code
|
CPT 59025
|
| Hospital Charge Code |
92000004
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$158.18 |
| Max. Negotiated Rate |
$323.54 |
| Rate for Payer: Aetna American Axle |
$233.67
|
| Rate for Payer: Aetna Commercial |
$305.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$233.67
|
| Rate for Payer: Cash Price |
$287.59
|
| Rate for Payer: Cofinity Advantage |
$251.64
|
| Rate for Payer: Cofinity Commercial |
$309.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$287.59
|
| Rate for Payer: Healthscope Commercial |
$323.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$251.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$269.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$305.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$269.62
|
| Rate for Payer: PHP Commercial |
$305.57
|
| Rate for Payer: Priority Health SBD |
$226.48
|
| Rate for Payer: UMR Bronson Commercial |
$158.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$269.62
|
|
|
HC NONSTRESS TEST
|
Facility
|
OP
|
$359.49
|
|
|
Service Code
|
CPT 59025
|
| Hospital Charge Code |
92000004
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$105.35 |
| Max. Negotiated Rate |
$651.46 |
| Rate for Payer: Aetna American Axle |
$233.67
|
| Rate for Payer: Aetna Commercial |
$305.57
|
| Rate for Payer: Aetna Medicare |
$209.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$233.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$251.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$251.80
|
| Rate for Payer: BCBS Complete |
$110.63
|
| Rate for Payer: BCBS MAPPO |
$201.44
|
| Rate for Payer: BCBS Trust/PPO |
$241.37
|
| Rate for Payer: BCN Commercial |
$241.37
|
| Rate for Payer: BCN Medicare Advantage |
$201.44
|
| Rate for Payer: Cash Price |
$287.59
|
| Rate for Payer: Cash Price |
$287.59
|
| Rate for Payer: Cash Price |
$287.59
|
| Rate for Payer: Cofinity Advantage |
$251.64
|
| Rate for Payer: Cofinity Commercial |
$309.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$287.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$201.44
|
| Rate for Payer: Healthscope Commercial |
$323.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$251.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$269.62
|
| Rate for Payer: Mclaren Medicaid |
$201.44
|
| Rate for Payer: Mclaren Medicare |
$201.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$211.51
|
| Rate for Payer: Meridian Medicaid |
$211.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$231.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$221.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$305.57
|
| Rate for Payer: Nomi Health Commercial |
$604.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$269.62
|
| Rate for Payer: PACE Medicare |
$191.37
|
| Rate for Payer: PACE SWMI |
$201.44
|
| Rate for Payer: PHP Commercial |
$305.57
|
| Rate for Payer: PHP Medicare Advantage |
$201.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$105.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$651.46
|
| Rate for Payer: Priority Health Medicare |
$201.44
|
| Rate for Payer: Priority Health SBD |
$226.48
|
| Rate for Payer: Priority Health Tiered Network |
$521.17
|
| Rate for Payer: Railroad Medicare Medicare |
$201.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$233.67
|
| Rate for Payer: UHC Core |
$187.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$201.44
|
| Rate for Payer: UHC Exchange |
$141.28
|
| Rate for Payer: UHC Medicaid |
$105.35
|
| Rate for Payer: UHCCP Medicaid |
$105.35
|
| Rate for Payer: UMR Bronson Commercial |
$133.01
|
| Rate for Payer: VA VA |
$201.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$269.62
|
|
|
HC NON THROMBOLYTIC INTRACRANIAL EA ADDL VASCULAR TERRITORY
|
Facility
|
OP
|
$3,378.32
|
|
|
Service Code
|
CPT 61651
|
| Hospital Charge Code |
36100515
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,010.46 |
| Max. Negotiated Rate |
$3,040.49 |
| Rate for Payer: Aetna American Axle |
$2,195.91
|
| Rate for Payer: Aetna Commercial |
$2,871.57
|
| Rate for Payer: Aetna Medicare |
$1,689.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,195.91
|
| Rate for Payer: BCBS Complete |
$1,351.33
|
| Rate for Payer: BCBS Trust/PPO |
$1,010.46
|
| Rate for Payer: BCN Commercial |
