|
HC NASAL/SINUS ENDSC SURG W/BX POLYPEC/DBRD SPX
|
Facility
|
OP
|
$4,437.00
|
|
|
Service Code
|
CPT 31237
|
| Hospital Charge Code |
76100454
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$901.47 |
| Max. Negotiated Rate |
$4,734.21 |
| Rate for Payer: Aetna American Axle |
$2,884.05
|
| Rate for Payer: Aetna Commercial |
$3,771.45
|
| Rate for Payer: Aetna Medicare |
$1,749.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,884.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,102.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,102.30
|
| Rate for Payer: BCBS Complete |
$946.54
|
| Rate for Payer: BCBS MAPPO |
$1,681.84
|
| Rate for Payer: BCN Medicare Advantage |
$1,681.84
|
| Rate for Payer: Cash Price |
$3,549.60
|
| Rate for Payer: Cash Price |
$3,549.60
|
| Rate for Payer: Cofinity Commercial |
$3,815.82
|
| Rate for Payer: Cofinity Commercial |
$3,105.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,105.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,549.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,681.84
|
| Rate for Payer: Healthscope Commercial |
$3,993.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,105.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,327.75
|
| Rate for Payer: Mclaren Medicaid |
$901.47
|
| Rate for Payer: Mclaren Medicare |
$1,681.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,765.93
|
| Rate for Payer: Meridian Medicaid |
$946.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,934.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,771.45
|
| Rate for Payer: PACE Medicare |
$1,597.75
|
| Rate for Payer: PACE SWMI |
$1,681.84
|
| Rate for Payer: PHP Commercial |
$3,771.45
|
| Rate for Payer: PHP Medicare Advantage |
$1,681.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$901.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,884.05
|
| Rate for Payer: Priority Health Medicare |
$1,681.84
|
| Rate for Payer: Priority Health SBD |
$2,795.31
|
| Rate for Payer: Railroad Medicare Medicare |
$1,681.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,734.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,681.84
|
| Rate for Payer: UHC Exchange |
$3,214.16
|
| Rate for Payer: UHC Medicare Advantage |
$1,681.84
|
| Rate for Payer: UHCCP Medicaid |
$901.47
|
| Rate for Payer: UMR Bronson Commercial |
$1,641.69
|
| Rate for Payer: VA VA |
$1,681.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,327.75
|
|
|
HC NASAL/SINUS ENDSC SURG W/BX POLYPEC/DBRD SPX
|
Facility
|
IP
|
$4,437.00
|
|
|
Service Code
|
CPT 31237
|
| Hospital Charge Code |
76100454
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,952.28 |
| Max. Negotiated Rate |
$3,993.30 |
| Rate for Payer: Aetna American Axle |
$2,884.05
|
| Rate for Payer: Aetna Commercial |
$3,771.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,884.05
|
| Rate for Payer: Cash Price |
$3,549.60
|
| Rate for Payer: Cofinity Commercial |
$3,105.90
|
| Rate for Payer: Cofinity Commercial |
$3,815.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,105.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,549.60
|
| Rate for Payer: Healthscope Commercial |
$3,993.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,105.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,327.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,771.45
|
| Rate for Payer: PHP Commercial |
$3,771.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,884.05
|
| Rate for Payer: Priority Health SBD |
$2,795.31
|
| Rate for Payer: UMR Bronson Commercial |
$1,952.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,327.75
|
|
|
HC NASOPHARYNGOSCOPY
|
Facility
|
OP
|
$255.90
|
|
|
Service Code
|
CPT 92511
|
| Hospital Charge Code |
76100177
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$94.68 |
| Max. Negotiated Rate |
$532.97 |
| Rate for Payer: Aetna American Axle |
$166.34
|
| Rate for Payer: Aetna Commercial |
$217.51
|
| Rate for Payer: Aetna Medicare |
$196.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$236.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$236.68
|
| Rate for Payer: BCBS Complete |
$106.56
|
| Rate for Payer: BCBS MAPPO |
$189.34
|
| Rate for Payer: BCN Medicare Advantage |
$189.34
|
| Rate for Payer: Cash Price |
$204.72
|
| Rate for Payer: Cash Price |
$204.72
|
| Rate for Payer: Cofinity Commercial |
$220.07
|
| Rate for Payer: Cofinity Commercial |
$179.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$179.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$189.34
|
| Rate for Payer: Healthscope Commercial |
$230.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$179.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$191.93
|
| Rate for Payer: Mclaren Medicaid |
$101.49
|
| Rate for Payer: Mclaren Medicare |
$189.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$198.81
|
| Rate for Payer: Meridian Medicaid |
$106.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$217.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.51
|
| Rate for Payer: PACE Medicare |
$179.87
|
| Rate for Payer: PACE SWMI |
$189.34
|
| Rate for Payer: PHP Commercial |
$217.51
|
| Rate for Payer: PHP Medicare Advantage |
$189.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$101.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.34
|
| Rate for Payer: Priority Health Medicare |
$189.34
|
| Rate for Payer: Priority Health SBD |
$161.22
|
| Rate for Payer: Railroad Medicare Medicare |
$189.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$532.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$189.34
