|
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
|
|
|
HC NUSHIELD (1.6 SQ CM DISC) PER SQ CM
|
Facility
|
IP
|
$628.77
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600153
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$276.66 |
| Max. Negotiated Rate |
$565.89 |
| Rate for Payer: Aetna American Axle |
$408.70
|
| Rate for Payer: Aetna Commercial |
$534.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$408.70
|
| Rate for Payer: Cash Price |
$503.02
|
| Rate for Payer: Cofinity Advantage |
$440.14
|
| Rate for Payer: Cofinity Commercial |
$540.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$503.02
|
| Rate for Payer: Healthscope Commercial |
$565.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$440.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$471.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$534.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$471.58
|
| Rate for Payer: PHP Commercial |
$534.45
|
| Rate for Payer: Priority Health SBD |
$396.13
|
| Rate for Payer: UMR Bronson Commercial |
$276.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$471.58
|
|
|
HC NUSHIELD (1.6 SQ CM DISC) PER SQ CM
|
Facility
|
OP
|
$628.77
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600153
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.85 |
| Max. Negotiated Rate |
$565.89 |
| Rate for Payer: Aetna American Axle |
$408.70
|
| Rate for Payer: Aetna Commercial |
$534.45
|
| Rate for Payer: Aetna Medicare |
$128.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$408.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.00
|
| Rate for Payer: BCBS Complete |
$68.10
|
| Rate for Payer: BCBS MAPPO |
$124.00
|
| Rate for Payer: BCN Medicare Advantage |
$124.00
|
| Rate for Payer: Cash Price |
$503.02
|
| Rate for Payer: Cash Price |
$503.02
|
| Rate for Payer: Cofinity Advantage |
$440.14
|
| Rate for Payer: Cofinity Commercial |
$540.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$503.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.00
|
| Rate for Payer: Healthscope Commercial |
$565.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$440.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$471.58
|
| Rate for Payer: Mclaren Medicaid |
$124.00
|
| Rate for Payer: Mclaren Medicare |
$124.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.20
|
| Rate for Payer: Meridian Medicaid |
$130.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$534.45
|
| Rate for Payer: Nomi Health Commercial |
$372.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$471.58
|
| Rate for Payer: PACE Medicare |
$117.80
|
| Rate for Payer: PACE SWMI |
$124.00
|
| Rate for Payer: PHP Commercial |
$534.45
|
| Rate for Payer: PHP Medicare Advantage |
$124.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$401.00
|
| Rate for Payer: Priority Health Medicare |
$124.00
|
| Rate for Payer: Priority Health SBD |
$396.13
|
| Rate for Payer: Priority Health Tiered Network |
$320.80
|
| Rate for Payer: Railroad Medicare Medicare |
$124.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.78
|
| Rate for Payer: UHC Core |
$209.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$124.00
|
| Rate for Payer: UHC Exchange |
$209.78
|
| Rate for Payer: UHC Medicaid |
$64.85
|
| Rate for Payer: UHCCP Medicaid |
$64.85
|
| Rate for Payer: UMR Bronson Commercial |
$232.64
|
| Rate for Payer: VA VA |
$124.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$471.58
|
|
|
HC NUSHIELD 2X3 PER SQ CM
|
Facility
|
IP
|
$335.55
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600154
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$147.64 |
| Max. Negotiated Rate |
$302.00 |
| Rate for Payer: Aetna American Axle |
$218.11
|
| Rate for Payer: Aetna Commercial |
$285.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$218.11
|
| Rate for Payer: Cash Price |
$268.44
|
| Rate for Payer: Cofinity Advantage |
$234.88
|
| Rate for Payer: Cofinity Commercial |
$288.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.44
|
| Rate for Payer: Healthscope Commercial |
$302.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$234.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$251.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$251.66
|
| Rate for Payer: PHP Commercial |
$285.22
|
| Rate for Payer: Priority Health SBD |
$211.40
|
| Rate for Payer: UMR Bronson Commercial |
$147.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$251.66
|
|
|
HC NUSHIELD 2X3 PER SQ CM
|
Facility
|
OP
|
$335.55
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600154
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.85 |
| Max. Negotiated Rate |
$401.00 |
