|
HC NASAL BONES COMP MIN 3 VW
|
Facility
|
IP
|
$198.81
|
|
|
Service Code
|
CPT 70160
|
| Hospital Charge Code |
32000011
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$87.48 |
| Max. Negotiated Rate |
$178.93 |
| Rate for Payer: Aetna American Axle |
$129.23
|
| Rate for Payer: Aetna Commercial |
$168.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.23
|
| Rate for Payer: Cash Price |
$159.05
|
| Rate for Payer: Cofinity Commercial |
$139.17
|
| Rate for Payer: Cofinity Commercial |
$170.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$139.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.05
|
| Rate for Payer: Healthscope Commercial |
$178.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$139.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$149.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.99
|
| Rate for Payer: PHP Commercial |
$168.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.23
|
| Rate for Payer: Priority Health SBD |
$125.25
|
| Rate for Payer: UMR Bronson Commercial |
$87.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$149.11
|
|
|
HC NASAL BONES COMP MIN 3 VW
|
Facility
|
OP
|
$198.81
|
|
|
Service Code
|
CPT 70160
|
| Hospital Charge Code |
32000011
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$34.37 |
| Max. Negotiated Rate |
$271.13 |
| Rate for Payer: Aetna American Axle |
$129.23
|
| Rate for Payer: Aetna Commercial |
$168.99
|
| Rate for Payer: Aetna Medicare |
$89.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$107.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$107.84
|
| Rate for Payer: BCBS Complete |
$48.55
|
| Rate for Payer: BCBS MAPPO |
$86.27
|
| Rate for Payer: BCBS Trust/PPO |
$60.89
|
| Rate for Payer: BCN Commercial |
$60.89
|
| Rate for Payer: BCN Medicare Advantage |
$86.27
|
| Rate for Payer: Cash Price |
$159.05
|
| Rate for Payer: Cash Price |
$159.05
|
| Rate for Payer: Cofinity Commercial |
$170.98
|
| Rate for Payer: Cofinity Commercial |
$139.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$139.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.27
|
| Rate for Payer: Healthscope Commercial |
$178.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$139.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$149.11
|
| Rate for Payer: Mclaren Medicaid |
$46.24
|
| Rate for Payer: Mclaren Medicare |
$86.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.58
|
| Rate for Payer: Meridian Medicaid |
$48.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.99
|
| Rate for Payer: Nomi Health Commercial |
$258.81
|
| Rate for Payer: PACE Medicare |
$81.96
|
| Rate for Payer: PACE SWMI |
$86.27
|
| Rate for Payer: PHP Commercial |
$168.99
|
| Rate for Payer: PHP Medicare Advantage |
$86.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$271.13
|
| Rate for Payer: Priority Health Medicare |
$86.27
|
| Rate for Payer: Priority Health Narrow Network |
$216.90
|
| Rate for Payer: Priority Health SBD |
$125.25
|
| Rate for Payer: Railroad Medicare Medicare |
$86.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.81
|
| Rate for Payer: UHC Core |
$262.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$86.27
|
| Rate for Payer: UHC Exchange |
$34.37
|
| Rate for Payer: UHC Medicare Advantage |
$86.27
|
| Rate for Payer: UHCCP Medicaid |
$46.24
|
| Rate for Payer: UMR Bronson Commercial |
$73.56
|
| Rate for Payer: VA VA |
$86.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$149.11
|
|
|
HC NASAL ENDOSCOPY DX
|
Facility
|
OP
|
$255.90
|
|
|
Service Code
|
CPT 31231
|
| Hospital Charge Code |
76100183
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$62.15 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna American Axle |
$166.34
|
| Rate for Payer: Aetna Commercial |
$217.52
|
| Rate for Payer: Aetna Medicare |
$197.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$237.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$237.76
|
| Rate for Payer: BCBS Complete |
$107.05
|
| Rate for Payer: BCBS MAPPO |
$190.21
|
| Rate for Payer: BCBS Trust/PPO |
$99.76
|
| Rate for Payer: BCN Commercial |
$99.76
|
| Rate for Payer: BCN Medicare Advantage |
$190.21
|
| Rate for Payer: Cash Price |
$204.72
|
| 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 |
$190.21
|
| 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 |
$191.92
|
| Rate for Payer: Mclaren Medicaid |
$101.95
|
| Rate for Payer: Mclaren Medicare |
$190.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$199.72
|
| Rate for Payer: Meridian Medicaid |
$107.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$218.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.52