|
| Rate for Payer: UHC Exchange |
$361.85
|
| Rate for Payer: UHC Medicare Advantage |
$189.34
|
| Rate for Payer: UHCCP Medicaid |
$101.49
|
| Rate for Payer: UMR Bronson Commercial |
$94.68
|
| Rate for Payer: VA VA |
$189.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$191.93
|
|
|
HC NASOPHARYNGOSCOPY
|
Facility
|
IP
|
$255.90
|
|
|
Service Code
|
CPT 92511
|
| Hospital Charge Code |
76100177
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$112.60 |
| Max. Negotiated Rate |
$230.31 |
| Rate for Payer: Aetna American Axle |
$166.34
|
| Rate for Payer: Aetna Commercial |
$217.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.34
|
| Rate for Payer: Cash Price |
$204.72
|
| Rate for Payer: Cofinity Commercial |
$179.13
|
| Rate for Payer: Cofinity Commercial |
$220.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$179.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.72
|
| Rate for Payer: Healthscope Commercial |
$230.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$179.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$191.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.51
|
| Rate for Payer: PHP Commercial |
$217.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.34
|
| Rate for Payer: Priority Health SBD |
$161.22
|
| Rate for Payer: UMR Bronson Commercial |
$112.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$191.93
|
|
|
HC NASOPHARYNGOSCOPY DILAT EUSTACHIAN TUBE BI
|
Facility
|
IP
|
$16,400.00
|
|
|
Service Code
|
CPT 69706
|
| Hospital Charge Code |
76100518
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$7,216.00 |
| Max. Negotiated Rate |
$14,760.00 |
| Rate for Payer: Aetna American Axle |
$10,660.00
|
| Rate for Payer: Aetna Commercial |
$13,940.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,660.00
|
| Rate for Payer: Cash Price |
$13,120.00
|
| Rate for Payer: Cofinity Commercial |
$11,480.00
|
| Rate for Payer: Cofinity Commercial |
$14,104.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$11,480.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,120.00
|
| Rate for Payer: Healthscope Commercial |
$14,760.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11,480.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12,300.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,940.00
|
| Rate for Payer: PHP Commercial |
$13,940.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,660.00
|
| Rate for Payer: Priority Health SBD |
$10,332.00
|
| Rate for Payer: UMR Bronson Commercial |
$7,216.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12,300.00
|
|
|
HC NASOPHARYNGOSCOPY DILAT EUSTACHIAN TUBE BI
|
Facility
|
OP
|
$16,400.00
|
|
|
Service Code
|
CPT 69706
|
| Hospital Charge Code |
76100518
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,092.41 |
| Max. Negotiated Rate |
$16,240.34 |
| Rate for Payer: Aetna American Axle |
$10,660.00
|
| Rate for Payer: Aetna Commercial |
$13,940.00
|
| Rate for Payer: Aetna Medicare |
$6,000.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,660.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,211.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,211.77
|
| Rate for Payer: BCBS Complete |
$3,247.03
|
| Rate for Payer: BCBS MAPPO |
$5,769.42
|
| Rate for Payer: BCN Medicare Advantage |
$5,769.42
|
| Rate for Payer: Cash Price |
$13,120.00
|
| Rate for Payer: Cash Price |
$13,120.00
|
| Rate for Payer: Cofinity Commercial |
$14,104.00
|
| Rate for Payer: Cofinity Commercial |
$11,480.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$11,480.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,120.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,769.42
|
| Rate for Payer: Healthscope Commercial |
$14,760.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11,480.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12,300.00
|
| Rate for Payer: Mclaren Medicaid |
$3,092.41
|
| Rate for Payer: Mclaren Medicare |
$5,769.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,057.89
|
| Rate for Payer: Meridian Medicaid |
$3,247.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,634.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,940.00
|
| Rate for Payer: PACE Medicare |
$5,480.95
|
| Rate for Payer: PACE SWMI |
$5,769.42
|
| Rate for Payer: PHP Commercial |
$13,940.00
|
| Rate for Payer: PHP Medicare Advantage |
$5,769.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,092.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,660.00
|
| Rate for Payer: Priority Health Medicare |
$5,769.42
|
| Rate for Payer: Priority Health SBD |
$10,332.00
|
| Rate for Payer: Railroad Medicare Medicare |
$5,769.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,240.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,769.42
|
| Rate for Payer: UHC Exchange |
$11,025.94
|
| Rate for Payer: UHC Medicare Advantage |
$5,769.42
|
| Rate for Payer: UHCCP Medicaid |
$3,092.41
|
| Rate for Payer: UMR Bronson Commercial |
$6,068.00
|
| Rate for Payer: VA VA |
$5,769.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12,300.00
|
|
|
HC NASOPHARYNGOSCOPY DILAT EUSTACHIAN TUBE UNI
|
Facility
|
IP
|
$16,400.00
|
|
|
Service Code
|
CPT 69705
|
| Hospital Charge Code |
76100519
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$7,216.00 |
| Max. Negotiated Rate |
$14,760.00 |
| Rate for Payer: Aetna American Axle |
$10,660.00
|
| Rate for Payer: Aetna Commercial |
$13,940.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,660.00
|
| Rate for Payer: Cash Price |
$13,120.00
|
