|
HC NON-SELECTIVE VERTEBRAL ARTERY UNI
|
Facility
|
IP
|
$9,547.08
|
|
|
Service Code
|
CPT 36225
|
| Hospital Charge Code |
36100380
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,200.72 |
| Max. Negotiated Rate |
$8,592.37 |
| Rate for Payer: Aetna American Axle |
$6,205.60
|
| Rate for Payer: Aetna Commercial |
$8,115.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,205.60
|
| Rate for Payer: Cash Price |
$7,637.66
|
| Rate for Payer: Cofinity Commercial |
$6,682.96
|
| Rate for Payer: Cofinity Commercial |
$8,210.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,682.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,637.66
|
| Rate for Payer: Healthscope Commercial |
$8,592.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,682.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,160.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,115.02
|
| Rate for Payer: PHP Commercial |
$8,115.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,205.60
|
| Rate for Payer: Priority Health SBD |
$6,014.66
|
| Rate for Payer: UMR Bronson Commercial |
$4,200.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,160.31
|
|
|
HC NONSTRESS TEST
|
Facility
|
OP
|
$352.44
|
|
|
Service Code
|
CPT 59025
|
| Hospital Charge Code |
92000004
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$105.16 |
| Max. Negotiated Rate |
$552.28 |
| Rate for Payer: Aetna American Axle |
$229.09
|
| Rate for Payer: Aetna Commercial |
$299.57
|
| Rate for Payer: Aetna Medicare |
$204.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$229.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$245.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$245.25
|
| Rate for Payer: BCBS Complete |
$110.42
|
| Rate for Payer: BCBS MAPPO |
$196.20
|
| Rate for Payer: BCN Medicare Advantage |
$196.20
|
| Rate for Payer: Cash Price |
$281.95
|
| Rate for Payer: Cash Price |
$281.95
|
| Rate for Payer: Cash Price |
$281.95
|
| Rate for Payer: Cofinity Commercial |
$246.71
|
| Rate for Payer: Cofinity Commercial |
$303.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$246.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$281.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$196.20
|
| Rate for Payer: Healthscope Commercial |
$317.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$246.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$264.33
|
| Rate for Payer: Mclaren Medicaid |
$105.16
|
| Rate for Payer: Mclaren Medicare |
$196.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$206.01
|
| Rate for Payer: Meridian Medicaid |
$110.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$225.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$299.57
|
| Rate for Payer: PACE Medicare |
$186.39
|
| Rate for Payer: PACE SWMI |
$196.20
|
| Rate for Payer: PHP Commercial |
$299.57
|
| Rate for Payer: PHP Medicare Advantage |
$196.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$105.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$229.09
|
| Rate for Payer: Priority Health Medicare |
$196.20
|
| Rate for Payer: Priority Health SBD |
$222.04
|
| Rate for Payer: Railroad Medicare Medicare |
$196.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$552.28
|
| Rate for Payer: UHC Core |
$294.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$196.20
|
| Rate for Payer: UHC Exchange |
$374.96
|
| Rate for Payer: UHC Medicare Advantage |
$196.20
|
| Rate for Payer: UHCCP Medicaid |
$105.16
|
| Rate for Payer: UMR Bronson Commercial |
$130.40
|
| Rate for Payer: VA VA |
$196.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$264.33
|
|
|
HC NONSTRESS TEST
|
Facility
|
IP
|
$352.44
|
|
|
Service Code
|
CPT 59025
|
| Hospital Charge Code |
92000004
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$155.07 |
| Max. Negotiated Rate |
$317.20 |
| Rate for Payer: Aetna American Axle |
$229.09
|
| Rate for Payer: Aetna Commercial |
$299.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$229.09
|
| Rate for Payer: Cash Price |
$281.95
|
| Rate for Payer: Cofinity Commercial |
$246.71
|
| Rate for Payer: Cofinity Commercial |
$303.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$246.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$281.95
|
| Rate for Payer: Healthscope Commercial |
$317.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$246.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$264.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$299.57
|
| Rate for Payer: PHP Commercial |
$299.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$229.09
|