|
| Rate for Payer: Nomi Health Commercial |
$399.44
|
| Rate for Payer: PACE Medicare |
$180.70
|
| Rate for Payer: PACE SWMI |
$190.21
|
| Rate for Payer: PHP Commercial |
$217.52
|
| Rate for Payer: PHP Medicare Advantage |
$190.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$101.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$597.84
|
| Rate for Payer: Priority Health Medicare |
$190.21
|
| Rate for Payer: Priority Health Narrow Network |
$478.27
|
| Rate for Payer: Priority Health SBD |
$161.22
|
| Rate for Payer: Railroad Medicare Medicare |
$190.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.36
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$190.21
|
| Rate for Payer: UHC Exchange |
$62.15
|
| Rate for Payer: UHC Medicare Advantage |
$190.21
|
| Rate for Payer: UHCCP Medicaid |
$101.95
|
| Rate for Payer: UMR Bronson Commercial |
$94.68
|
| Rate for Payer: VA VA |
$190.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$191.92
|
|
|
HC NASAL ENDOSCOPY DX
|
Facility
|
IP
|
$255.90
|
|
|
Service Code
|
CPT 31231
|
| Hospital Charge Code |
76100183
|
|
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 |
$217.52
|
| 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 |
$191.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.52
|
| Rate for Payer: PHP Commercial |
$217.52
|
| 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 |
$191.92
|
|
|
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 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 |
$153.72 |
| Max. Negotiated Rate |
$5,310.41 |
| Rate for Payer: Aetna American Axle |
$2,884.05
|
| Rate for Payer: Aetna Commercial |
$3,771.45
|
| Rate for Payer: Aetna Medicare |
$1,757.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,884.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,112.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,112.00
|
| Rate for Payer: BCBS Complete |
$950.91
|
| Rate for Payer: BCBS MAPPO |
$1,689.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,362.49
|
| Rate for Payer: BCN Commercial |
$1,362.49
|
| Rate for Payer: BCN Medicare Advantage |
$1,689.60
|
| Rate for Payer: Cash Price |
$3,549.60
|
| 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 |
$1,689.60
|
| 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: Mclaren Medicaid |
$905.63
|
| Rate for Payer: Mclaren Medicare |
$1,689.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,774.08
|
| Rate for Payer: Meridian Medicaid |
$950.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,943.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,771.45
|
| Rate for Payer: Nomi Health Commercial |
$3,548.16
|
| Rate for Payer: PACE Medicare |
$1,605.12
|
| Rate for Payer: PACE SWMI |
$1,689.60
|
| Rate for Payer: PHP Commercial |
$3,771.45
|
| Rate for Payer: PHP Medicare Advantage |
$1,689.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$905.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,884.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,310.41
|
| Rate for Payer: Priority Health Medicare |
$1,689.60
|
| Rate for Payer: Priority Health Narrow Network |
$4,248.33
|
| Rate for Payer: Priority Health SBD |
$2,795.31
|
| Rate for Payer: Railroad Medicare Medicare |
$1,689.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$169.09
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,689.60
|
| Rate for Payer: UHC Exchange |
$153.72
|
| Rate for Payer: UHC Medicare Advantage |
$1,689.60
|
| Rate for Payer: UHCCP Medicaid |
$905.63
|
| Rate for Payer: UMR Bronson Commercial |
$1,641.69
|
| Rate for Payer: VA VA |
$1,689.60
|
| 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 |
$35.83 |
| Max. Negotiated Rate |
$597.84 |
| Rate for Payer: Aetna American Axle |
$166.34
|
| Rate for Payer: Aetna Commercial |
$217.52
|
| Rate for Payer: Aetna Medicare |
$197.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$237.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$237.76
|
| Rate for Payer: BCBS Complete |
$107.05
|
| Rate for Payer: BCBS MAPPO |
$190.21
|
| Rate for Payer: BCBS Trust/PPO |
$319.00
|
| Rate for Payer: BCN Commercial |
$319.00
|
| Rate for Payer: BCN Medicare Advantage |
$190.21
|
| Rate for Payer: Cash Price |
$204.72
|
| 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 |
$190.21
|
| 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 |
$191.92
|
| Rate for Payer: Mclaren Medicaid |
$101.95
|
| Rate for Payer: Mclaren Medicare |
$190.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$199.72
|
| Rate for Payer: Meridian Medicaid |
$107.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$218.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.52
