|
HC OAT IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200051
|
|
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 OAT IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200051
|
|
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 OB ANTEPARTUM R&B
|
Facility
|
IP
|
$3,707.30
|
|
| Hospital Charge Code |
20000003
|
|
Hospital Revenue Code
|
110
|
| Min. Negotiated Rate |
$1,631.21 |
| Max. Negotiated Rate |
$3,336.57 |
| Rate for Payer: Aetna American Axle |
$2,409.74
|
| Rate for Payer: Aetna Commercial |
$3,151.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,409.74
|
| Rate for Payer: Cash Price |
$2,965.84
|
| Rate for Payer: Cofinity Advantage |
$2,595.11
|
| Rate for Payer: Cofinity Commercial |
$3,188.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,965.84
|
| Rate for Payer: Healthscope Commercial |
$3,336.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,595.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,780.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,151.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,780.47
|
| Rate for Payer: PHP Commercial |
$3,151.20
|
| Rate for Payer: Priority Health SBD |
$2,335.60
|
| Rate for Payer: UMR Bronson Commercial |
$1,631.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,780.47
|
|
|
HC OB DELIVERY R&B
|
Facility
|
IP
|
$1,846.93
|
|
| Hospital Charge Code |
11200001
|
|
Hospital Revenue Code
|
112
|
| Min. Negotiated Rate |
$812.65 |
| Max. Negotiated Rate |
$1,662.24 |
| Rate for Payer: Aetna American Axle |
$1,200.50
|
| Rate for Payer: Aetna Commercial |
$1,569.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,200.50
|
| Rate for Payer: Cash Price |
$1,477.54
|
| Rate for Payer: Cofinity Advantage |
$1,292.85
|
| Rate for Payer: Cofinity Commercial |
$1,588.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,477.54
|
| Rate for Payer: Healthscope Commercial |
$1,662.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,292.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,385.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,569.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,385.20
|
| Rate for Payer: PHP Commercial |
$1,569.89
|
| Rate for Payer: Priority Health SBD |
$1,163.57
|
| Rate for Payer: UMR Bronson Commercial |
$812.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,385.20
|
|
|
HC OB HIGH RISK R&B
|
Facility
|
IP
|
$4,063.66
|
|
| Hospital Charge Code |
20000004
|
|
Hospital Revenue Code
|
110
|
| Min. Negotiated Rate |
$1,788.01 |
| Max. Negotiated Rate |
$3,657.29 |
| Rate for Payer: Aetna American Axle |
$2,641.38
|
| Rate for Payer: Aetna Commercial |
$3,454.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,641.38
|
| Rate for Payer: Cash Price |
$3,250.93
|
| Rate for Payer: Cofinity Advantage |
$2,844.56
|
| Rate for Payer: Cofinity Commercial |
$3,494.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,250.93
|
| Rate for Payer: Healthscope Commercial |
$3,657.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,844.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,047.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,454.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,047.74
|
| Rate for Payer: PHP Commercial |
$3,454.11
|
| Rate for Payer: Priority Health SBD |
$2,560.11
|
| Rate for Payer: UMR Bronson Commercial |
$1,788.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,047.74
|
|
|
HC OB MED OBSERVATION PER HOUR
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200012
|
|
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 OB MED OBSERVATION PER HOUR
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200012
|
|
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 OB POSTPARTUM R&B
|
Facility
|
IP
|
$2,611.50
|
|
| Hospital Charge Code |
11200002
|
|
Hospital Revenue Code
|
112
|
| Min. Negotiated Rate |
$1,149.06 |
| Max. Negotiated Rate |
$2,350.35 |
| Rate for Payer: Aetna American Axle |
$1,697.47
|
| Rate for Payer: Aetna Commercial |
$2,219.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,697.47
|
| Rate for Payer: Cash Price |
$2,089.20
|
| Rate for Payer: Cofinity Advantage |
$1,828.05
|
| Rate for Payer: Cofinity Commercial |
$2,245.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,089.20
|
| Rate for Payer: Healthscope Commercial |
$2,350.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,828.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,958.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,219.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,958.62
|
| Rate for Payer: PHP Commercial |
$2,219.78
|
| Rate for Payer: Priority Health SBD |
$1,645.24
|
| Rate for Payer: UMR Bronson Commercial |
$1,149.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,958.62
|
|
|
HC OBSERVATION OVERFLOW PER HOUR
|
Facility
|
IP
|
$160.00
|
|
| Hospital Charge Code |
76900005
|
|
Hospital Revenue Code
|
769
|