| Rate for Payer: Priority Health SBD |
$222.04
|
| Rate for Payer: UMR Bronson Commercial |
$155.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$264.33
|
|
|
HC NON THROMBOLYTIC INTRACRANIAL EA ADDL VASCULAR TERRITORY
|
Facility
|
OP
|
$3,312.08
|
|
|
Service Code
|
CPT 61651
|
| Hospital Charge Code |
36100515
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,225.47 |
| Max. Negotiated Rate |
$2,980.87 |
| Rate for Payer: Aetna American Axle |
$2,152.85
|
| Rate for Payer: Aetna Commercial |
$2,815.27
|
| Rate for Payer: Aetna Medicare |
$1,656.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,152.85
|
| Rate for Payer: BCBS Complete |
$1,324.83
|
| Rate for Payer: Cash Price |
$2,649.66
|
| Rate for Payer: Cofinity Commercial |
$2,318.46
|
| Rate for Payer: Cofinity Commercial |
$2,848.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,318.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,649.66
|
| Rate for Payer: Healthscope Commercial |
$2,980.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,318.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,484.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,815.27
|
| Rate for Payer: PHP Commercial |
$2,815.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,152.85
|
| Rate for Payer: Priority Health SBD |
$2,086.61
|
| Rate for Payer: UMR Bronson Commercial |
$1,225.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,484.06
|
|
|
HC NON THROMBOLYTIC INTRACRANIAL EA ADDL VASCULAR TERRITORY
|
Facility
|
IP
|
$3,312.08
|
|
|
Service Code
|
CPT 61651
|
| Hospital Charge Code |
36100515
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,457.32 |
| Max. Negotiated Rate |
$2,980.87 |
| Rate for Payer: Aetna American Axle |
$2,152.85
|
| Rate for Payer: Aetna Commercial |
$2,815.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,152.85
|
| Rate for Payer: Cash Price |
$2,649.66
|
| Rate for Payer: Cofinity Commercial |
$2,318.46
|
| Rate for Payer: Cofinity Commercial |
$2,848.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,318.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,649.66
|
| Rate for Payer: Healthscope Commercial |
$2,980.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,318.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,484.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,815.27
|
| Rate for Payer: PHP Commercial |
$2,815.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,152.85
|
| Rate for Payer: Priority Health SBD |
$2,086.61
|
| Rate for Payer: UMR Bronson Commercial |
$1,457.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,484.06
|
|
|
HC NON THROMBOLYTIC INTRACRANIAL INITIAL VASCULAR TERRITORY
|
Facility
|
OP
|
$4,516.48
|
|
|
Service Code
|
CPT 61650
|
| Hospital Charge Code |
36100514
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,671.10 |
| Max. Negotiated Rate |
$4,064.83 |
| Rate for Payer: Aetna American Axle |
$2,935.71
|
| Rate for Payer: Aetna Commercial |
$3,839.01
|
| Rate for Payer: Aetna Medicare |
$2,258.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,935.71
|
| Rate for Payer: BCBS Complete |
$1,806.59
|
| Rate for Payer: Cash Price |
$3,613.18
|
| Rate for Payer: Cofinity Commercial |
$3,161.54
|
| Rate for Payer: Cofinity Commercial |
$3,884.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,161.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,613.18
|
| Rate for Payer: Healthscope Commercial |
$4,064.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,161.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,387.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,839.01
|
| Rate for Payer: PHP Commercial |
$3,839.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,935.71
|
| Rate for Payer: Priority Health SBD |
$2,845.38
|
| Rate for Payer: UMR Bronson Commercial |
$1,671.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,387.36
|
|
|
HC NON THROMBOLYTIC INTRACRANIAL INITIAL VASCULAR TERRITORY
|
Facility
|
IP
|
$4,516.48
|
|
|
Service Code
|
CPT 61650
|
| Hospital Charge Code |
36100514
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,987.25 |
| Max. Negotiated Rate |
$4,064.83 |
| Rate for Payer: Aetna American Axle |
$2,935.71
|
| Rate for Payer: Aetna Commercial |
$3,839.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,935.71
|
| Rate for Payer: Cash Price |
$3,613.18
|
| Rate for Payer: Cofinity Commercial |
$3,161.54
|
| Rate for Payer: Cofinity Commercial |
$3,884.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,161.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,613.18
|