$1,010.46
|
| Rate for Payer: Cash Price |
$2,702.66
|
| Rate for Payer: Cash Price |
$2,702.66
|
| Rate for Payer: Cash Price |
$2,702.66
|
| Rate for Payer: Cofinity Advantage |
$2,364.82
|
| Rate for Payer: Cofinity Commercial |
$2,905.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,702.66
|
| Rate for Payer: Healthscope Commercial |
$3,040.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,364.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,533.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,702.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,871.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,533.74
|
| Rate for Payer: PHP Commercial |
$2,871.57
|
| Rate for Payer: Priority Health SBD |
$2,128.34
|
| Rate for Payer: UMR Bronson Commercial |
$1,249.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,533.74
|
|
|
HC NON THROMBOLYTIC INTRACRANIAL EA ADDL VASCULAR TERRITORY
|
Facility
|
IP
|
$3,378.32
|
|
|
Service Code
|
CPT 61651
|
| Hospital Charge Code |
36100515
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,486.46 |
| Max. Negotiated Rate |
$3,040.49 |
| Rate for Payer: Aetna American Axle |
$2,195.91
|
| Rate for Payer: Aetna Commercial |
$2,871.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,195.91
|
| Rate for Payer: Cash Price |
$2,702.66
|
| Rate for Payer: Cofinity Advantage |
$2,364.82
|
| Rate for Payer: Cofinity Commercial |
$2,905.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,702.66
|
| Rate for Payer: Healthscope Commercial |
$3,040.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,364.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,533.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,871.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,533.74
|
| Rate for Payer: PHP Commercial |
$2,871.57
|
| Rate for Payer: Priority Health SBD |
$2,128.34
|
| Rate for Payer: UMR Bronson Commercial |
$1,486.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,533.74
|
|
|
HC NON THROMBOLYTIC INTRACRANIAL INITIAL VASCULAR TERRITORY
|
Facility
|
IP
|
$4,606.81
|
|
|
Service Code
|
CPT 61650
|
| Hospital Charge Code |
36100514
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,027.00 |
| Max. Negotiated Rate |
$4,146.13 |
| Rate for Payer: Aetna American Axle |
$2,994.43
|
| Rate for Payer: Aetna Commercial |
$3,915.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,994.43
|
| Rate for Payer: Cash Price |
$3,685.45
|
| Rate for Payer: Cofinity Advantage |
$3,224.77
|
| Rate for Payer: Cofinity Commercial |
$3,961.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,685.45
|
| Rate for Payer: Healthscope Commercial |
$4,146.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,224.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,455.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,915.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,455.11
|
| Rate for Payer: PHP Commercial |
$3,915.79
|
| Rate for Payer: Priority Health SBD |
$2,902.29
|
| Rate for Payer: UMR Bronson Commercial |
$2,027.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,455.11
|
|
|
HC NON THROMBOLYTIC INTRACRANIAL INITIAL VASCULAR TERRITORY
|
Facility
|
OP
|
$4,606.81
|
|
|
Service Code
|
CPT 61650
|
| Hospital Charge Code |
36100514
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,704.52 |
| Max. Negotiated Rate |
$4,146.13 |
| Rate for Payer: Aetna American Axle |
$2,994.43
|
| Rate for Payer: Aetna Commercial |
$3,915.79
|
| Rate for Payer: Aetna Medicare |
$2,303.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,994.43
|
| Rate for Payer: BCBS Complete |
$1,842.72
|
| Rate for Payer: BCBS Trust/PPO |
$2,376.60
|
| Rate for Payer: BCN Commercial |
$2,376.60
|
| Rate for Payer: Cash Price |
$3,685.45
|
| Rate for Payer: Cash Price |
$3,685.45
|
| Rate for Payer: Cash Price |
$3,685.45
|
| Rate for Payer: Cofinity Advantage |
$3,224.77
|
| Rate for Payer: Cofinity Commercial |
$3,961.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,685.45
|
| Rate for Payer: Healthscope Commercial |
$4,146.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,224.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,455.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,685.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,915.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,455.11