| 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 OBSERVATION OVERFLOW PER HOUR
|
Facility
|
OP
|
$160.00
|
|
| Hospital Charge Code |
76900005
|
|
Hospital Revenue Code
|
769
|
| Min. Negotiated Rate |
$59.20 |
| Max. Negotiated Rate |
$144.00 |
| 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: 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 All Payor (Choice/PPO) |
$104.00
|
| Rate for Payer: UHC Core |
$83.36
|
| Rate for Payer: UHC Exchange |
$62.88
|
| Rate for Payer: UMR Bronson Commercial |
$59.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$120.00
|
|
|
HC OBSERVATION PER HOUR
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200023
|
|
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 OBSERVATION PER HOUR
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200023
|
|
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 OBS OVERFLOW PER HR
|
Facility
|
OP
|
$160.00
|
|
| Hospital Charge Code |
76900002
|
|
Hospital Revenue Code
|
769
|
| Min. Negotiated Rate |
$59.20 |
| Max. Negotiated Rate |
$144.00 |
| 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: 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 All Payor (Choice/PPO) |
$104.00
|
| Rate for Payer: UHC Core |
$83.36
|
| Rate for Payer: UHC Exchange |
$62.88
|
| Rate for Payer: UMR Bronson Commercial |
$59.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$120.00
|
|
|
HC OBS OVERFLOW PER HR
|
Facility
|
IP
|
$160.00
|
|
| Hospital Charge Code |
76900002
|
|
Hospital Revenue Code
|
769
|
| 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 OB SURGERY ADDL 15 MIN
|
Facility
|
OP
|
$279.50
|
|
| Hospital Charge Code |
36000104
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$103.42 |
| Max. Negotiated Rate |
$251.55 |
| Rate for Payer: Aetna American Axle |
$181.68
|
| Rate for Payer: Aetna Commercial |
$237.57
|
| Rate for Payer: Aetna Medicare |
$139.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$181.68
|
| Rate for Payer: BCBS Complete |
$111.80
|
| Rate for Payer: Cash Price |
$223.60
|
| Rate for Payer: Cofinity Advantage |
$195.65
|
| Rate for Payer: Cofinity Commercial |
$240.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.60
|
| Rate for Payer: Healthscope Commercial |
$251.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$195.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$209.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$223.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$209.62
|
| Rate for Payer: PHP Commercial |
$237.57
|
| Rate for Payer: Priority Health SBD |
$176.09
|
| Rate for Payer: UMR Bronson Commercial |
$103.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$209.62
|
|
|
HC OB SURGERY ADDL 15 MIN
|
Facility
|
IP
|
$279.50
|
|
| Hospital Charge Code |
36000104
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$122.98 |
| Max. Negotiated Rate |
$251.55 |
| Rate for Payer: Aetna American Axle |
$181.68
|
| Rate for Payer: Aetna Commercial |
$237.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$181.68
|
| Rate for Payer: Cash Price |
$223.60
|
| Rate for Payer: Cofinity Advantage |
$195.65
|
| Rate for Payer: Cofinity Commercial |
$240.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.60
|
| Rate for Payer: Healthscope Commercial |
$251.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$195.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$209.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$209.62
|
| Rate for Payer: PHP Commercial |
$237.57
|
| Rate for Payer: Priority Health SBD |
$176.09
|
| Rate for Payer: UMR Bronson Commercial |
$122.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$209.62
|
|
|
HC OB SURGERY INITIAL 30 MIN
|
Facility
|
OP
|
$1,482.63
|
|
| Hospital Charge Code |
36000077
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$548.57 |
| Max. Negotiated Rate |
$1,334.37 |
| Rate for Payer: Aetna American Axle |
$963.71
|
| Rate for Payer: Aetna Commercial |
$1,260.24
|
| Rate for Payer: Aetna Medicare |
$741.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$963.71
|
| Rate for Payer: BCBS Complete |
$593.05
|
| Rate for Payer: Cash Price |
$1,186.10
|
| Rate for Payer: Cofinity Advantage |
$1,037.84
|
| Rate for Payer: Cofinity Commercial |
$1,275.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,186.10
|
| Rate for Payer: Healthscope Commercial |
$1,334.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,037.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,111.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,186.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,260.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,111.97
|
| Rate for Payer: PHP Commercial |
$1,260.24
|
| Rate for Payer: Priority Health SBD |
$934.06
|
| Rate for Payer: UMR Bronson Commercial |
$548.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,111.97
|
|
|
HC OB SURGERY INITIAL 30 MIN
|
Facility
|
IP
|
$1,482.63