| Rate for Payer: Healthscope Commercial |
$4,064.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,161.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,387.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,839.01
|
| Rate for Payer: PHP Commercial |
$3,839.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,935.71
|
| Rate for Payer: Priority Health SBD |
$2,845.38
|
| Rate for Payer: UMR Bronson Commercial |
$1,987.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,387.36
|
|
|
HC NORCLOZAPINE LEVEL
|
Facility
|
OP
|
$24.97
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100065
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.24 |
| Max. Negotiated Rate |
$52.47 |
| Rate for Payer: Aetna American Axle |
$16.23
|
| Rate for Payer: Aetna Commercial |
$21.22
|
| Rate for Payer: Aetna Medicare |
$19.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.30
|
| Rate for Payer: BCBS Complete |
$10.49
|
| Rate for Payer: BCBS MAPPO |
$18.64
|
| Rate for Payer: BCN Medicare Advantage |
$18.64
|
| Rate for Payer: Cash Price |
$19.98
|
| Rate for Payer: Cash Price |
$19.98
|
| Rate for Payer: Cofinity Commercial |
$21.47
|
| Rate for Payer: Cofinity Commercial |
$17.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.64
|
| Rate for Payer: Healthscope Commercial |
$22.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.73
|
| Rate for Payer: Mclaren Medicaid |
$9.99
|
| Rate for Payer: Mclaren Medicare |
$18.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.57
|
| Rate for Payer: Meridian Medicaid |
$10.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.22
|
| Rate for Payer: PACE Medicare |
$17.71
|
| Rate for Payer: PACE SWMI |
$18.64
|
| Rate for Payer: PHP Commercial |
$21.22
|
| Rate for Payer: PHP Medicare Advantage |
$18.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.23
|
| Rate for Payer: Priority Health Medicare |
$18.64
|
| Rate for Payer: Priority Health SBD |
$15.73
|
| Rate for Payer: Railroad Medicare Medicare |
$18.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.64
|
| Rate for Payer: UHC Exchange |
$35.62
|
| Rate for Payer: UHC Medicare Advantage |
$18.64
|
| Rate for Payer: UHCCP Medicaid |
$9.99
|
| Rate for Payer: UMR Bronson Commercial |
$9.24
|
| Rate for Payer: VA VA |
$18.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.73
|
|
|
HC NORCLOZAPINE LEVEL
|
Facility
|
IP
|
$24.97
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100065
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.99 |
| Max. Negotiated Rate |
$22.47 |
| Rate for Payer: Aetna American Axle |
$16.23
|
| Rate for Payer: Aetna Commercial |
$21.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.23
|
| Rate for Payer: Cash Price |
$19.98
|
| Rate for Payer: Cofinity Commercial |
$17.48
|
| Rate for Payer: Cofinity Commercial |
$21.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.98
|
| Rate for Payer: Healthscope Commercial |
$22.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.22
|
| Rate for Payer: PHP Commercial |
$21.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.23
|
| Rate for Payer: Priority Health SBD |
$15.73
|
| Rate for Payer: UMR Bronson Commercial |
$10.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.73
|
|
|
HC NORTRIPTYLINE LVL
|
Facility
|
IP
|
$43.86
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
30100592
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.30 |
| Max. Negotiated Rate |
$39.47 |
| Rate for Payer: Aetna American Axle |
$28.51
|
| Rate for Payer: Aetna Commercial |
$37.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.51
|
| Rate for Payer: Cash Price |
$35.09
|
| Rate for Payer: Cofinity Commercial |
$30.70
|
| Rate for Payer: Cofinity Commercial |
$37.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$30.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$39.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.28
|
| Rate for Payer: PHP Commercial |
$37.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.51
|
| Rate for Payer: Priority Health SBD |
$27.63
|
| Rate for Payer: UMR Bronson Commercial |
$19.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.90
|
|
|
HC NORTRIPTYLINE LVL
|
Facility
|
OP
|
$43.86
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
30100592
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.23 |
| Max. Negotiated Rate |
$39.47 |
| Rate for Payer: Aetna American Axle |
$28.51
|
| Rate for Payer: Aetna Commercial |
$37.28
|
| Rate for Payer: Aetna Medicare |
$21.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.51
|
| Rate for Payer: BCBS Complete |