| Rate for Payer: Cofinity Commercial |
$11,480.00
|
| Rate for Payer: Cofinity Commercial |
$14,104.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$11,480.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,120.00
|
| Rate for Payer: Healthscope Commercial |
$14,760.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11,480.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12,300.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,940.00
|
| Rate for Payer: PHP Commercial |
$13,940.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,660.00
|
| Rate for Payer: Priority Health SBD |
$10,332.00
|
| Rate for Payer: UMR Bronson Commercial |
$7,216.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12,300.00
|
|
|
HC NASOPHARYNGOSCOPY DILAT EUSTACHIAN TUBE UNI
|
Facility
|
OP
|
$16,400.00
|
|
|
Service Code
|
CPT 69705
|
| Hospital Charge Code |
76100519
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,092.41 |
| Max. Negotiated Rate |
$16,240.34 |
| Rate for Payer: Aetna American Axle |
$10,660.00
|
| Rate for Payer: Aetna Commercial |
$13,940.00
|
| Rate for Payer: Aetna Medicare |
$6,000.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,660.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,211.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,211.77
|
| Rate for Payer: BCBS Complete |
$3,247.03
|
| Rate for Payer: BCBS MAPPO |
$5,769.42
|
| Rate for Payer: BCN Medicare Advantage |
$5,769.42
|
| Rate for Payer: Cash Price |
$13,120.00
|
| Rate for Payer: Cash Price |
$13,120.00
|
| Rate for Payer: Cofinity Commercial |
$14,104.00
|
| Rate for Payer: Cofinity Commercial |
$11,480.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$11,480.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,120.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,769.42
|
| Rate for Payer: Healthscope Commercial |
$14,760.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11,480.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12,300.00
|
| Rate for Payer: Mclaren Medicaid |
$3,092.41
|
| Rate for Payer: Mclaren Medicare |
$5,769.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,057.89
|
| Rate for Payer: Meridian Medicaid |
$3,247.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,634.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,940.00
|
| Rate for Payer: PACE Medicare |
$5,480.95
|
| Rate for Payer: PACE SWMI |
$5,769.42
|
| Rate for Payer: PHP Commercial |
$13,940.00
|
| Rate for Payer: PHP Medicare Advantage |
$5,769.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,092.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,660.00
|
| Rate for Payer: Priority Health Medicare |
$5,769.42
|
| Rate for Payer: Priority Health SBD |
$10,332.00
|
| Rate for Payer: Railroad Medicare Medicare |
$5,769.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,240.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,769.42
|
| Rate for Payer: UHC Exchange |
$11,025.94
|
| Rate for Payer: UHC Medicare Advantage |
$5,769.42
|
| Rate for Payer: UHCCP Medicaid |
$3,092.41
|
| Rate for Payer: UMR Bronson Commercial |
$6,068.00
|
| Rate for Payer: VA VA |
$5,769.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12,300.00
|
|
|
HC NASOTRACHEAL SUCTION
|
Facility
|
OP
|
$278.92
|
|
|
Service Code
|
CPT 31720
|
| Hospital Charge Code |
41000001
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$103.20 |
| Max. Negotiated Rate |
$558.36 |
| Rate for Payer: Aetna American Axle |
$181.30
|
| Rate for Payer: Aetna Commercial |
$237.08
|
| Rate for Payer: Aetna Medicare |
$206.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$181.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$247.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$247.95
|
| Rate for Payer: BCBS Complete |
$111.64
|
| Rate for Payer: BCBS MAPPO |
$198.36
|
| Rate for Payer: BCN Medicare Advantage |
$198.36
|
| Rate for Payer: Cash Price |
$223.14
|
| Rate for Payer: Cash Price |
$223.14
|
| Rate for Payer: Cash Price |
$223.14
|
| Rate for Payer: Cofinity Commercial |
$195.24
|
| Rate for Payer: Cofinity Commercial |
$239.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$195.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$198.36
|
| Rate for Payer: Healthscope Commercial |
$251.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$195.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$209.19
|
| Rate for Payer: Mclaren Medicaid |
$106.32
|
| Rate for Payer: Mclaren Medicare |
$198.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$208.28
|
| Rate for Payer: Meridian Medicaid |
$111.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$228.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.08
|
| Rate for Payer: PACE Medicare |
$188.44
|
| Rate for Payer: PACE SWMI |
$198.36
|
| Rate for Payer: PHP Commercial |
$237.08
|
| Rate for Payer: PHP Medicare Advantage |
$198.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$106.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$181.30
|
| Rate for Payer: Priority Health Medicare |
$198.36
|
| Rate for Payer: Priority Health SBD |
$175.72
|
| Rate for Payer: Railroad Medicare Medicare |
$198.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$558.36
|
| Rate for Payer: UHC Core |
$294.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$198.36
|
| Rate for Payer: UHC Exchange |
$379.09
|
| Rate for Payer: UHC Medicare Advantage |
$198.36
|
| Rate for Payer: UHCCP Medicaid |
$106.32
|
| Rate for Payer: UMR Bronson Commercial |
$103.20
|
| Rate for Payer: VA VA |