|
| Rate for Payer: Nomi Health Commercial |
$399.44
|
| Rate for Payer: PACE Medicare |
$180.70
|
| Rate for Payer: PACE SWMI |
$190.21
|
| Rate for Payer: PHP Commercial |
$217.52
|
| Rate for Payer: PHP Medicare Advantage |
$190.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$101.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$597.84
|
| Rate for Payer: Priority Health Medicare |
$190.21
|
| Rate for Payer: Priority Health Narrow Network |
$478.27
|
| Rate for Payer: Priority Health SBD |
$161.22
|
| Rate for Payer: Railroad Medicare Medicare |
$190.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$190.21
|
| Rate for Payer: UHC Exchange |
$35.83
|
| Rate for Payer: UHC Medicare Advantage |
$190.21
|
| Rate for Payer: UHCCP Medicaid |
$101.95
|
| Rate for Payer: UMR Bronson Commercial |
$94.68
|
| Rate for Payer: VA VA |
$190.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$191.92
|
|
|
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 |
$217.52
|
| 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 |
$191.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.52
|
| Rate for Payer: PHP Commercial |
$217.52
|
| 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 |
$191.92
|
|
|
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 |
$234.03 |
| Max. Negotiated Rate |
$18,216.88 |
| Rate for Payer: Aetna American Axle |
$10,660.00
|
| Rate for Payer: Aetna Commercial |
$13,940.00
|
| Rate for Payer: Aetna Medicare |
$6,027.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,660.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,245.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,245.06
|
| Rate for Payer: BCBS Complete |
$3,262.02
|
| Rate for Payer: BCBS MAPPO |
$5,796.05
|
| Rate for Payer: BCBS Trust/PPO |
$5,105.81
|
| Rate for Payer: BCN Commercial |
$5,105.81
|
| Rate for Payer: BCN Medicare Advantage |
$5,796.05
|
| Rate for Payer: Cash Price |
$13,120.00
|
| 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 |
$5,796.05
|
| 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 |
$3,106.68
|
| Rate for Payer: Mclaren Medicare |
$5,796.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,085.85
|
| Rate for Payer: Meridian Medicaid |
$3,262.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,665.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,940.00
|
| Rate for Payer: Nomi Health Commercial |
$12,171.70
|
| Rate for Payer: PACE Medicare |
$5,506.25
|
| Rate for Payer: PACE SWMI |
$5,796.05
|
| Rate for Payer: PHP Commercial |
$13,940.00
|
| Rate for Payer: PHP Medicare Advantage |
$5,796.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,106.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,660.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18,216.88
|
| Rate for Payer: Priority Health Medicare |
$5,796.05
|
| Rate for Payer: Priority Health Narrow Network |
$14,573.50
|
| Rate for Payer: Priority Health SBD |
$10,332.00
|
| Rate for Payer: Railroad Medicare Medicare |
$5,796.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$257.43
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,796.05
|
| Rate for Payer: UHC Exchange |
$234.03
|
| Rate for Payer: UHC Medicare Advantage |
$5,796.05
|
| Rate for Payer: UHCCP Medicaid |
$3,106.68
|
| Rate for Payer: UMR Bronson Commercial |
$6,068.00
|
| Rate for Payer: VA VA |
$5,796.05
|
| 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 |
$167.25 |
| Max. Negotiated Rate |
$18,216.88 |
| Rate for Payer: UHC All Payor (Choice/PPO) |
$183.98
|
| Rate for Payer: Aetna American Axle |
$10,660.00
|
| Rate for Payer: Aetna Commercial |
$13,940.00
|
| Rate for Payer: Aetna Medicare |
$6,027.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,660.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,245.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,245.06
|
| Rate for Payer: BCBS Complete |
$3,262.02
|
| Rate for Payer: BCBS MAPPO |
$5,796.05
|
| Rate for Payer: BCBS Trust/PPO |
$4,735.86
|
| Rate for Payer: BCN Commercial |
$4,735.86
|
| Rate for Payer: BCN Medicare Advantage |
$5,796.05
|
| Rate for Payer: Cash Price |
$13,120.00
|
| 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 |
$5,796.05
|
| 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 |
$3,106.68
|
| Rate for Payer: Mclaren Medicare |
$5,796.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,085.85
|
| Rate for Payer: Meridian Medicaid |
$3,262.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,665.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,940.00
|
| Rate for Payer: Nomi Health Commercial |
$12,171.70
|
