|
HC NUSHIELD 4X4 PER SQ CM
|
Facility
|
IP
|
$231.65
|
|
|
Service Code
|
CPT Q4160
|
| Hospital Charge Code |
63600177
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$101.93 |
| Max. Negotiated Rate |
$208.49 |
| Rate for Payer: Aetna American Axle |
$150.57
|
| Rate for Payer: Aetna Commercial |
$196.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$150.57
|
| Rate for Payer: Cash Price |
$185.32
|
| Rate for Payer: Cofinity Commercial |
$162.16
|
| Rate for Payer: Cofinity Commercial |
$199.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$162.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$185.32
|
| Rate for Payer: Healthscope Commercial |
$208.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$162.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$173.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$196.90
|
| Rate for Payer: PHP Commercial |
$196.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.57
|
| Rate for Payer: Priority Health SBD |
$145.94
|
| Rate for Payer: UMR Bronson Commercial |
$101.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$173.74
|
|
|
HC NUSHIELD 4X4 PER SQ CM
|
Facility
|
OP
|
$231.65
|
|
|
Service Code
|
CPT Q4160
|
| Hospital Charge Code |
63600177
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$85.71 |
| Max. Negotiated Rate |
$208.49 |
| Rate for Payer: Aetna American Axle |
$150.57
|
| Rate for Payer: Aetna Commercial |
$196.90
|
| Rate for Payer: Aetna Medicare |
$115.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$150.57
|
| Rate for Payer: BCBS Complete |
$92.66
|
| Rate for Payer: Cash Price |
$185.32
|
| Rate for Payer: Cofinity Commercial |
$162.16
|
| Rate for Payer: Cofinity Commercial |
$199.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$162.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$185.32
|
| Rate for Payer: Healthscope Commercial |
$208.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$162.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$173.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$196.90
|
| Rate for Payer: PHP Commercial |
$196.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.57
|
| Rate for Payer: Priority Health SBD |
$145.94
|
| Rate for Payer: UMR Bronson Commercial |
$85.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$173.74
|
|
|
HC NUSHIELD 4X6 PER SQ CM
|
Facility
|
IP
|
$162.57
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600178
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$71.53 |
| Max. Negotiated Rate |
$146.31 |
| Rate for Payer: Aetna American Axle |
$105.67
|
| Rate for Payer: Aetna Commercial |
$138.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.67
|
| Rate for Payer: Cash Price |
$130.06
|
| Rate for Payer: Cofinity Commercial |
$113.80
|
| Rate for Payer: Cofinity Commercial |
$139.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$113.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.06
|
| Rate for Payer: Healthscope Commercial |
$146.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$113.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$121.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$138.18
|
| Rate for Payer: PHP Commercial |
$138.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.67
|
| Rate for Payer: Priority Health SBD |
$102.42
|
| Rate for Payer: UMR Bronson Commercial |
$71.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$121.93
|
|
|
HC NUSHIELD 4X6 PER SQ CM
|
Facility
|
OP
|
$162.57
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600178
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$60.15 |
| Max. Negotiated Rate |
$146.31 |
| Rate for Payer: Aetna American Axle |
$105.67
|
| Rate for Payer: Aetna Commercial |
$138.18
|
| Rate for Payer: Aetna Medicare |
$81.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.67
|
| Rate for Payer: BCBS Complete |
$65.03
|
| Rate for Payer: Cash Price |
$130.06
|
| Rate for Payer: Cofinity Commercial |
$113.80
|
| Rate for Payer: Cofinity Commercial |
$139.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$113.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.06
|
| Rate for Payer: Healthscope Commercial |
$146.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$113.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$121.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$138.18
|
| Rate for Payer: PHP Commercial |
$138.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.67
|
| Rate for Payer: Priority Health SBD |
$102.42
|
| Rate for Payer: UMR Bronson Commercial |
$60.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$121.93
|
|
|
HC NUSHIELD 6X6 PER SQ CM
|
Facility
|
OP
|
$143.93