|
|
| Hospital Charge Code |
36000077
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$652.36 |
| Max. Negotiated Rate |
$1,334.37 |
| Rate for Payer: Aetna American Axle |
$963.71
|
| Rate for Payer: Aetna Commercial |
$1,260.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$963.71
|
| Rate for Payer: Cash Price |
$1,186.10
|
| Rate for Payer: Cofinity Advantage |
$1,037.84
|
| Rate for Payer: Cofinity Commercial |
$1,275.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,186.10
|
| Rate for Payer: Healthscope Commercial |
$1,334.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,037.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,111.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,260.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,111.97
|
| Rate for Payer: PHP Commercial |
$1,260.24
|
| Rate for Payer: Priority Health SBD |
$934.06
|
| Rate for Payer: UMR Bronson Commercial |
$652.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,111.97
|
|
|
HC OB VAC DEL KIT DISP (OB)
|
Facility
|
IP
|
$262.93
|
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$115.69 |
| Max. Negotiated Rate |
$236.64 |
| Rate for Payer: Aetna American Axle |
$170.90
|
| Rate for Payer: Aetna Commercial |
$223.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.90
|
| Rate for Payer: Cash Price |
$210.34
|
| Rate for Payer: Cofinity Advantage |
$184.05
|
| Rate for Payer: Cofinity Commercial |
$226.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.34
|
| Rate for Payer: Healthscope Commercial |
$236.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$184.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$197.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$223.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$197.20
|
| Rate for Payer: PHP Commercial |
$223.49
|
| Rate for Payer: Priority Health SBD |
$165.65
|
| Rate for Payer: UMR Bronson Commercial |
$115.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$197.20
|
|
|
HC OB VAC DEL KIT DISP (OB)
|
Facility
|
OP
|
$262.93
|
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$97.28 |
| Max. Negotiated Rate |
$236.64 |
| Rate for Payer: Aetna American Axle |
$170.90
|
| Rate for Payer: Aetna Commercial |
$223.49
|
| Rate for Payer: Aetna Medicare |
$131.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.90
|
| Rate for Payer: BCBS Complete |
$105.17
|
| Rate for Payer: Cash Price |
$210.34
|
| Rate for Payer: Cofinity Advantage |
$184.05
|
| Rate for Payer: Cofinity Commercial |
$226.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.34
|
| Rate for Payer: Healthscope Commercial |
$236.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$184.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$197.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$210.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$223.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$197.20
|
| Rate for Payer: PHP Commercial |
$223.49
|
| Rate for Payer: Priority Health SBD |
$165.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$170.90
|
| Rate for Payer: UHC Core |
$136.99
|
| Rate for Payer: UHC Exchange |
$103.33
|
| Rate for Payer: UMR Bronson Commercial |
$97.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$197.20
|
|
|
HC OCCLUSION CATH
|
Facility
|
OP
|
$4,849.72
|
|
|
Service Code
|
HCPCS C2628
|
| Hospital Charge Code |
27200344
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,794.40 |
| Max. Negotiated Rate |
$4,364.75 |
| Rate for Payer: Aetna American Axle |
$3,152.32
|
| Rate for Payer: Aetna Commercial |
$4,122.26
|
| Rate for Payer: Aetna Medicare |
$2,424.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,152.32
|
| Rate for Payer: BCBS Complete |
$1,939.89
|
| Rate for Payer: Cash Price |
$3,879.78
|
| Rate for Payer: Cofinity Advantage |
$3,394.80
|
| Rate for Payer: Cofinity Commercial |
$4,170.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,879.78
|
| Rate for Payer: Healthscope Commercial |
$4,364.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,394.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,637.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,879.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,122.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,637.29
|
| Rate for Payer: PHP Commercial |
$4,122.26
|
| Rate for Payer: Priority Health SBD |
$3,055.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,152.32
|
| Rate for Payer: UHC Core |
$2,526.70
|
| Rate for Payer: UHC Exchange |
$1,905.94
|
| Rate for Payer: UMR Bronson Commercial |
$1,794.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,637.29
|
|
|
HC OCCLUSION CATH
|
Facility
|
IP
|
$4,849.72
|
|
|
Service Code
|
HCPCS C2628
|
| Hospital Charge Code |
27200344
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,133.88 |
| Max. Negotiated Rate |
$4,364.75 |
| Rate for Payer: Aetna American Axle |
$3,152.32
|