| Rate for Payer: PACE Medicare |
$5,506.25
|
| Rate for Payer: PACE SWMI |
$5,796.05
|
| Rate for Payer: PHP Commercial |
$13,940.00
|
| Rate for Payer: PHP Medicare Advantage |
$5,796.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,106.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,660.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18,216.88
|
| Rate for Payer: Priority Health Medicare |
$5,796.05
|
| Rate for Payer: Priority Health Narrow Network |
$14,573.50
|
| Rate for Payer: Priority Health SBD |
$10,332.00
|
| Rate for Payer: Railroad Medicare Medicare |
$5,796.05
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,796.05
|
| Rate for Payer: UHC Exchange |
$167.25
|
| Rate for Payer: UHC Medicare Advantage |
$5,796.05
|
| Rate for Payer: UHCCP Medicaid |
$3,106.68
|
| Rate for Payer: UMR Bronson Commercial |
$6,068.00
|
| Rate for Payer: VA VA |
$5,796.05
|
| 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 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 NASOTRACHEAL SUCTION
|
Facility
|
OP
|
$278.92
|
|
|
Service Code
|
CPT 31720
|
| Hospital Charge Code |
41000001
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$46.43 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna American Axle |
$181.30
|
| Rate for Payer: Aetna Commercial |
$237.08
|
| Rate for Payer: Aetna Medicare |
$207.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$181.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$249.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$249.10
|
| Rate for Payer: BCBS Complete |
$112.15
|
| Rate for Payer: BCBS MAPPO |
$199.28
|
| Rate for Payer: BCBS Trust/PPO |
$151.38
|
| Rate for Payer: BCN Commercial |
$151.38
|
| Rate for Payer: BCN Medicare Advantage |
$199.28
|
| 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 |
$199.28
|
| 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 |
$106.81
|
| Rate for Payer: Mclaren Medicare |
$199.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$209.24
|
| Rate for Payer: Meridian Medicaid |
$112.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$229.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.08
|
| Rate for Payer: Nomi Health Commercial |
$597.84
|
| Rate for Payer: PACE Medicare |
$189.32
|
| Rate for Payer: PACE SWMI |
$199.28
|
| Rate for Payer: PHP Commercial |
$237.08
|
| Rate for Payer: PHP Medicare Advantage |
$199.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$106.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$181.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$626.34
|
| Rate for Payer: Priority Health Medicare |
$199.28
|
| Rate for Payer: Priority Health Narrow Network |
$501.07
|
| Rate for Payer: Priority Health SBD |
$175.72
|
| Rate for Payer: Railroad Medicare Medicare |
$199.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.07
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$199.28
|
| Rate for Payer: UHC Exchange |
$46.43
|
| Rate for Payer: UHC Medicare Advantage |
$199.28
|
| Rate for Payer: UHCCP Medicaid |
$106.81
|
| Rate for Payer: UMR Bronson Commercial |
$103.20
|
| Rate for Payer: VA VA |
$199.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$209.19
|
|
|
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 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: BCBS Trust/PPO |
$103.16
|
| Rate for Payer: BCN Commercial |
$103.16
|
| Rate for Payer: Cash Price |
$116.06
|
| 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 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 |
$1,707.82
|
| 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 |
$1,707.82
|
|
|
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 |
$230.69 |
| 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 |
$540.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,480.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$649.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$649.84
|
| Rate for Payer: BCBS Complete |
$292.58
|
| Rate for Payer: BCBS MAPPO |
$519.87
|
| Rate for Payer: BCBS Trust/PPO |
$393.26
|
| Rate for Payer: BCN Commercial |
$393.26
|
| Rate for Payer: BCN Medicare Advantage |
$519.87
|
| 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 |
$519.87
|
| 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 |
$1,707.82
|
| Rate for Payer: Mclaren Medicaid |
$278.65
|
| Rate for Payer: Mclaren Medicare |
$519.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$545.86
|
| Rate for Payer: Meridian Medicaid |
$292.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$597.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,935.54
|
| Rate for Payer: Nomi Health Commercial |
$1,559.61