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600166
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$53.25 |
| Max. Negotiated Rate |
$129.54 |
| Rate for Payer: Aetna American Axle |
$93.55
|
| Rate for Payer: Aetna Commercial |
$122.34
|
| Rate for Payer: Aetna Medicare |
$71.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.55
|
| Rate for Payer: BCBS Complete |
$57.57
|
| Rate for Payer: Cash Price |
$115.14
|
| Rate for Payer: Cofinity Commercial |
$100.75
|
| Rate for Payer: Cofinity Commercial |
$123.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$100.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.14
|
| Rate for Payer: Healthscope Commercial |
$129.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$100.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$107.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$122.34
|
| Rate for Payer: PHP Commercial |
$122.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.55
|
| Rate for Payer: Priority Health SBD |
$90.68
|
| Rate for Payer: UMR Bronson Commercial |
$53.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.95
|
|
|
HC NUSHIELD 6X6 PER SQ CM
|
Facility
|
IP
|
$143.93
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600166
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$63.33 |
| Max. Negotiated Rate |
$129.54 |
| Rate for Payer: Aetna American Axle |
$93.55
|
| Rate for Payer: Aetna Commercial |
$122.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.55
|
| Rate for Payer: Cash Price |
$115.14
|
| Rate for Payer: Cofinity Commercial |
$100.75
|
| Rate for Payer: Cofinity Commercial |
$123.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$100.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.14
|
| Rate for Payer: Healthscope Commercial |
$129.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$100.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$107.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$122.34
|
| Rate for Payer: PHP Commercial |
$122.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.55
|
| Rate for Payer: Priority Health SBD |
$90.68
|
| Rate for Payer: UMR Bronson Commercial |
$63.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.95
|
|
|
HC NUT ALLERGEN PANEL
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200123
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.17 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna American Axle |
$16.50
|
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health SBD |
$16.00
|
| Rate for Payer: UMR Bronson Commercial |
$11.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.04
|
|
|
HC NUT ALLERGEN PANEL
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200123
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna American Axle |
$16.50
|
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.04
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$16.00
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$9.98
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.80
|
| Rate for Payer: UMR Bronson Commercial |
$9.39
|
| Rate for Payer: VA VA |
$5.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.04
|
|
|
HC NVU OBSERVATION PER HOUR
|
Facility
|
OP
|
$145.08
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200004
|
|
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 NVU OBSERVATION PER HOUR
|
Facility
|
IP
|
$145.08
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200004
|
|
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 OAK IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200050
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna American Axle |
$16.50
|
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.04
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$16.00
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$9.98
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.80
|
| Rate for Payer: UMR Bronson Commercial |
$9.39
|
| Rate for Payer: VA VA |
$5.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.04
|
|
|
HC OAK IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200050
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.17 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna American Axle |
$16.50
|
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health SBD |
$16.00
|
| Rate for Payer: UMR Bronson Commercial |
$11.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.04
|
|
|
HC OASIS ULTRA TRI LAYER WD MATRIX PER SQ CM
|
Facility
|
IP
|
$54.19
|
|
|
Service Code
|
HCPCS Q4124
|
| Hospital Charge Code |
63600059
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.84 |
| Max. Negotiated Rate |
$48.77 |
| Rate for Payer: Aetna American Axle |