$198.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$209.19
|
|
|
HC NASOTRACHEAL SUCTION
|
Facility
|
IP
|
$278.92
|
|
|
Service Code
|
CPT 31720
|
| Hospital Charge Code |
41000001
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$122.72 |
| Max. Negotiated Rate |
$251.03 |
| Rate for Payer: Aetna American Axle |
$181.30
|
| Rate for Payer: Aetna Commercial |
$237.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$181.30
|
| Rate for Payer: Cash Price |
$223.14
|
| Rate for Payer: Cofinity Commercial |
$195.24
|
| Rate for Payer: Cofinity Commercial |
$239.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$195.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.14
|
| Rate for Payer: Healthscope Commercial |
$251.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$195.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$209.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.08
|
| Rate for Payer: PHP Commercial |
$237.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$181.30
|
| Rate for Payer: Priority Health SBD |
$175.72
|
| Rate for Payer: UMR Bronson Commercial |
$122.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$209.19
|
|
|
HC NCCU OBSERVATION PER HOUR
|
Facility
|
OP
|
$145.08
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200021
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$53.68 |
| Max. Negotiated Rate |
$4,092.00 |
| Rate for Payer: Aetna American Axle |
$94.30
|
| Rate for Payer: Aetna Commercial |
$123.32
|
| Rate for Payer: Aetna Medicare |
$72.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.30
|
| Rate for Payer: BCBS Complete |
$58.03
|
| Rate for Payer: Cash Price |
$116.06
|
| Rate for Payer: Cash Price |
$116.06
|
| Rate for Payer: Cofinity Commercial |
$124.77
|
| Rate for Payer: Cofinity Commercial |
$101.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$101.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.06
|
| Rate for Payer: Healthscope Commercial |
$130.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$101.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.81
|
| Rate for Payer: Meridian Medicaid |
$1,000.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.32
|
| Rate for Payer: PHP Commercial |
$123.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.30
|
| Rate for Payer: Priority Health SBD |
$91.40
|
| Rate for Payer: UHC Core |
$4,092.00
|
| Rate for Payer: UMR Bronson Commercial |
$53.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.81
|
|
|
HC NCCU OBSERVATION PER HOUR
|
Facility
|
IP
|
$145.08
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200021
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$63.84 |
| Max. Negotiated Rate |
$130.57 |
| Rate for Payer: Aetna American Axle |
$94.30
|
| Rate for Payer: Aetna Commercial |
$123.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.30
|
| Rate for Payer: Cash Price |
$116.06
|
| Rate for Payer: Cofinity Commercial |
$101.56
|
| Rate for Payer: Cofinity Commercial |
$124.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$101.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.06
|
| Rate for Payer: Healthscope Commercial |
$130.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$101.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.32
|
| Rate for Payer: PHP Commercial |
$123.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.30
|
| Rate for Payer: Priority Health SBD |
$91.40
|
| Rate for Payer: UMR Bronson Commercial |
$63.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.81
|
|
|
HC NCS 11-12 STUDIES INCL F&H WAVES
|
Facility
|
OP
|
$2,277.10
|
|
|
Service Code
|
CPT 95912
|
| Hospital Charge Code |
92200032
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$277.37 |
| Max. Negotiated Rate |
$2,049.39 |
| Rate for Payer: Aetna American Axle |
$1,480.12
|
| Rate for Payer: Aetna Commercial |
$1,935.54
|
| Rate for Payer: Aetna Medicare |
$538.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,480.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$646.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$646.85
|
| Rate for Payer: BCBS Complete |
$291.24
|
| Rate for Payer: BCBS MAPPO |
$517.48
|
| Rate for Payer: BCN Medicare Advantage |
$517.48
|
| Rate for Payer: Cash Price |
$1,821.68
|
| Rate for Payer: Cash Price |
$1,821.68
|
| Rate for Payer: Cash Price |
$1,821.68
|
| Rate for Payer: Cofinity Commercial |
$1,593.97
|
| Rate for Payer: Cofinity Commercial |
$1,958.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,593.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,821.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$517.48
|
| Rate for Payer: Healthscope Commercial |
$2,049.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,593.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,707.83
|
| Rate for Payer: Mclaren Medicaid |
$277.37
|
| Rate for Payer: Mclaren Medicare |
$517.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$543.35
|
| Rate for Payer: Meridian Medicaid |
$291.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$595.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,935.54
|
| Rate for Payer: PACE Medicare |
$491.61
|
| Rate for Payer: PACE SWMI |
$517.48
|
| Rate for Payer: PHP Commercial |
$1,935.54
|
| Rate for Payer: PHP Medicare Advantage |
$517.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$277.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,480.12
|
| Rate for Payer: Priority Health Medicare |
$517.48
|
| Rate for Payer: Priority Health SBD |
$1,434.57
|
| Rate for Payer: Railroad Medicare Medicare |