|
| Rate for Payer: PACE Medicare |
$493.88
|
| Rate for Payer: PACE SWMI |
$519.87
|
| Rate for Payer: PHP Commercial |
$1,935.54
|
| Rate for Payer: PHP Medicare Advantage |
$519.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$278.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,480.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,633.95
|
| Rate for Payer: Priority Health Medicare |
$519.87
|
| Rate for Payer: Priority Health Narrow Network |
$1,307.16
|
| Rate for Payer: Priority Health SBD |
$1,434.57
|
| Rate for Payer: Railroad Medicare Medicare |
$519.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$253.76
|
| Rate for Payer: UHC Core |
$522.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$519.87
|
| Rate for Payer: UHC Exchange |
$230.69
|
| Rate for Payer: UHC Medicare Advantage |
$519.87
|
| Rate for Payer: UHCCP Medicaid |
$278.65
|
| Rate for Payer: UMR Bronson Commercial |
$842.53
|
| Rate for Payer: VA VA |
$519.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,707.82
|
|
|
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 |
$370.76
|
| 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 |
$370.76
|
|
|
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 |
$82.17 |
| 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 |
$159.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$321.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$191.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$191.62
|
| Rate for Payer: BCBS Complete |
$86.28
|
| Rate for Payer: BCBS MAPPO |
$153.30
|
| Rate for Payer: BCBS Trust/PPO |
$162.09
|
| Rate for Payer: BCN Commercial |
$162.09
|
| Rate for Payer: BCN Medicare Advantage |
$153.30
|
| 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 |
$153.30
|
| 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 |
$370.76
|
| Rate for Payer: Mclaren Medicaid |
$82.17
|
| Rate for Payer: Mclaren Medicare |
$153.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$160.96
|
| Rate for Payer: Meridian Medicaid |
$86.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$176.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$420.19
|
| Rate for Payer: Nomi Health Commercial |
$459.90
|
| Rate for Payer: PACE Medicare |
$145.64
|
| Rate for Payer: PACE SWMI |
$153.30
|
| Rate for Payer: PHP Commercial |
$420.19
|
| Rate for Payer: PHP Medicare Advantage |
$153.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$321.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$481.80
|
| Rate for Payer: Priority Health Medicare |
$153.30
|
| Rate for Payer: Priority Health Narrow Network |
$385.44
|
| Rate for Payer: Priority Health SBD |
$311.43
|
| Rate for Payer: Railroad Medicare Medicare |
$153.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$92.27
|
| Rate for Payer: UHC Core |
$522.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$153.30
|
| Rate for Payer: UHC Exchange |
$83.88
|
| Rate for Payer: UHC Medicare Advantage |
$153.30
|
| Rate for Payer: UHCCP Medicaid |
$82.17
|
| Rate for Payer: UMR Bronson Commercial |
$182.91
|
| Rate for Payer: VA VA |
$153.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$370.76
|
|
|
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 |
$266.50 |
| 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 |
$540.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,920.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$649.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$649.84
|
| Rate for Payer: BCBS Complete |
$292.58
|
| Rate for Payer: BCBS MAPPO |
$519.87
|
| Rate for Payer: BCBS Trust/PPO |
$435.52
|
| Rate for Payer: BCN Commercial |
$435.52
|
| Rate for Payer: BCN Medicare Advantage |
$519.87
|
| 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 |
$519.87
|
| 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 |
$278.65
|
| Rate for Payer: Mclaren Medicare |
$519.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$545.86
|
| Rate for Payer: Meridian Medicaid |
$292.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$597.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,511.27
|
| Rate for Payer: Nomi Health Commercial |
$1,559.61
|
| Rate for Payer: PACE Medicare |
$493.88
|
| Rate for Payer: PACE SWMI |
$519.87
|
| Rate for Payer: PHP Commercial |
$2,511.27
|
| Rate for Payer: PHP Medicare Advantage |
$519.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$278.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,920.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,633.95
|
| Rate for Payer: Priority Health Medicare |
$519.87
|
| Rate for Payer: Priority Health Narrow Network |
$1,307.16