$17.54
|
| Rate for Payer: Cash Price |
$35.09
|
| Rate for Payer: Cofinity Commercial |
$30.70
|
| Rate for Payer: Cofinity Commercial |
$37.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$30.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$39.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.28
|
| Rate for Payer: PHP Commercial |
$37.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.51
|
| Rate for Payer: Priority Health SBD |
$27.63
|
| Rate for Payer: UMR Bronson Commercial |
$16.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.90
|
|
|
HC NOSEBLEED/ENT
|
Facility
|
OP
|
$414.53
|
|
| Hospital Charge Code |
45000061
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$153.38 |
| Max. Negotiated Rate |
$373.08 |
| Rate for Payer: Aetna American Axle |
$269.44
|
| Rate for Payer: Aetna Commercial |
$352.35
|
| Rate for Payer: Aetna Medicare |
$207.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$269.44
|
| Rate for Payer: BCBS Complete |
$165.81
|
| Rate for Payer: Cash Price |
$331.62
|
| Rate for Payer: Cofinity Commercial |
$290.17
|
| Rate for Payer: Cofinity Commercial |
$356.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$290.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$331.62
|
| Rate for Payer: Healthscope Commercial |
$373.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$290.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$310.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$352.35
|
| Rate for Payer: PHP Commercial |
$352.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$269.44
|
| Rate for Payer: Priority Health SBD |
$261.15
|
| Rate for Payer: UMR Bronson Commercial |
$153.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$310.90
|
|
|
HC NOSEBLEED/ENT
|
Facility
|
IP
|
$414.53
|
|
| Hospital Charge Code |
45000061
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$182.39 |
| Max. Negotiated Rate |
$373.08 |
| Rate for Payer: Aetna American Axle |
$269.44
|
| Rate for Payer: Aetna Commercial |
$352.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$269.44
|
| Rate for Payer: Cash Price |
$331.62
|
| Rate for Payer: Cofinity Commercial |
$290.17
|
| Rate for Payer: Cofinity Commercial |
$356.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$290.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$331.62
|
| Rate for Payer: Healthscope Commercial |
$373.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$290.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$310.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$352.35
|
| Rate for Payer: PHP Commercial |
$352.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$269.44
|
| Rate for Payer: Priority Health SBD |
$261.15
|
| Rate for Payer: UMR Bronson Commercial |
$182.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$310.90
|
|
|
HC NUC MED STRESS TEST
|
Facility
|
OP
|
$948.26
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
48200005
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$162.78 |
| Max. Negotiated Rate |
$854.89 |
| Rate for Payer: Aetna American Axle |
$616.37
|
| Rate for Payer: Aetna Commercial |
$806.02
|
| Rate for Payer: Aetna Medicare |
$315.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$616.37
|
| 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 |
$758.61
|
| Rate for Payer: Cash Price |
$758.61
|
| Rate for Payer: Cash Price |
$758.61
|
| Rate for Payer: Cofinity Commercial |
$663.78
|
| Rate for Payer: Cofinity Commercial |
$815.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$663.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$758.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$303.70
|
| Rate for Payer: Healthscope Commercial |
$853.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$663.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$711.20
|
| 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 |
$806.02
|
| Rate for Payer: PACE Medicare |
$288.51
|
| Rate for Payer: PACE SWMI |
$303.70
|
| Rate for Payer: PHP Commercial |
$806.02
|
| 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 |
$616.37
|
| Rate for Payer: Priority Health Medicare |
$303.70
|
| Rate for Payer: Priority Health SBD |
$597.40
|
| Rate for Payer: Railroad Medicare Medicare |
$303.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$854.89
|
| Rate for Payer: UHC Core |
$457.00
|
| 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 |
$350.86
|
| Rate for Payer: VA VA |
$303.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$711.20
|
|
|
HC NUC MED STRESS TEST
|
Facility
|
IP
|