| Rate for Payer: Aetna American Axle |
$218.11
|
| Rate for Payer: Aetna Commercial |
$285.22
|
| Rate for Payer: Aetna Medicare |
$128.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$218.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.00
|
| Rate for Payer: BCBS Complete |
$68.10
|
| Rate for Payer: BCBS MAPPO |
$124.00
|
| Rate for Payer: BCN Medicare Advantage |
$124.00
|
| Rate for Payer: Cash Price |
$268.44
|
| Rate for Payer: Cash Price |
$268.44
|
| Rate for Payer: Cofinity Advantage |
$234.88
|
| Rate for Payer: Cofinity Commercial |
$288.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.00
|
| Rate for Payer: Healthscope Commercial |
$302.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$234.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$251.66
|
| Rate for Payer: Mclaren Medicaid |
$124.00
|
| Rate for Payer: Mclaren Medicare |
$124.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.20
|
| Rate for Payer: Meridian Medicaid |
$130.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.22
|
| Rate for Payer: Nomi Health Commercial |
$372.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$251.66
|
| Rate for Payer: PACE Medicare |
$117.80
|
| Rate for Payer: PACE SWMI |
$124.00
|
| Rate for Payer: PHP Commercial |
$285.22
|
| Rate for Payer: PHP Medicare Advantage |
$124.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$401.00
|
| Rate for Payer: Priority Health Medicare |
$124.00
|
| Rate for Payer: Priority Health SBD |
$211.40
|
| Rate for Payer: Priority Health Tiered Network |
$320.80
|
| Rate for Payer: Railroad Medicare Medicare |
$124.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.78
|
| Rate for Payer: UHC Core |
$209.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$124.00
|
| Rate for Payer: UHC Exchange |
$209.78
|
| Rate for Payer: UHC Medicaid |
$64.85
|
| Rate for Payer: UHCCP Medicaid |
$64.85
|
| Rate for Payer: UMR Bronson Commercial |
$124.15
|
| Rate for Payer: VA VA |
$124.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$251.66
|
|
|
HC NUSHIELD 2X4 PER SQ CM
|
Facility
|
OP
|
$315.06
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600175
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.85 |
| Max. Negotiated Rate |
$401.00 |
| Rate for Payer: Aetna American Axle |
$204.79
|
| Rate for Payer: Aetna Commercial |
$267.80
|
| Rate for Payer: Aetna Medicare |
$128.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$204.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.00
|
| Rate for Payer: BCBS Complete |
$68.10
|
| Rate for Payer: BCBS MAPPO |
$124.00
|
| Rate for Payer: BCN Medicare Advantage |
$124.00
|
| Rate for Payer: Cash Price |
$252.05
|
| Rate for Payer: Cash Price |
$252.05
|
| Rate for Payer: Cofinity Advantage |
$220.54
|
| Rate for Payer: Cofinity Commercial |
$270.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.00
|
| Rate for Payer: Healthscope Commercial |
$283.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$220.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$236.29
|
| Rate for Payer: Mclaren Medicaid |
$124.00
|
| Rate for Payer: Mclaren Medicare |
$124.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.20
|
| Rate for Payer: Meridian Medicaid |
$130.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$267.80
|
| Rate for Payer: Nomi Health Commercial |
$372.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$236.29
|
| Rate for Payer: PACE Medicare |
$117.80
|
| Rate for Payer: PACE SWMI |
$124.00
|
| Rate for Payer: PHP Commercial |
$267.80
|
| Rate for Payer: PHP Medicare Advantage |
$124.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$401.00
|
| Rate for Payer: Priority Health Medicare |
$124.00
|
| Rate for Payer: Priority Health SBD |
$198.49
|
| Rate for Payer: Priority Health Tiered Network |
$320.80
|
| Rate for Payer: Railroad Medicare Medicare |
$124.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.78
|
| Rate for Payer: UHC Core |
$209.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$124.00
|
| Rate for Payer: UHC Exchange |
$209.78
|
| Rate for Payer: UHC Medicaid |
$64.85
|
| Rate for Payer: UHCCP Medicaid |
$64.85
|
| Rate for Payer: UMR Bronson Commercial |
$116.57
|
| Rate for Payer: VA VA |
$124.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$236.29
|
|
|
HC NUSHIELD 2X4 PER SQ CM
|
Facility
|
IP
|
$315.06
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600175
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$138.63 |
| Max. Negotiated Rate |
$283.55 |
| Rate for Payer: Aetna American Axle |
$204.79
|
| Rate for Payer: Aetna Commercial |
$267.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$204.79
|
| Rate for Payer: Cash Price |