$517.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,456.65
|
| Rate for Payer: UHC Core |
$522.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$517.48
|
| Rate for Payer: UHC Exchange |
$988.96
|
| Rate for Payer: UHC Medicare Advantage |
$517.48
|
| Rate for Payer: UHCCP Medicaid |
$277.37
|
| Rate for Payer: UMR Bronson Commercial |
$842.53
|
| Rate for Payer: VA VA |
$517.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,707.83
|
|
|
HC NCS 11-12 STUDIES INCL F&H WAVES
|
Facility
|
IP
|
$2,277.10
|
|
|
Service Code
|
CPT 95912
|
| Hospital Charge Code |
92200032
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$1,001.92 |
| Max. Negotiated Rate |
$2,049.39 |
| Rate for Payer: Aetna American Axle |
$1,480.12
|
| Rate for Payer: Aetna Commercial |
$1,935.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,480.12
|
| Rate for Payer: Cash Price |
$1,821.68
|
| Rate for Payer: Cofinity Commercial |
$1,593.97
|
| Rate for Payer: Cofinity Commercial |
$1,958.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,593.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,821.68
|
| Rate for Payer: Healthscope Commercial |
$2,049.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,593.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,707.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,935.54
|
| Rate for Payer: PHP Commercial |
$1,935.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,480.12
|
| Rate for Payer: Priority Health SBD |
$1,434.57
|
| Rate for Payer: UMR Bronson Commercial |
$1,001.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,707.83
|
|
|
HC NCS 1-2 STUDIES INCL F&H WAVES
|
Facility
|
IP
|
$494.34
|
|
|
Service Code
|
CPT 95907
|
| Hospital Charge Code |
92200027
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$217.51 |
| Max. Negotiated Rate |
$444.91 |
| Rate for Payer: Aetna American Axle |
$321.32
|
| Rate for Payer: Aetna Commercial |
$420.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$321.32
|
| Rate for Payer: Cash Price |
$395.47
|
| Rate for Payer: Cofinity Commercial |
$346.04
|
| Rate for Payer: Cofinity Commercial |
$425.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$346.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$395.47
|
| Rate for Payer: Healthscope Commercial |
$444.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$346.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$370.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$420.19
|
| Rate for Payer: PHP Commercial |
$420.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$321.32
|
| Rate for Payer: Priority Health SBD |
$311.43
|
| Rate for Payer: UMR Bronson Commercial |
$217.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$370.75
|
|
|
HC NCS 1-2 STUDIES INCL F&H WAVES
|
Facility
|
OP
|
$494.34
|
|
|
Service Code
|
CPT 95907
|
| Hospital Charge Code |
92200027
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$81.79 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Aetna American Axle |
$321.32
|
| Rate for Payer: Aetna Commercial |
$420.19
|
| Rate for Payer: Aetna Medicare |
$158.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$321.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$190.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$190.74
|
| Rate for Payer: BCBS Complete |
$85.88
|
| Rate for Payer: BCBS MAPPO |
$152.59
|
| Rate for Payer: BCN Medicare Advantage |
$152.59
|
| Rate for Payer: Cash Price |
$395.47
|
| Rate for Payer: Cash Price |
$395.47
|
| Rate for Payer: Cash Price |
$395.47
|
| Rate for Payer: Cofinity Commercial |
$346.04
|
| Rate for Payer: Cofinity Commercial |
$425.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$346.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$395.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$152.59
|
| Rate for Payer: Healthscope Commercial |
$444.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$346.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$370.75
|
| Rate for Payer: Mclaren Medicaid |
$81.79
|
| Rate for Payer: Mclaren Medicare |
$152.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$160.22
|
| Rate for Payer: Meridian Medicaid |
$85.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$175.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$420.19
|
| Rate for Payer: PACE Medicare |
$144.96
|
| Rate for Payer: PACE SWMI |
$152.59
|
| Rate for Payer: PHP Commercial |
$420.19
|
| Rate for Payer: PHP Medicare Advantage |
$152.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$81.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$321.32
|
| Rate for Payer: Priority Health Medicare |
$152.59
|
| Rate for Payer: Priority Health SBD |
$311.43
|
| Rate for Payer: Railroad Medicare Medicare |
$152.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$429.53
|
| Rate for Payer: UHC Core |
$522.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$152.59
|
| Rate for Payer: UHC Exchange |
$291.61
|
| Rate for Payer: UHC Medicare Advantage |
$152.59
|
| Rate for Payer: UHCCP Medicaid |
$81.79
|
| Rate for Payer: UMR Bronson Commercial |
$182.91
|
| Rate for Payer: VA VA |
$152.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$370.75
|
|
|
HC NCS 13 OR MORE STUDIES INCL F&H WAVES
|
Facility
|
IP
|
$2,954.43
|
|
|
Service Code
|
CPT 95913
|
| Hospital Charge Code |
92200033
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$1,299.95 |
| Max. Negotiated Rate |
$2,658.99 |
| Rate for Payer: Aetna American Axle |
$1,920.38
|
| Rate for Payer: Aetna Commercial |