|
| Rate for Payer: PHP Commercial |
$3,915.79
|
| Rate for Payer: Priority Health SBD |
$2,902.29
|
| Rate for Payer: UMR Bronson Commercial |
$1,704.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,455.11
|
|
|
HC NORCLOZAPINE LEVEL
|
Facility
|
IP
|
$25.47
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100065
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.21 |
| Max. Negotiated Rate |
$22.92 |
| Rate for Payer: Aetna American Axle |
$16.56
|
| Rate for Payer: Aetna Commercial |
$21.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.56
|
| Rate for Payer: Cash Price |
$20.38
|
| Rate for Payer: Cofinity Advantage |
$17.83
|
| Rate for Payer: Cofinity Commercial |
$21.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.38
|
| Rate for Payer: Healthscope Commercial |
$22.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.10
|
| Rate for Payer: PHP Commercial |
$21.65
|
| Rate for Payer: Priority Health SBD |
$16.05
|
| Rate for Payer: UMR Bronson Commercial |
$11.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.10
|
|
|
HC NORCLOZAPINE LEVEL
|
Facility
|
OP
|
$25.47
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100065
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.42 |
| Max. Negotiated Rate |
$27.96 |
| Rate for Payer: Aetna American Axle |
$16.56
|
| Rate for Payer: Aetna Commercial |
$21.65
|
| Rate for Payer: Aetna Medicare |
$19.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.56
|
| 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 |
$10.24
|
| Rate for Payer: BCBS MAPPO |
$18.64
|
| Rate for Payer: BCBS Trust/PPO |
$21.55
|
| Rate for Payer: BCN Commercial |
$21.55
|
| Rate for Payer: BCN Medicare Advantage |
$18.64
|
| Rate for Payer: Cash Price |
$20.38
|
| Rate for Payer: Cash Price |
$20.38
|
| Rate for Payer: Cofinity Advantage |
$17.83
|
| Rate for Payer: Cofinity Commercial |
$21.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.64
|
| Rate for Payer: Healthscope Commercial |
$22.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.10
|
| Rate for Payer: Mclaren Medicaid |
$18.64
|
| Rate for Payer: Mclaren Medicare |
$18.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.57
|
| Rate for Payer: Meridian Medicaid |
$19.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.65
|
| Rate for Payer: Nomi Health Commercial |
$27.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.10
|
| Rate for Payer: PACE Medicare |
$17.71
|
| Rate for Payer: PACE SWMI |
$18.64
|
| Rate for Payer: PHP Commercial |
$21.65
|
| Rate for Payer: PHP Medicare Advantage |
$18.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.75
|
| Rate for Payer: Priority Health Medicare |
$18.64
|
| Rate for Payer: Priority Health SBD |
$16.05
|
| Rate for Payer: Railroad Medicare Medicare |
$18.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.96
|
| Rate for Payer: UHC Core |
$27.96
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18.64
|
| Rate for Payer: UHC Exchange |
$27.96
|
| Rate for Payer: UHC Medicaid |
$9.75
|
| Rate for Payer: UHCCP Medicaid |
$9.75
|
| Rate for Payer: UMR Bronson Commercial |
$9.42
|
| Rate for Payer: VA VA |
$18.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.10
|
|
|
HC NORTRIPTYLINE LVL
|
Facility
|
IP
|
$44.74
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
30100592
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.69 |
| Max. Negotiated Rate |
$40.27 |
| Rate for Payer: Aetna American Axle |
$29.08
|
| Rate for Payer: Aetna Commercial |
$38.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.08
|
| Rate for Payer: Cash Price |
$35.79
|
| Rate for Payer: Cofinity Advantage |
$31.32
|
| Rate for Payer: Cofinity Commercial |
$38.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.79
|
| Rate for Payer: Healthscope Commercial |
$40.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.55
|
| Rate for Payer: PHP Commercial |
$38.03
|
| Rate for Payer: Priority Health SBD |
$28.19
|
| Rate for Payer: UMR Bronson Commercial |
$19.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.55
|
|
|
HC NORTRIPTYLINE LVL
|
Facility
|
OP
|
$44.74
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
30100592
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.55 |