$252.05
|
| Rate for Payer: Cofinity Advantage |
$220.54
|
| Rate for Payer: Cofinity Commercial |
$270.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.05
|
| Rate for Payer: Healthscope Commercial |
$283.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$220.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$236.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$267.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$236.29
|
| Rate for Payer: PHP Commercial |
$267.80
|
| Rate for Payer: Priority Health SBD |
$198.49
|
| Rate for Payer: UMR Bronson Commercial |
$138.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$236.29
|
|
|
HC NUSHIELD 3X4 PER SQ CM
|
Facility
|
OP
|
$303.99
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600176
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.85 |
| Max. Negotiated Rate |
$401.00 |
| Rate for Payer: Aetna American Axle |
$197.59
|
| Rate for Payer: Aetna Commercial |
$258.39
|
| Rate for Payer: Aetna Medicare |
$128.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$197.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.00
|
| Rate for Payer: BCBS Complete |
$68.10
|
| Rate for Payer: BCBS MAPPO |
$124.00
|
| Rate for Payer: BCN Medicare Advantage |
$124.00
|
| Rate for Payer: Cash Price |
$243.19
|
| Rate for Payer: Cash Price |
$243.19
|
| Rate for Payer: Cofinity Advantage |
$212.79
|
| Rate for Payer: Cofinity Commercial |
$261.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$243.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.00
|
| Rate for Payer: Healthscope Commercial |
$273.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$212.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$227.99
|
| Rate for Payer: Mclaren Medicaid |
$124.00
|
| Rate for Payer: Mclaren Medicare |
$124.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.20
|
| Rate for Payer: Meridian Medicaid |
$130.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$258.39
|
| Rate for Payer: Nomi Health Commercial |
$372.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$227.99
|
| Rate for Payer: PACE Medicare |
$117.80
|
| Rate for Payer: PACE SWMI |
$124.00
|
| Rate for Payer: PHP Commercial |
$258.39
|
| Rate for Payer: PHP Medicare Advantage |
$124.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$401.00
|
| Rate for Payer: Priority Health Medicare |
$124.00
|
| Rate for Payer: Priority Health SBD |
$191.51
|
| Rate for Payer: Priority Health Tiered Network |
$320.80
|
| Rate for Payer: Railroad Medicare Medicare |
$124.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.78
|
| Rate for Payer: UHC Core |
$209.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$124.00
|
| Rate for Payer: UHC Exchange |
$209.78
|
| Rate for Payer: UHC Medicaid |
$64.85
|
| Rate for Payer: UHCCP Medicaid |
$64.85
|
| Rate for Payer: UMR Bronson Commercial |
$112.48
|
| Rate for Payer: VA VA |
$124.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$227.99
|
|
|
HC NUSHIELD 3X4 PER SQ CM
|
Facility
|
IP
|
$303.99
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600176
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$133.76 |
| Max. Negotiated Rate |
$273.59 |
| Rate for Payer: Aetna American Axle |
$197.59
|
| Rate for Payer: Aetna Commercial |
$258.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$197.59
|
| Rate for Payer: Cash Price |
$243.19
|
| Rate for Payer: Cofinity Advantage |
$212.79
|
| Rate for Payer: Cofinity Commercial |
$261.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$243.19
|
| Rate for Payer: Healthscope Commercial |
$273.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$212.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$227.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$258.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$227.99
|
| Rate for Payer: PHP Commercial |
$258.39
|
| Rate for Payer: Priority Health SBD |
$191.51
|
| Rate for Payer: UMR Bronson Commercial |
$133.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$227.99
|
|
|
HC NUSHIELD 4X4 PER SQ CM
|
Facility
|
OP
|
$236.28
|
|
|
Service Code
|
CPT Q4160
|
| Hospital Charge Code |
63600177
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.85 |
| Max. Negotiated Rate |
$401.00 |
| Rate for Payer: Aetna American Axle |
$153.58
|
| Rate for Payer: Aetna Commercial |
$200.84
|
| Rate for Payer: Aetna Medicare |
$128.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.00
|
| Rate for Payer: BCBS Complete |
$68.10
|
| Rate for Payer: BCBS MAPPO |
$124.00
|
| Rate for Payer: BCN Medicare Advantage |
$124.00
|
| Rate for Payer: Cash Price |
$189.02
|
| Rate for Payer: Cash Price |
$189.02
|
| Rate for Payer: Cofinity Advantage |