$2,511.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,920.38
|
| Rate for Payer: Cash Price |
$2,363.54
|
| Rate for Payer: Cofinity Commercial |
$2,068.10
|
| Rate for Payer: Cofinity Commercial |
$2,540.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,068.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,363.54
|
| Rate for Payer: Healthscope Commercial |
$2,658.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,068.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,215.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,511.27
|
| Rate for Payer: PHP Commercial |
$2,511.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,920.38
|
| Rate for Payer: Priority Health SBD |
$1,861.29
|
| Rate for Payer: UMR Bronson Commercial |
$1,299.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,215.82
|
|
|
HC NCS 13 OR MORE STUDIES INCL F&H WAVES
|
Facility
|
OP
|
$2,954.43
|
|
|
Service Code
|
CPT 95913
|
| Hospital Charge Code |
92200033
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$277.37 |
| Max. Negotiated Rate |
$2,658.99 |
| Rate for Payer: Aetna American Axle |
$1,920.38
|
| Rate for Payer: Aetna Commercial |
$2,511.27
|
| Rate for Payer: Aetna Medicare |
$538.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,920.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$646.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$646.85
|
| Rate for Payer: BCBS Complete |
$291.24
|
| Rate for Payer: BCBS MAPPO |
$517.48
|
| Rate for Payer: BCN Medicare Advantage |
$517.48
|
| Rate for Payer: Cash Price |
$2,363.54
|
| Rate for Payer: Cash Price |
$2,363.54
|
| Rate for Payer: Cash Price |
$2,363.54
|
| Rate for Payer: Cofinity Commercial |
$2,068.10
|
| Rate for Payer: Cofinity Commercial |
$2,540.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,068.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,363.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$517.48
|
| Rate for Payer: Healthscope Commercial |
$2,658.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,068.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,215.82
|
| Rate for Payer: Mclaren Medicaid |
$277.37
|
| Rate for Payer: Mclaren Medicare |
$517.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$543.35
|
| Rate for Payer: Meridian Medicaid |
$291.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$595.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,511.27
|
| Rate for Payer: PACE Medicare |
$491.61
|
| Rate for Payer: PACE SWMI |
$517.48
|
| Rate for Payer: PHP Commercial |
$2,511.27
|
| Rate for Payer: PHP Medicare Advantage |
$517.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$277.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,920.38
|
| Rate for Payer: Priority Health Medicare |
$517.48
|
| Rate for Payer: Priority Health SBD |
$1,861.29
|
| Rate for Payer: Railroad Medicare Medicare |
$517.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,456.65
|
| Rate for Payer: UHC Core |
$522.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$517.48
|
| Rate for Payer: UHC Exchange |
$988.96
|
| Rate for Payer: UHC Medicare Advantage |
$517.48
|
| Rate for Payer: UHCCP Medicaid |
$277.37
|
| Rate for Payer: UMR Bronson Commercial |
$1,093.14
|
| Rate for Payer: VA VA |
$517.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,215.82
|
|
|
HC NCS 3-4 STUDIES INCL F&H WAVES
|
Facility
|
IP
|
$913.43
|
|
|
Service Code
|
CPT 95908
|
| Hospital Charge Code |
92200028
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$401.91 |
| Max. Negotiated Rate |
$822.09 |
| Rate for Payer: Aetna American Axle |
$593.73
|
| Rate for Payer: Aetna Commercial |
$776.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$593.73
|
| Rate for Payer: Cash Price |
$730.74
|
| Rate for Payer: Cofinity Commercial |
$639.40
|
| Rate for Payer: Cofinity Commercial |
$785.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$639.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$730.74
|
| Rate for Payer: Healthscope Commercial |
$822.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$639.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$685.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$776.42
|
| Rate for Payer: PHP Commercial |
$776.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$593.73
|
| Rate for Payer: Priority Health SBD |
$575.46
|
| Rate for Payer: UMR Bronson Commercial |
$401.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$685.07
|
|
|
HC NCS 3-4 STUDIES INCL F&H WAVES
|
Facility
|
OP
|
$913.43
|
|
|
Service Code
|
CPT 95908
|
| Hospital Charge Code |
92200028
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$162.78 |
| Max. Negotiated Rate |
$854.89 |
| Rate for Payer: Aetna American Axle |
$593.73
|
| Rate for Payer: Aetna Commercial |
$776.42
|
| Rate for Payer: Aetna Medicare |
$315.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$593.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$379.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$379.62
|
| Rate for Payer: BCBS Complete |
$170.92
|
| Rate for Payer: BCBS MAPPO |
$303.70
|
| Rate for Payer: BCN Medicare Advantage |
$303.70
|
| Rate for Payer: Cash Price |
$730.74
|
| Rate for Payer: Cash Price |
$730.74
|
| Rate for Payer: Cash Price |
$730.74
|
| Rate for Payer: Cofinity Commercial |
$639.40
|
| Rate for Payer: Cofinity Commercial |
$785.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$639.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$730.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$303.70
|
| Rate for Payer: Healthscope Commercial |