| Rate for Payer: Aetna Commercial |
$4,122.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,152.32
|
| Rate for Payer: Cash Price |
$3,879.78
|
| Rate for Payer: Cofinity Advantage |
$3,394.80
|
| Rate for Payer: Cofinity Commercial |
$4,170.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,879.78
|
| Rate for Payer: Healthscope Commercial |
$4,364.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,394.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,637.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,122.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,637.29
|
| Rate for Payer: PHP Commercial |
$4,122.26
|
| Rate for Payer: Priority Health SBD |
$3,055.32
|
| Rate for Payer: UMR Bronson Commercial |
$2,133.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,637.29
|
|
|
HC OCCULT BLOOD OTHER SOURCES
|
Facility
|
IP
|
$31.31
|
|
|
Service Code
|
CPT 82271
|
| Hospital Charge Code |
30100122
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.78 |
| Max. Negotiated Rate |
$28.18 |
| Rate for Payer: Aetna American Axle |
$20.35
|
| Rate for Payer: Aetna Commercial |
$26.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.35
|
| Rate for Payer: Cash Price |
$25.05
|
| Rate for Payer: Cofinity Advantage |
$21.92
|
| Rate for Payer: Cofinity Commercial |
$26.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.05
|
| Rate for Payer: Healthscope Commercial |
$28.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.48
|
| Rate for Payer: PHP Commercial |
$26.61
|
| Rate for Payer: Priority Health SBD |
$19.73
|
| Rate for Payer: UMR Bronson Commercial |
$13.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.48
|
|
|
HC OCCULT BLOOD OTHER SOURCES
|
Facility
|
OP
|
$31.31
|
|
|
Service Code
|
CPT 82271
|
| Hospital Charge Code |
30100122
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.78 |
| Max. Negotiated Rate |
$28.18 |
| Rate for Payer: Aetna American Axle |
$20.35
|
| Rate for Payer: Aetna Commercial |
$26.61
|
| Rate for Payer: Aetna Medicare |
$5.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.65
|
| Rate for Payer: BCBS Complete |
$2.92
|
| Rate for Payer: BCBS MAPPO |
$5.32
|
| Rate for Payer: BCBS Trust/PPO |
$6.15
|
| Rate for Payer: BCN Commercial |
$6.15
|
| Rate for Payer: BCN Medicare Advantage |
$5.32
|
| Rate for Payer: Cash Price |
$25.05
|
| Rate for Payer: Cash Price |
$25.05
|
| Rate for Payer: Cofinity Advantage |
$21.92
|
| Rate for Payer: Cofinity Commercial |
$26.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.32
|
| Rate for Payer: Healthscope Commercial |
$28.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.48
|
| Rate for Payer: Mclaren Medicaid |
$5.32
|
| Rate for Payer: Mclaren Medicare |
$5.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.59
|
| Rate for Payer: Meridian Medicaid |
$5.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.61
|
| Rate for Payer: Nomi Health Commercial |
$7.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.48
|
| Rate for Payer: PACE Medicare |
$5.05
|
| Rate for Payer: PACE SWMI |
$5.32
|
| Rate for Payer: PHP Commercial |
$26.61
|
| Rate for Payer: PHP Medicare Advantage |
$5.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.32
|
| Rate for Payer: Priority Health Medicare |
$5.32
|
| Rate for Payer: Priority Health SBD |
$19.73
|
| Rate for Payer: Priority Health Tiered Network |
$4.26
|
| Rate for Payer: Railroad Medicare Medicare |
$5.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.98
|
| Rate for Payer: UHC Core |
$7.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.32
|
| Rate for Payer: UHC Exchange |
$7.98
|
| Rate for Payer: UHC Medicaid |
$2.78
|
| Rate for Payer: UHCCP Medicaid |
$2.78
|
| Rate for Payer: UMR Bronson Commercial |
$11.58
|
| Rate for Payer: VA VA |
$5.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.48
|
|
|
HC OCT CATHETER
|
Facility
|
IP
|
$2,631.90
|
|
|
Service Code
|
HCPCS C1753
|
| Hospital Charge Code |
27200243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,158.04 |
| Max. Negotiated Rate |
$2,368.71 |
| Rate for Payer: Aetna American Axle |
$1,710.73
|
| Rate for Payer: Aetna Commercial |
$2,237.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,710.73
|
| Rate for Payer: Cash Price |
$2,105.52
|
| Rate for Payer: Cofinity Advantage |
$1,842.33
|
| Rate for Payer: Cofinity Commercial |
$2,263.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,105.52
|
| Rate for Payer: Healthscope Commercial |
$2,368.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,842.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,973.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,237.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,973.92
|
| Rate for Payer: PHP Commercial |
$2,237.11
|
| Rate for Payer: Priority Health SBD |
$1,658.10
|
| Rate for Payer: UMR Bronson Commercial |
$1,158.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,973.92
|
|