$35.22
|
| Rate for Payer: Aetna Commercial |
$46.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.22
|
| Rate for Payer: Cash Price |
$43.35
|
| Rate for Payer: Cofinity Commercial |
$37.93
|
| Rate for Payer: Cofinity Commercial |
$46.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.35
|
| Rate for Payer: Healthscope Commercial |
$48.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.06
|
| Rate for Payer: PHP Commercial |
$46.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.22
|
| Rate for Payer: Priority Health SBD |
$34.14
|
| Rate for Payer: UMR Bronson Commercial |
$23.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.64
|
|
|
HC OASIS ULTRA TRI LAYER WD MATRIX PER SQ CM
|
Facility
|
OP
|
$54.19
|
|
|
Service Code
|
HCPCS Q4124
|
| Hospital Charge Code |
63600059
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.05 |
| Max. Negotiated Rate |
$48.77 |
| Rate for Payer: Aetna American Axle |
$35.22
|
| Rate for Payer: Aetna Commercial |
$46.06
|
| Rate for Payer: Aetna Medicare |
$27.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.22
|
| Rate for Payer: BCBS Complete |
$21.68
|
| Rate for Payer: Cash Price |
$43.35
|
| Rate for Payer: Cofinity Commercial |
$37.93
|
| Rate for Payer: Cofinity Commercial |
$46.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.35
|
| Rate for Payer: Healthscope Commercial |
$48.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.06
|
| Rate for Payer: PHP Commercial |
$46.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.22
|
| Rate for Payer: Priority Health SBD |
$34.14
|
| Rate for Payer: UMR Bronson Commercial |
$20.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.64
|
|
|
HC OASIS WD MATRIX PER SQ CM
|
Facility
|
OP
|
$31.92
|
|
|
Service Code
|
HCPCS Q4102
|
| Hospital Charge Code |
63600050
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.81 |
| Max. Negotiated Rate |
$28.73 |
| Rate for Payer: Aetna American Axle |
$20.75
|
| Rate for Payer: Aetna Commercial |
$27.13
|
| Rate for Payer: Aetna Medicare |
$15.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.75
|
| Rate for Payer: BCBS Complete |
$12.77
|
| Rate for Payer: Cash Price |
$25.54
|
| Rate for Payer: Cofinity Commercial |
$22.34
|
| Rate for Payer: Cofinity Commercial |
$27.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.54
|
| Rate for Payer: Healthscope Commercial |
$28.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.13
|
| Rate for Payer: PHP Commercial |
$27.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.75
|
| Rate for Payer: Priority Health SBD |
$20.11
|
| Rate for Payer: UMR Bronson Commercial |
$11.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.94
|
|
|
HC OASIS WD MATRIX PER SQ CM
|
Facility
|
IP
|
$31.92
|
|
|
Service Code
|
HCPCS Q4102
|
| Hospital Charge Code |
63600050
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.04 |
| Max. Negotiated Rate |
$28.73 |
| Rate for Payer: Aetna American Axle |
$20.75
|
| Rate for Payer: Aetna Commercial |
$27.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.75
|
| Rate for Payer: Cash Price |
$25.54
|
| Rate for Payer: Cofinity Commercial |
$22.34
|
| Rate for Payer: Cofinity Commercial |
$27.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.54
|
| Rate for Payer: Healthscope Commercial |
$28.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.13
|
| Rate for Payer: PHP Commercial |
$27.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.75
|
| Rate for Payer: Priority Health SBD |
$20.11
|
| Rate for Payer: UMR Bronson Commercial |
$14.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.94
|
|
|
HC OAT IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200051
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.17 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna American Axle |
$16.50
|
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health SBD |
$16.00
|
| Rate for Payer: UMR Bronson Commercial |
$11.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.04
|
|
|
HC OAT IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200051
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna American Axle |
$16.50
|
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.04
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$16.00
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$9.98
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.80
|
| Rate for Payer: UMR Bronson Commercial |
$9.39
|
| Rate for Payer: VA VA |
$5.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.04
|
|
|
HC OB ANTEPARTUM R&B
|
Facility
|
IP
|
$3,634.61
|
|
| Hospital Charge Code |
20000003
|
|
Hospital Revenue Code
|
110
|
| Min. Negotiated Rate |
$1,599.23 |