$822.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$639.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$685.07
|
| Rate for Payer: Mclaren Medicaid |
$162.78
|
| Rate for Payer: Mclaren Medicare |
$303.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$318.88
|
| Rate for Payer: Meridian Medicaid |
$170.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$349.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$776.42
|
| Rate for Payer: PACE Medicare |
$288.51
|
| Rate for Payer: PACE SWMI |
$303.70
|
| Rate for Payer: PHP Commercial |
$776.42
|
| Rate for Payer: PHP Medicare Advantage |
$303.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$162.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$593.73
|
| Rate for Payer: Priority Health Medicare |
$303.70
|
| Rate for Payer: Priority Health SBD |
$575.46
|
| Rate for Payer: Railroad Medicare Medicare |
$303.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$854.89
|
| Rate for Payer: UHC Core |
$522.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$303.70
|
| Rate for Payer: UHC Exchange |
$580.40
|
| Rate for Payer: UHC Medicare Advantage |
$303.70
|
| Rate for Payer: UHCCP Medicaid |
$162.78
|
| Rate for Payer: UMR Bronson Commercial |
$337.97
|
| Rate for Payer: VA VA |
$303.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$685.07
|
|
|
HC NCS 5-6 STUDIES INCL F&H WAVES
|
Facility
|
IP
|
$1,128.89
|
|
|
Service Code
|
CPT 95909
|
| Hospital Charge Code |
92200029
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$496.71 |
| Max. Negotiated Rate |
$1,016.00 |
| Rate for Payer: Aetna American Axle |
$733.78
|
| Rate for Payer: Aetna Commercial |
$959.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$733.78
|
| Rate for Payer: Cash Price |
$903.11
|
| Rate for Payer: Cofinity Commercial |
$790.22
|
| Rate for Payer: Cofinity Commercial |
$970.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$790.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$903.11
|
| Rate for Payer: Healthscope Commercial |
$1,016.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$790.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$846.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$959.56
|
| Rate for Payer: PHP Commercial |
$959.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$733.78
|
| Rate for Payer: Priority Health SBD |
$711.20
|
| Rate for Payer: UMR Bronson Commercial |
$496.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$846.67
|
|
|
HC NCS 5-6 STUDIES INCL F&H WAVES
|
Facility
|
OP
|
$1,128.89
|
|
|
Service Code
|
CPT 95909
|
| Hospital Charge Code |
92200029
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$162.78 |
| Max. Negotiated Rate |
$1,016.00 |
| Rate for Payer: Aetna American Axle |
$733.78
|
| Rate for Payer: Aetna Commercial |
$959.56
|
| Rate for Payer: Aetna Medicare |
$315.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$733.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$379.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$379.62
|
| Rate for Payer: BCBS Complete |
$170.92
|
| Rate for Payer: BCBS MAPPO |
$303.70
|
| Rate for Payer: BCN Medicare Advantage |
$303.70
|
| Rate for Payer: Cash Price |
$903.11
|
| Rate for Payer: Cash Price |
$903.11
|
| Rate for Payer: Cash Price |
$903.11
|
| Rate for Payer: Cofinity Commercial |
$790.22
|
| Rate for Payer: Cofinity Commercial |
$970.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$790.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$903.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$303.70
|
| Rate for Payer: Healthscope Commercial |
$1,016.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$790.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$846.67
|
| Rate for Payer: Mclaren Medicaid |
$162.78
|
| Rate for Payer: Mclaren Medicare |
$303.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$318.88
|
| Rate for Payer: Meridian Medicaid |
$170.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$349.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$959.56
|
| Rate for Payer: PACE Medicare |
$288.51
|
| Rate for Payer: PACE SWMI |
$303.70
|
| Rate for Payer: PHP Commercial |
$959.56
|
| Rate for Payer: PHP Medicare Advantage |
$303.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$162.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$733.78
|
| Rate for Payer: Priority Health Medicare |
$303.70
|
| Rate for Payer: Priority Health SBD |
$711.20
|
| Rate for Payer: Railroad Medicare Medicare |
$303.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$854.89
|
| Rate for Payer: UHC Core |
$522.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$303.70
|
| Rate for Payer: UHC Exchange |
$580.40
|
| Rate for Payer: UHC Medicare Advantage |
$303.70
|
| Rate for Payer: UHCCP Medicaid |
$162.78
|
| Rate for Payer: UMR Bronson Commercial |
$417.69
|
| Rate for Payer: VA VA |
$303.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$846.67
|
|
|
HC NCS 7-8 STUDIES INCL F&H WAVES
|
Facility
|
OP
|
$1,457.88
|
|
|
Service Code
|
CPT 95910
|
| Hospital Charge Code |
92200030
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$162.78 |
| Max. Negotiated Rate |
$1,312.09 |
| Rate for Payer: Aetna American Axle |
$947.62
|
| Rate for Payer: Aetna Commercial |
$1,239.20
|
| Rate for Payer: Aetna Medicare |
$315.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$947.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$379.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$379.62
|
| Rate for Payer: BCBS Complete |