|
| Rate for Payer: Priority Health SBD |
$1,861.29
|
| Rate for Payer: Railroad Medicare Medicare |
$519.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$293.15
|
| Rate for Payer: UHC Core |
$522.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$519.87
|
| Rate for Payer: UHC Exchange |
$266.50
|
| Rate for Payer: UHC Medicare Advantage |
$519.87
|
| Rate for Payer: UHCCP Medicaid |
$278.65
|
| Rate for Payer: UMR Bronson Commercial |
$1,093.14
|
| Rate for Payer: VA VA |
$519.87
|
| 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 |
$104.09 |
| Max. Negotiated Rate |
$958.92 |
| Rate for Payer: Aetna American Axle |
$593.73
|
| Rate for Payer: Aetna Commercial |
$776.42
|
| Rate for Payer: Aetna Medicare |
$317.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$593.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$381.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$381.38
|
| Rate for Payer: BCBS Complete |
$171.71
|
| Rate for Payer: BCBS MAPPO |
$305.10
|
| Rate for Payer: BCBS Trust/PPO |
$198.74
|
| Rate for Payer: BCN Commercial |
$198.74
|
| Rate for Payer: BCN Medicare Advantage |
$305.10
|
| 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 |
$305.10
|
| 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 |
$163.53
|
| Rate for Payer: Mclaren Medicare |
$305.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$320.36
|
| Rate for Payer: Meridian Medicaid |
$171.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$350.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$776.42
|
| Rate for Payer: Nomi Health Commercial |
$915.30
|
| Rate for Payer: PACE Medicare |
$289.84
|
| Rate for Payer: PACE SWMI |
$305.10
|
| Rate for Payer: PHP Commercial |
$776.42
|
| Rate for Payer: PHP Medicare Advantage |
$305.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$163.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$593.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$958.92
|
| Rate for Payer: Priority Health Medicare |
$305.10
|
| Rate for Payer: Priority Health Narrow Network |
$767.14
|
| Rate for Payer: Priority Health SBD |
$575.46
|
| Rate for Payer: Railroad Medicare Medicare |
$305.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$114.50
|
| Rate for Payer: UHC Core |
$522.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$305.10
|
| Rate for Payer: UHC Exchange |
$104.09
|
| Rate for Payer: UHC Medicare Advantage |
$305.10
|
| Rate for Payer: UHCCP Medicaid |
$163.53
|
| Rate for Payer: UMR Bronson Commercial |
$337.97
|
| Rate for Payer: VA VA |
$305.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$685.07
|
|
|
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 |
$124.89 |
| 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 |
$317.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$733.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$381.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$381.38
|
| Rate for Payer: BCBS Complete |
$171.71
|
| Rate for Payer: BCBS MAPPO |
$305.10
|
| Rate for Payer: BCBS Trust/PPO |
$239.61
|
| Rate for Payer: BCN Commercial |
$239.61
|
| Rate for Payer: BCN Medicare Advantage |
$305.10
|
| 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 |
$305.10
|
| 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 |
$163.53
|
| Rate for Payer: Mclaren Medicare |
$305.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$320.36
|
| Rate for Payer: Meridian Medicaid |
$171.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$350.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$959.56
|
| Rate for Payer: Nomi Health Commercial |
$915.30
|
| Rate for Payer: PACE Medicare |
$289.84
|
| Rate for Payer: PACE SWMI |
$305.10
|
| Rate for Payer: PHP Commercial |
$959.56
|
| Rate for Payer: PHP Medicare Advantage |
$305.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$163.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$733.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$958.92
|
| Rate for Payer: Priority Health Medicare |
$305.10
|
| Rate for Payer: Priority Health Narrow Network |
$767.14
|
| Rate for Payer: Priority Health SBD |
$711.20
|
| Rate for Payer: Railroad Medicare Medicare |
$305.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$137.38
|
| Rate for Payer: UHC Core |
$522.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$305.10
|
| Rate for Payer: UHC Exchange |
$124.89
|
| Rate for Payer: UHC Medicare Advantage |
$305.10
|
| Rate for Payer: UHCCP Medicaid |
$163.53
|
| Rate for Payer: UMR Bronson Commercial |
$417.69
|
| Rate for Payer: VA VA |
$305.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$846.67
|
|