$165.40
|
| Rate for Payer: Cofinity Commercial |
$203.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.00
|
| Rate for Payer: Healthscope Commercial |
$212.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$165.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$177.21
|
| Rate for Payer: Mclaren Medicaid |
$124.00
|
| Rate for Payer: Mclaren Medicare |
$124.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.20
|
| Rate for Payer: Meridian Medicaid |
$130.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.84
|
| Rate for Payer: Nomi Health Commercial |
$372.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$177.21
|
| Rate for Payer: PACE Medicare |
$117.80
|
| Rate for Payer: PACE SWMI |
$124.00
|
| Rate for Payer: PHP Commercial |
$200.84
|
| Rate for Payer: PHP Medicare Advantage |
$124.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$401.00
|
| Rate for Payer: Priority Health Medicare |
$124.00
|
| Rate for Payer: Priority Health SBD |
$148.86
|
| Rate for Payer: Priority Health Tiered Network |
$320.80
|
| Rate for Payer: Railroad Medicare Medicare |
$124.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.78
|
| Rate for Payer: UHC Core |
$209.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$124.00
|
| Rate for Payer: UHC Exchange |
$209.78
|
| Rate for Payer: UHC Medicaid |
$64.85
|
| Rate for Payer: UHCCP Medicaid |
$64.85
|
| Rate for Payer: UMR Bronson Commercial |
$87.42
|
| Rate for Payer: VA VA |
$124.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$177.21
|
|
|
HC NUSHIELD 4X4 PER SQ CM
|
Facility
|
IP
|
$236.28
|
|
|
Service Code
|
CPT Q4160
|
| Hospital Charge Code |
63600177
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$103.96 |
| Max. Negotiated Rate |
$212.65 |
| Rate for Payer: Aetna American Axle |
$153.58
|
| Rate for Payer: Aetna Commercial |
$200.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.58
|
| Rate for Payer: Cash Price |
$189.02
|
| Rate for Payer: Cofinity Advantage |
$165.40
|
| Rate for Payer: Cofinity Commercial |
$203.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.02
|
| Rate for Payer: Healthscope Commercial |
$212.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$165.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$177.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$177.21
|
| Rate for Payer: PHP Commercial |
$200.84
|
| Rate for Payer: Priority Health SBD |
$148.86
|
| Rate for Payer: UMR Bronson Commercial |
$103.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$177.21
|
|
|
HC NUSHIELD 4X6 PER SQ CM
|
Facility
|
IP
|
$165.82
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600178
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$72.96 |
| Max. Negotiated Rate |
$149.24 |
| Rate for Payer: Aetna American Axle |
$107.78
|
| Rate for Payer: Aetna Commercial |
$140.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.78
|
| Rate for Payer: Cash Price |
$132.66
|
| Rate for Payer: Cofinity Advantage |
$116.07
|
| Rate for Payer: Cofinity Commercial |
$142.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.66
|
| Rate for Payer: Healthscope Commercial |
$149.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$116.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$124.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$124.36
|
| Rate for Payer: PHP Commercial |
$140.95
|
| Rate for Payer: Priority Health SBD |
$104.47
|
| Rate for Payer: UMR Bronson Commercial |
$72.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$124.36
|
|
|
HC NUSHIELD 4X6 PER SQ CM
|
Facility
|
OP
|
$165.82
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600178
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$61.35 |
| Max. Negotiated Rate |
$401.00 |
| Rate for Payer: Aetna American Axle |
$107.78
|
| Rate for Payer: Aetna Commercial |
$140.95
|
| Rate for Payer: Aetna Medicare |
$128.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.00
|
| Rate for Payer: BCBS Complete |
$68.10
|
| Rate for Payer: BCBS MAPPO |
$124.00
|
| Rate for Payer: BCN Medicare Advantage |
$124.00
|
| Rate for Payer: Cash Price |
$132.66
|
| Rate for Payer: Cash Price |
$132.66
|
| Rate for Payer: Cofinity Advantage |
$116.07
|
| Rate for Payer: Cofinity Commercial |
$142.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.00
|
| Rate for Payer: Healthscope Commercial |
$149.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$116.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$124.36
|
| Rate for Payer: Mclaren Medicaid |
$124.00
|
| Rate for Payer: Mclaren Medicare |
$124.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.20
|
| Rate for Payer: Meridian Medicaid |