| Max. Negotiated Rate |
$40.27 |
| Rate for Payer: Aetna American Axle |
$29.08
|
| Rate for Payer: Aetna Commercial |
$38.03
|
| Rate for Payer: Aetna Medicare |
$22.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.08
|
| Rate for Payer: BCBS Complete |
$17.90
|
| Rate for Payer: Cash Price |
$35.79
|
| Rate for Payer: Cofinity Advantage |
$31.32
|
| Rate for Payer: Cofinity Commercial |
$38.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.79
|
| Rate for Payer: Healthscope Commercial |
$40.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.55
|
| Rate for Payer: PHP Commercial |
$38.03
|
| Rate for Payer: Priority Health SBD |
$28.19
|
| Rate for Payer: UMR Bronson Commercial |
$16.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.55
|
|
|
HC NOSEBLEED/ENT
|
Facility
|
OP
|
$422.82
|
|
| Hospital Charge Code |
45000061
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$125.00 |
| Max. Negotiated Rate |
$380.54 |
| Rate for Payer: Aetna American Axle |
$274.83
|
| Rate for Payer: Aetna Commercial |
$359.40
|
| Rate for Payer: Aetna Medicare |
$211.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$274.83
|
| Rate for Payer: BCBS Complete |
$169.13
|
| Rate for Payer: Cash Price |
$338.26
|
| Rate for Payer: Cash Price |
$338.26
|
| Rate for Payer: Cofinity Advantage |
$295.97
|
| Rate for Payer: Cofinity Commercial |
$363.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$338.26
|
| Rate for Payer: Healthscope Commercial |
$380.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$295.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$317.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$338.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$359.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$317.12
|
| Rate for Payer: PHP Commercial |
$359.40
|
| Rate for Payer: Priority Health SBD |
$266.38
|
| Rate for Payer: UHCCP Medicaid |
$125.00
|
| Rate for Payer: UMR Bronson Commercial |
$156.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$317.12
|
|
|
HC NOSEBLEED/ENT
|
Facility
|
IP
|
$422.82
|
|
| Hospital Charge Code |
45000061
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$186.04 |
| Max. Negotiated Rate |
$380.54 |
| Rate for Payer: Aetna American Axle |
$274.83
|
| Rate for Payer: Aetna Commercial |
$359.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$274.83
|
| Rate for Payer: Cash Price |
$338.26
|
| Rate for Payer: Cofinity Advantage |
$295.97
|
| Rate for Payer: Cofinity Commercial |
$363.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$338.26
|
| Rate for Payer: Healthscope Commercial |
$380.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$295.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$317.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$359.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$317.12
|
| Rate for Payer: PHP Commercial |
$359.40
|
| Rate for Payer: Priority Health SBD |
$266.38
|
| Rate for Payer: UMR Bronson Commercial |
$186.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$317.12
|
|
|
HC NUC MED STRESS TEST
|
Facility
|
IP
|
$967.23
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
48200005
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$425.58 |
| Max. Negotiated Rate |
$870.51 |
| Rate for Payer: Aetna American Axle |
$628.70
|
| Rate for Payer: Aetna Commercial |
$822.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$628.70
|
| Rate for Payer: Cash Price |
$773.78
|
| Rate for Payer: Cofinity Advantage |
$677.06
|
| Rate for Payer: Cofinity Commercial |
$831.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$773.78
|
| Rate for Payer: Healthscope Commercial |
$870.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$677.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$725.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$822.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$725.42
|
| Rate for Payer: PHP Commercial |
$822.15
|
| Rate for Payer: Priority Health SBD |
$609.35
|
| Rate for Payer: UMR Bronson Commercial |
$425.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$725.42
|
|
|
HC NUC MED STRESS TEST
|
Facility
|
OP
|
$967.23
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
48200005
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$112.52 |