$948.26
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
48200005
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$417.23 |
| Max. Negotiated Rate |
$853.43 |
| Rate for Payer: Aetna American Axle |
$616.37
|
| Rate for Payer: Aetna Commercial |
$806.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$616.37
|
| Rate for Payer: Cash Price |
$758.61
|
| Rate for Payer: Cofinity Commercial |
$663.78
|
| Rate for Payer: Cofinity Commercial |
$815.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$663.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$758.61
|
| Rate for Payer: Healthscope Commercial |
$853.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$663.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$711.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$806.02
|
| Rate for Payer: PHP Commercial |
$806.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$616.37
|
| Rate for Payer: Priority Health SBD |
$597.40
|
| Rate for Payer: UMR Bronson Commercial |
$417.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$711.20
|
|
|
HC NURSEMAID ELBOW REDUCTION
|
Facility
|
OP
|
$215.97
|
|
|
Service Code
|
CPT 24640
|
| Hospital Charge Code |
45000008
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$79.91 |
| Max. Negotiated Rate |
$658.55 |
| Rate for Payer: Aetna American Axle |
$140.38
|
| Rate for Payer: Aetna Commercial |
$183.57
|
| Rate for Payer: Aetna Medicare |
$243.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$140.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$292.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$292.44
|
| Rate for Payer: BCBS Complete |
$131.67
|
| Rate for Payer: BCBS MAPPO |
$233.95
|
| Rate for Payer: BCN Medicare Advantage |
$233.95
|
| Rate for Payer: Cash Price |
$172.78
|
| Rate for Payer: Cash Price |
$172.78
|
| Rate for Payer: Cofinity Commercial |
$185.73
|
| Rate for Payer: Cofinity Commercial |
$151.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$151.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$233.95
|
| Rate for Payer: Healthscope Commercial |
$194.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$151.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$161.98
|
| Rate for Payer: Mclaren Medicaid |
$125.40
|
| Rate for Payer: Mclaren Medicare |
$233.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$245.65
|
| Rate for Payer: Meridian Medicaid |
$131.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$269.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.57
|
| Rate for Payer: PACE Medicare |
$222.25
|
| Rate for Payer: PACE SWMI |
$233.95
|
| Rate for Payer: PHP Commercial |
$183.57
|
| Rate for Payer: PHP Medicare Advantage |
$233.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.38
|
| Rate for Payer: Priority Health Medicare |
$233.95
|
| Rate for Payer: Priority Health SBD |
$136.06
|
| Rate for Payer: Railroad Medicare Medicare |
$233.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$658.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$233.95
|
| Rate for Payer: UHC Exchange |
$447.10
|
| Rate for Payer: UHC Medicare Advantage |
$233.95
|
| Rate for Payer: UHCCP Medicaid |
$125.40
|
| Rate for Payer: UMR Bronson Commercial |
$79.91
|
| Rate for Payer: VA VA |
$233.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$161.98
|
|
|
HC NURSEMAID ELBOW REDUCTION
|
Facility
|
IP
|
$215.97
|
|
|
Service Code
|
CPT 24640
|
| Hospital Charge Code |
45000008
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$95.03 |
| Max. Negotiated Rate |
$194.37 |
| Rate for Payer: Aetna American Axle |
$140.38
|
| Rate for Payer: Aetna Commercial |
$183.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$140.38
|
| Rate for Payer: Cash Price |
$172.78
|
| Rate for Payer: Cofinity Commercial |
$151.18
|
| Rate for Payer: Cofinity Commercial |
$185.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$151.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.78
|
| Rate for Payer: Healthscope Commercial |
$194.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$151.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$161.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.57
|
| Rate for Payer: PHP Commercial |
$183.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.38
|
| Rate for Payer: Priority Health SBD |
$136.06
|
| Rate for Payer: UMR Bronson Commercial |
$95.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$161.98
|
|
|
HC NUSHIELD (1.6 SQ CM DISC) PER SQ CM
|
Facility
|
IP
|
$616.44
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600153