$130.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.95
|
| Rate for Payer: Nomi Health Commercial |
$372.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$124.36
|
| Rate for Payer: PACE Medicare |
$117.80
|
| Rate for Payer: PACE SWMI |
$124.00
|
| Rate for Payer: PHP Commercial |
$140.95
|
| Rate for Payer: PHP Medicare Advantage |
$124.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$401.00
|
| Rate for Payer: Priority Health Medicare |
$124.00
|
| Rate for Payer: Priority Health SBD |
$104.47
|
| Rate for Payer: Priority Health Tiered Network |
$320.80
|
| Rate for Payer: Railroad Medicare Medicare |
$124.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.78
|
| Rate for Payer: UHC Core |
$209.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$124.00
|
| Rate for Payer: UHC Exchange |
$209.78
|
| Rate for Payer: UHC Medicaid |
$64.85
|
| Rate for Payer: UHCCP Medicaid |
$64.85
|
| Rate for Payer: UMR Bronson Commercial |
$61.35
|
| Rate for Payer: VA VA |
$124.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$124.36
|
|
|
HC NUSHIELD 6X6 PER SQ CM
|
Facility
|
OP
|
$146.81
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600166
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$54.32 |
| Max. Negotiated Rate |
$401.00 |
| Rate for Payer: Aetna American Axle |
$95.43
|
| Rate for Payer: Aetna Commercial |
$124.79
|
| Rate for Payer: Aetna Medicare |
$128.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.00
|
| Rate for Payer: BCBS Complete |
$68.10
|
| Rate for Payer: BCBS MAPPO |
$124.00
|
| Rate for Payer: BCN Medicare Advantage |
$124.00
|
| Rate for Payer: Cash Price |
$117.45
|
| Rate for Payer: Cash Price |
$117.45
|
| Rate for Payer: Cofinity Advantage |
$102.77
|
| Rate for Payer: Cofinity Commercial |
$126.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.00
|
| Rate for Payer: Healthscope Commercial |
$132.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$102.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.11
|
| Rate for Payer: Mclaren Medicaid |
$124.00
|
| Rate for Payer: Mclaren Medicare |
$124.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.20
|
| Rate for Payer: Meridian Medicaid |
$130.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$124.79
|
| Rate for Payer: Nomi Health Commercial |
$372.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$110.11
|
| Rate for Payer: PACE Medicare |
$117.80
|
| Rate for Payer: PACE SWMI |
$124.00
|
| Rate for Payer: PHP Commercial |
$124.79
|
| Rate for Payer: PHP Medicare Advantage |
$124.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$401.00
|
| Rate for Payer: Priority Health Medicare |
$124.00
|
| Rate for Payer: Priority Health SBD |
$92.49
|
| Rate for Payer: Priority Health Tiered Network |
$320.80
|
| Rate for Payer: Railroad Medicare Medicare |
$124.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.78
|
| Rate for Payer: UHC Core |
$209.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$124.00
|
| Rate for Payer: UHC Exchange |
$209.78
|
| Rate for Payer: UHC Medicaid |
$64.85
|
| Rate for Payer: UHCCP Medicaid |
$64.85
|
| Rate for Payer: UMR Bronson Commercial |
$54.32
|
| Rate for Payer: VA VA |
$124.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.11
|
|
|
HC NUSHIELD 6X6 PER SQ CM
|
Facility
|
IP
|
$146.81
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600166
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.60 |
| Max. Negotiated Rate |
$132.13 |
| Rate for Payer: Aetna American Axle |
$95.43
|
| Rate for Payer: Aetna Commercial |
$124.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.43
|
| Rate for Payer: Cash Price |
$117.45
|
| Rate for Payer: Cofinity Advantage |
$102.77
|
| Rate for Payer: Cofinity Commercial |
$126.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.45
|
| Rate for Payer: Healthscope Commercial |
$132.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$102.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$124.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$110.11
|
| Rate for Payer: PHP Commercial |
$124.79
|
| Rate for Payer: Priority Health SBD |
$92.49
|
| Rate for Payer: UMR Bronson Commercial |
$64.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.11
|
|
|
HC NUT ALLERGEN PANEL
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200123
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna American Axle |
$16.84
|
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: BCBS Complete |
$2.87
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$6.04
|
| Rate for Payer: BCN Commercial |
$6.04
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Advantage |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.43