$170.92
|
| Rate for Payer: BCBS MAPPO |
$303.70
|
| Rate for Payer: BCN Medicare Advantage |
$303.70
|
| Rate for Payer: Cash Price |
$1,166.30
|
| Rate for Payer: Cash Price |
$1,166.30
|
| Rate for Payer: Cash Price |
$1,166.30
|
| Rate for Payer: Cofinity Commercial |
$1,020.52
|
| Rate for Payer: Cofinity Commercial |
$1,253.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,020.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,166.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$303.70
|
| Rate for Payer: Healthscope Commercial |
$1,312.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,020.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,093.41
|
| Rate for Payer: Mclaren Medicaid |
$162.78
|
| Rate for Payer: Mclaren Medicare |
$303.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$318.88
|
| Rate for Payer: Meridian Medicaid |
$170.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$349.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,239.20
|
| Rate for Payer: PACE Medicare |
$288.51
|
| Rate for Payer: PACE SWMI |
$303.70
|
| Rate for Payer: PHP Commercial |
$1,239.20
|
| Rate for Payer: PHP Medicare Advantage |
$303.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$162.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$947.62
|
| Rate for Payer: Priority Health Medicare |
$303.70
|
| Rate for Payer: Priority Health SBD |
$918.46
|
| Rate for Payer: Railroad Medicare Medicare |
$303.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$854.89
|
| Rate for Payer: UHC Core |
$522.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$303.70
|
| Rate for Payer: UHC Exchange |
$580.40
|
| Rate for Payer: UHC Medicare Advantage |
$303.70
|
| Rate for Payer: UHCCP Medicaid |
$162.78
|
| Rate for Payer: UMR Bronson Commercial |
$539.42
|
| Rate for Payer: VA VA |
$303.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,093.41
|
|
|
HC NCS 7-8 STUDIES INCL F&H WAVES
|
Facility
|
IP
|
$1,457.88
|
|
|
Service Code
|
CPT 95910
|
| Hospital Charge Code |
92200030
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$641.47 |
| Max. Negotiated Rate |
$1,312.09 |
| Rate for Payer: Aetna American Axle |
$947.62
|
| Rate for Payer: Aetna Commercial |
$1,239.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$947.62
|
| Rate for Payer: Cash Price |
$1,166.30
|
| Rate for Payer: Cofinity Commercial |
$1,020.52
|
| Rate for Payer: Cofinity Commercial |
$1,253.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,020.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,166.30
|
| Rate for Payer: Healthscope Commercial |
$1,312.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,020.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,093.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,239.20
|
| Rate for Payer: PHP Commercial |
$1,239.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$947.62
|
| Rate for Payer: Priority Health SBD |
$918.46
|
| Rate for Payer: UMR Bronson Commercial |
$641.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,093.41
|
|
|
HC NCS 9-10 STUDIES INCL F&H WAVES
|
Facility
|
OP
|
$1,806.20
|
|
|
Service Code
|
CPT 95911
|
| Hospital Charge Code |
92200031
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$277.37 |
| Max. Negotiated Rate |
$1,625.58 |
| Rate for Payer: Aetna American Axle |
$1,174.03
|
| Rate for Payer: Aetna Commercial |
$1,535.27
|
| Rate for Payer: Aetna Medicare |
$538.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,174.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$646.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$646.85
|
| Rate for Payer: BCBS Complete |
$291.24
|
| Rate for Payer: BCBS MAPPO |
$517.48
|
| Rate for Payer: BCN Medicare Advantage |
$517.48
|
| Rate for Payer: Cash Price |
$1,444.96
|
| Rate for Payer: Cash Price |
$1,444.96
|
| Rate for Payer: Cash Price |
$1,444.96
|
| Rate for Payer: Cofinity Commercial |
$1,264.34
|
| Rate for Payer: Cofinity Commercial |
$1,553.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,264.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,444.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$517.48
|
| Rate for Payer: Healthscope Commercial |
$1,625.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,264.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,354.65
|
| Rate for Payer: Mclaren Medicaid |
$277.37
|
| Rate for Payer: Mclaren Medicare |
$517.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$543.35
|
| Rate for Payer: Meridian Medicaid |
$291.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$595.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,535.27
|
| Rate for Payer: PACE Medicare |
$491.61
|
| Rate for Payer: PACE SWMI |
$517.48
|
| Rate for Payer: PHP Commercial |
$1,535.27
|
| Rate for Payer: PHP Medicare Advantage |
$517.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$277.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,174.03
|
| Rate for Payer: Priority Health Medicare |
$517.48
|
| Rate for Payer: Priority Health SBD |
$1,137.91
|
| Rate for Payer: Railroad Medicare Medicare |
$517.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,456.65
|
| Rate for Payer: UHC Core |
$522.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$517.48
|
| Rate for Payer: UHC Exchange |
$988.96
|
| Rate for Payer: UHC Medicare Advantage |
$517.48
|
| Rate for Payer: UHCCP Medicaid |
$277.37
|
| Rate for Payer: UMR Bronson Commercial |
$668.29
|
| Rate for Payer: VA VA |
$517.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,354.65
|
|