| Max. Negotiated Rate |
$870.51 |
| Rate for Payer: Aetna American Axle |
$628.70
|
| Rate for Payer: Aetna Commercial |
$822.15
|
| Rate for Payer: Aetna Medicare |
$223.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$628.70
|
| 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 |
$159.19
|
| Rate for Payer: BCN Commercial |
$159.19
|
| Rate for Payer: BCN Medicare Advantage |
$215.15
|
| Rate for Payer: Cash Price |
$773.78
|
| Rate for Payer: Cash Price |
$773.78
|
| Rate for Payer: Cofinity Advantage |
$677.06
|
| Rate for Payer: Cofinity Commercial |
$831.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$773.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$215.15
|
| Rate for Payer: Healthscope Commercial |
$870.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$677.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$725.42
|
| 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 |
$822.15
|
| Rate for Payer: Nomi Health Commercial |
$645.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$725.42
|
| Rate for Payer: PACE Medicare |
$204.39
|
| Rate for Payer: PACE SWMI |
$215.15
|
| Rate for Payer: PHP Commercial |
$822.15
|
| 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 |
$609.35
|
| 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) |
$628.70
|
| Rate for Payer: UHC Core |
$503.93
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$215.15
|
| Rate for Payer: UHC Exchange |
$380.12
|
| Rate for Payer: UHC Medicaid |
$112.52
|
| Rate for Payer: UHCCP Medicaid |
$112.52
|
| Rate for Payer: UMR Bronson Commercial |
$357.88
|
| Rate for Payer: VA VA |
$215.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$725.42
|
|
|
HC NURSEMAID ELBOW REDUCTION
|
Facility
|
OP
|
$220.29
|
|
|
Service Code
|
CPT 24640
|
| Hospital Charge Code |
45000008
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$81.51 |
| Max. Negotiated Rate |
$794.84 |
| Rate for Payer: Aetna American Axle |
$143.19
|
| Rate for Payer: Aetna Commercial |
$187.25
|
| Rate for Payer: Aetna Medicare |
$255.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$307.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$307.23
|
| Rate for Payer: BCBS Complete |
$134.98
|
| Rate for Payer: BCBS MAPPO |
$245.78
|
| Rate for Payer: BCBS Trust/PPO |
$183.70
|
| Rate for Payer: BCN Commercial |
$183.70
|
| Rate for Payer: BCN Medicare Advantage |
$245.78
|
| Rate for Payer: Cash Price |
$176.23
|
| Rate for Payer: Cash Price |
$176.23
|
| Rate for Payer: Cash Price |
$176.23
|
| Rate for Payer: Cofinity Advantage |
$154.20
|
| Rate for Payer: Cofinity Commercial |
$189.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$245.78
|
| Rate for Payer: Healthscope Commercial |
$198.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$154.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$165.22
|
| Rate for Payer: Mclaren Medicaid |
$245.78
|
| Rate for Payer: Mclaren Medicare |
$245.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$258.07
|
| Rate for Payer: Meridian Medicaid |
$258.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$282.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$270.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$187.25
|
| Rate for Payer: Nomi Health Commercial |
$737.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$165.22
|
| Rate for Payer: PACE Medicare |
$233.49
|
| Rate for Payer: PACE SWMI |
$245.78
|
| Rate for Payer: PHP Commercial |
$187.25
|
| Rate for Payer: PHP Medicare Advantage |
$245.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$128.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$794.84
|
| Rate for Payer: Priority Health Medicare |
$245.78
|
| Rate for Payer: Priority Health SBD |
$138.78
|
| Rate for Payer: Priority Health Tiered Network |
$635.87
|
| Rate for Payer: Railroad Medicare Medicare |
$245.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$143.19
|
| Rate for Payer: UHC Core |
$114.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$245.78
|
| Rate for Payer: UHC Exchange |
$86.57
|
| Rate for Payer: UHC Medicaid |
$128.54
|
| Rate for Payer: UHCCP Medicaid |
$128.54
|
| Rate for Payer: UMR Bronson Commercial |
$81.51
|
| Rate for Payer: VA VA |
$245.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$165.22
|
|