|
| Rate for Payer: Mclaren Medicaid |
$5.22
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$7.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.22
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$16.32
|
| Rate for Payer: Priority Health Tiered Network |
$4.18
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.83
|
| Rate for Payer: UHC Core |
$7.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.22
|
| Rate for Payer: UHC Exchange |
$7.83
|
| Rate for Payer: UHC Medicaid |
$2.73
|
| Rate for Payer: UHCCP Medicaid |
$2.73
|
| Rate for Payer: UMR Bronson Commercial |
$9.58
|
| Rate for Payer: VA VA |
$5.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.43
|
|
|
HC NUT ALLERGEN PANEL
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200123
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.40 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna American Axle |
$16.84
|
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Advantage |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: Priority Health SBD |
$16.32
|
| Rate for Payer: UMR Bronson Commercial |
$11.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.43
|
|
|
HC NVU OBSERVATION PER HOUR
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200004
|
|
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 NVU OBSERVATION PER HOUR
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200004
|
|
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 OAK IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200050
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.40 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna American Axle |
$16.84
|
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Advantage |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: Priority Health SBD |
$16.32
|
| Rate for Payer: UMR Bronson Commercial |
$11.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.43
|
|
|
HC OAK IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200050
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna American Axle |
$16.84
|
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: BCBS Complete |
$2.87
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$6.04
|
| Rate for Payer: BCN Commercial |
$6.04
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Advantage |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.43
|
| Rate for Payer: Mclaren Medicaid |
$5.22
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$7.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.22
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$16.32
|
| Rate for Payer: Priority Health Tiered Network |
$4.18
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.83
|
| Rate for Payer: UHC Core |
$7.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.22
|
| Rate for Payer: UHC Exchange |
$7.83
|
| Rate for Payer: UHC Medicaid |
$2.73
|
| Rate for Payer: UHCCP Medicaid |
$2.73
|
| Rate for Payer: UMR Bronson Commercial |
$9.58
|
| Rate for Payer: VA VA |
$5.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.43
|
|
|
HC OASIS ULTRA TRI LAYER WD MATRIX PER SQ CM
|
Facility
|
OP
|
$55.27
|
|
|
Service Code
|
HCPCS Q4124
|
| Hospital Charge Code |
63600059
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.45 |
| Max. Negotiated Rate |
$401.00 |
| Rate for Payer: Aetna American Axle |
$35.93
|
| Rate for Payer: Aetna Commercial |
$46.98
|
| Rate for Payer: Aetna Medicare |
$128.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.00
|
| Rate for Payer: BCBS Complete |
$68.10
|
| Rate for Payer: BCBS MAPPO |
$124.00
|
| Rate for Payer: BCBS Trust/PPO |
$33.23
|
| Rate for Payer: BCN Commercial |
$33.23
|
| Rate for Payer: BCN Medicare Advantage |
$124.00
|
| Rate for Payer: Cash Price |
$44.22
|
| Rate for Payer: Cash Price |
$44.22
|
| Rate for Payer: Cofinity Advantage |
$38.69
|
| Rate for Payer: Cofinity Commercial |
$47.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.00
|
| Rate for Payer: Healthscope Commercial |
$49.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$38.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.45
|
| Rate for Payer: Mclaren Medicaid |
$124.00
|
| Rate for Payer: Mclaren Medicare |
$124.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.20
|
| Rate for Payer: Meridian Medicaid |
$130.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.98
|
| Rate for Payer: Nomi Health Commercial |
$372.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.45
|
| Rate for Payer: PACE Medicare |
$117.80
|
| Rate for Payer: PACE SWMI |
$124.00
|
| Rate for Payer: PHP Commercial |
$46.98
|
| Rate for Payer: PHP Medicare Advantage |