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$271.23 |
| Max. Negotiated Rate |
$554.80 |
| Rate for Payer: Aetna American Axle |
$400.69
|
| Rate for Payer: Aetna Commercial |
$523.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$400.69
|
| Rate for Payer: Cash Price |
$493.15
|
| Rate for Payer: Cofinity Commercial |
$431.51
|
| Rate for Payer: Cofinity Commercial |
$530.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$431.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$493.15
|
| Rate for Payer: Healthscope Commercial |
$554.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$431.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$462.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$523.97
|
| Rate for Payer: PHP Commercial |
$523.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$400.69
|
| Rate for Payer: Priority Health SBD |
$388.36
|
| Rate for Payer: UMR Bronson Commercial |
$271.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$462.33
|
|
|
HC NUSHIELD (1.6 SQ CM DISC) PER SQ CM
|
Facility
|
OP
|
$616.44
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600153
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$228.08 |
| Max. Negotiated Rate |
$554.80 |
| Rate for Payer: Aetna American Axle |
$400.69
|
| Rate for Payer: Aetna Commercial |
$523.97
|
| Rate for Payer: Aetna Medicare |
$308.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$400.69
|
| Rate for Payer: BCBS Complete |
$246.58
|
| Rate for Payer: Cash Price |
$493.15
|
| Rate for Payer: Cofinity Commercial |
$431.51
|
| Rate for Payer: Cofinity Commercial |
$530.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$431.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$493.15
|
| Rate for Payer: Healthscope Commercial |
$554.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$431.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$462.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$523.97
|
| Rate for Payer: PHP Commercial |
$523.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$400.69
|
| Rate for Payer: Priority Health SBD |
$388.36
|
| Rate for Payer: UMR Bronson Commercial |
$228.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$462.33
|
|
|
HC NUSHIELD 2X3 PER SQ CM
|
Facility
|
OP
|
$328.97
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600154
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$121.72 |
| Max. Negotiated Rate |
$296.07 |
| Rate for Payer: Aetna American Axle |
$213.83
|
| Rate for Payer: Aetna Commercial |
$279.62
|
| Rate for Payer: Aetna Medicare |
$164.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$213.83
|
| Rate for Payer: BCBS Complete |
$131.59
|
| Rate for Payer: Cash Price |
$263.18
|
| Rate for Payer: Cofinity Commercial |
$230.28
|
| Rate for Payer: Cofinity Commercial |
$282.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$230.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.18
|
| Rate for Payer: Healthscope Commercial |
$296.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$230.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$246.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$279.62
|
| Rate for Payer: PHP Commercial |
$279.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.83
|
| Rate for Payer: Priority Health SBD |
$207.25
|
| Rate for Payer: UMR Bronson Commercial |
$121.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$246.73
|
|
|
HC NUSHIELD 2X3 PER SQ CM
|
Facility
|
IP
|
$328.97
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600154
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$144.75 |
| Max. Negotiated Rate |
$296.07 |
| Rate for Payer: Aetna American Axle |
$213.83
|
| Rate for Payer: Aetna Commercial |
$279.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$213.83
|
| Rate for Payer: Cash Price |
$263.18
|
| Rate for Payer: Cofinity Commercial |
$230.28
|
| Rate for Payer: Cofinity Commercial |
$282.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$230.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.18
|
| Rate for Payer: Healthscope Commercial |
$296.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$230.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$246.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$279.62
|
| Rate for Payer: PHP Commercial |
$279.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.83
|
| Rate for Payer: Priority Health SBD |
$207.25
|
| Rate for Payer: UMR Bronson Commercial |
$144.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$246.73
|
|
|
HC NUSHIELD 2X4 PER SQ CM
|
Facility
|
OP