$124.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$401.00
|
| Rate for Payer: Priority Health Medicare |
$124.00
|
| Rate for Payer: Priority Health SBD |
$34.82
|
| Rate for Payer: Priority Health Tiered Network |
$320.80
|
| Rate for Payer: Railroad Medicare Medicare |
$124.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.78
|
| Rate for Payer: UHC Core |
$209.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$124.00
|
| Rate for Payer: UHC Exchange |
$209.78
|
| Rate for Payer: UHC Medicaid |
$64.85
|
| Rate for Payer: UHCCP Medicaid |
$64.85
|
| Rate for Payer: UMR Bronson Commercial |
$20.45
|
| Rate for Payer: VA VA |
$124.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.45
|
|
|
HC OASIS ULTRA TRI LAYER WD MATRIX PER SQ CM
|
Facility
|
IP
|
$55.27
|
|
|
Service Code
|
HCPCS Q4124
|
| Hospital Charge Code |
63600059
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.32 |
| Max. Negotiated Rate |
$49.74 |
| Rate for Payer: Aetna American Axle |
$35.93
|
| Rate for Payer: Aetna Commercial |
$46.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.93
|
| Rate for Payer: Cash Price |
$44.22
|
| Rate for Payer: Cofinity Advantage |
$38.69
|
| Rate for Payer: Cofinity Commercial |
$47.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.22
|
| Rate for Payer: Healthscope Commercial |
$49.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$38.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.45
|
| Rate for Payer: PHP Commercial |
$46.98
|
| Rate for Payer: Priority Health SBD |
$34.82
|
| Rate for Payer: UMR Bronson Commercial |
$24.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.45
|
|
|
HC OASIS WD MATRIX PER SQ CM
|
Facility
|
IP
|
$32.56
|
|
|
Service Code
|
HCPCS Q4102
|
| Hospital Charge Code |
63600050
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.33 |
| Max. Negotiated Rate |
$29.30 |
| Rate for Payer: Aetna American Axle |
$21.16
|
| Rate for Payer: Aetna Commercial |
$27.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.16
|
| Rate for Payer: Cash Price |
$26.05
|
| Rate for Payer: Cofinity Advantage |
$22.79
|
| Rate for Payer: Cofinity Commercial |
$28.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.05
|
| Rate for Payer: Healthscope Commercial |
$29.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.42
|
| Rate for Payer: PHP Commercial |
$27.68
|
| Rate for Payer: Priority Health SBD |
$20.51
|
| Rate for Payer: UMR Bronson Commercial |
$14.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.42
|
|
|
HC OASIS WD MATRIX PER SQ CM
|
Facility
|
OP
|
$32.56
|
|
|
Service Code
|
HCPCS Q4102
|
| Hospital Charge Code |
63600050
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$4,628.17 |
| Rate for Payer: Aetna American Axle |
$21.16
|
| Rate for Payer: Aetna Commercial |
$27.68
|
| Rate for Payer: Aetna Medicare |
$128.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.00
|
| Rate for Payer: BCBS Complete |
$68.10
|
| Rate for Payer: BCBS MAPPO |
$124.00
|
| Rate for Payer: BCBS Trust/PPO |
$4,628.17
|
| Rate for Payer: BCN Commercial |
$4,628.17
|
| Rate for Payer: BCN Medicare Advantage |
$124.00
|
| Rate for Payer: Cash Price |
$26.05
|
| Rate for Payer: Cash Price |
$26.05
|
| Rate for Payer: Cofinity Advantage |
$22.79
|
| Rate for Payer: Cofinity Commercial |
$28.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.00
|
| Rate for Payer: Healthscope Commercial |
$29.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.42
|
| Rate for Payer: Mclaren Medicaid |
$124.00
|
| Rate for Payer: Mclaren Medicare |
$124.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.20
|
| Rate for Payer: Meridian Medicaid |
$130.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.68
|
| Rate for Payer: Nomi Health Commercial |
$372.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.42
|
| Rate for Payer: PACE Medicare |
$117.80
|
| Rate for Payer: PACE SWMI |
$124.00
|
| Rate for Payer: PHP Commercial |
$27.68
|
| Rate for Payer: PHP Medicare Advantage |
$124.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$401.00
|
| Rate for Payer: Priority Health Medicare |
$124.00
|
| Rate for Payer: Priority Health SBD |
$20.51
|
| Rate for Payer: Priority Health Tiered Network |
$320.80
|
| Rate for Payer: Railroad Medicare Medicare |
$124.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.78
|
| Rate for Payer: UHC Core |
$209.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$124.00
|
| Rate for Payer: UHC Exchange |
$209.78
|
| Rate for Payer: UHC Medicaid |
$64.85
|
| Rate for Payer: UHCCP Medicaid |
$64.85
|
| Rate for Payer: UMR Bronson Commercial |
$12.05
|
| Rate for Payer: VA VA |
$124.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.42
|
|