|
$308.88
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600175
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$114.29 |
| Max. Negotiated Rate |
$277.99 |
| Rate for Payer: Aetna American Axle |
$200.77
|
| Rate for Payer: Aetna Commercial |
$262.55
|
| Rate for Payer: Aetna Medicare |
$154.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$200.77
|
| Rate for Payer: BCBS Complete |
$123.55
|
| Rate for Payer: Cash Price |
$247.10
|
| Rate for Payer: Cofinity Commercial |
$216.22
|
| Rate for Payer: Cofinity Commercial |
$265.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$216.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.10
|
| Rate for Payer: Healthscope Commercial |
$277.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$216.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$231.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$262.55
|
| Rate for Payer: PHP Commercial |
$262.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.77
|
| Rate for Payer: Priority Health SBD |
$194.59
|
| Rate for Payer: UMR Bronson Commercial |
$114.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$231.66
|
|
|
HC NUSHIELD 2X4 PER SQ CM
|
Facility
|
IP
|
$308.88
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600175
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$135.91 |
| Max. Negotiated Rate |
$277.99 |
| Rate for Payer: Aetna American Axle |
$200.77
|
| Rate for Payer: Aetna Commercial |
$262.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$200.77
|
| Rate for Payer: Cash Price |
$247.10
|
| Rate for Payer: Cofinity Commercial |
$216.22
|
| Rate for Payer: Cofinity Commercial |
$265.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$216.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.10
|
| Rate for Payer: Healthscope Commercial |
$277.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$216.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$231.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$262.55
|
| Rate for Payer: PHP Commercial |
$262.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.77
|
| Rate for Payer: Priority Health SBD |
$194.59
|
| Rate for Payer: UMR Bronson Commercial |
$135.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$231.66
|
|
|
HC NUSHIELD 3X4 PER SQ CM
|
Facility
|
IP
|
$298.03
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600176
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$131.13 |
| Max. Negotiated Rate |
$268.23 |
| Rate for Payer: Aetna American Axle |
$193.72
|
| Rate for Payer: Aetna Commercial |
$253.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$193.72
|
| Rate for Payer: Cash Price |
$238.42
|
| Rate for Payer: Cofinity Commercial |
$208.62
|
| Rate for Payer: Cofinity Commercial |
$256.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$208.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.42
|
| Rate for Payer: Healthscope Commercial |
$268.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$208.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$223.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$253.33
|
| Rate for Payer: PHP Commercial |
$253.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.72
|
| Rate for Payer: Priority Health SBD |
$187.76
|
| Rate for Payer: UMR Bronson Commercial |
$131.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$223.52
|
|
|
HC NUSHIELD 3X4 PER SQ CM
|
Facility
|
OP
|
$298.03
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600176
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$110.27 |
| Max. Negotiated Rate |
$268.23 |
| Rate for Payer: Aetna American Axle |
$193.72
|
| Rate for Payer: Aetna Commercial |
$253.33
|
| Rate for Payer: Aetna Medicare |
$149.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$193.72
|
| Rate for Payer: BCBS Complete |
$119.21
|
| Rate for Payer: Cash Price |
$238.42
|
| Rate for Payer: Cofinity Commercial |
$208.62
|
| Rate for Payer: Cofinity Commercial |
$256.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$208.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.42
|
| Rate for Payer: Healthscope Commercial |
$268.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$208.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$223.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$253.33
|
| Rate for Payer: PHP Commercial |
$253.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.72
|
| Rate for Payer: Priority Health SBD |
$187.76
|
| Rate for Payer: UMR Bronson Commercial |
$110.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$223.52
|
|