| Max. Negotiated Rate |
$3,271.15 |
| Rate for Payer: Aetna American Axle |
$2,362.50
|
| Rate for Payer: Aetna Commercial |
$3,089.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,362.50
|
| Rate for Payer: Cash Price |
$2,907.69
|
| Rate for Payer: Cofinity Commercial |
$2,544.23
|
| Rate for Payer: Cofinity Commercial |
$3,125.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,544.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,907.69
|
| Rate for Payer: Healthscope Commercial |
$3,271.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,544.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,725.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,089.42
|
| Rate for Payer: PHP Commercial |
$3,089.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,362.50
|
| Rate for Payer: Priority Health SBD |
$2,289.80
|
| Rate for Payer: UMR Bronson Commercial |
$1,599.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,725.96
|
|
|
HC OB DELIVERY R&B
|
Facility
|
IP
|
$1,810.72
|
|
| Hospital Charge Code |
11200001
|
|
Hospital Revenue Code
|
112
|
| Min. Negotiated Rate |
$796.72 |
| Max. Negotiated Rate |
$1,629.65 |
| Rate for Payer: Aetna American Axle |
$1,176.97
|
| Rate for Payer: Aetna Commercial |
$1,539.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,176.97
|
| Rate for Payer: Cash Price |
$1,448.58
|
| Rate for Payer: Cofinity Commercial |
$1,267.50
|
| Rate for Payer: Cofinity Commercial |
$1,557.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,267.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,448.58
|
| Rate for Payer: Healthscope Commercial |
$1,629.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,267.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,358.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,539.11
|
| Rate for Payer: PHP Commercial |
$1,539.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,176.97
|
| Rate for Payer: Priority Health SBD |
$1,140.75
|
| Rate for Payer: UMR Bronson Commercial |
$796.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,358.04
|
|
|
HC OB HIGH RISK R&B
|
Facility
|
IP
|
$3,983.98
|
|
| Hospital Charge Code |
20000004
|
|
Hospital Revenue Code
|
110
|
| Min. Negotiated Rate |
$1,752.95 |
| Max. Negotiated Rate |
$3,585.58 |
| Rate for Payer: Aetna American Axle |
$2,589.59
|
| Rate for Payer: Aetna Commercial |
$3,386.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,589.59
|
| Rate for Payer: Cash Price |
$3,187.18
|
| Rate for Payer: Cofinity Commercial |
$2,788.79
|
| Rate for Payer: Cofinity Commercial |
$3,426.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,788.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,187.18
|
| Rate for Payer: Healthscope Commercial |
$3,585.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,788.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,987.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,386.38
|
| Rate for Payer: PHP Commercial |
$3,386.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,589.59
|
| Rate for Payer: Priority Health SBD |
$2,509.91
|
| Rate for Payer: UMR Bronson Commercial |
$1,752.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,987.99
|
|
|
HC OB MED OBSERVATION PER HOUR
|
Facility
|
IP
|
$145.08
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200012
|
|
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 OB MED OBSERVATION PER HOUR
|
Facility
|
OP
|
$145.08
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200012
|
|
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 OB POSTPARTUM R&B
|
Facility
|
IP
|
$2,560.29
|
|
| Hospital Charge Code |
11200002
|
|
Hospital Revenue Code
|
112
|
| Min. Negotiated Rate |
$1,126.53 |
| Max. Negotiated Rate |
$2,304.26 |
| Rate for Payer: Aetna American Axle |
$1,664.19
|
| Rate for Payer: Aetna Commercial |
$2,176.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,664.19
|
| Rate for Payer: Cash Price |
$2,048.23
|
| Rate for Payer: Cofinity Commercial |
$1,792.20
|
| Rate for Payer: Cofinity Commercial |
$2,201.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,792.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,048.23
|
| Rate for Payer: Healthscope Commercial |
$2,304.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,792.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,920.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,176.25
|
| Rate for Payer: PHP Commercial |
$2,176.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,664.19
|
| Rate for Payer: Priority Health SBD |
$1,612.98
|
| Rate for Payer: UMR Bronson Commercial |
$1,126.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,920.22
|
|
|
HC OBSERVATION OVERFLOW PER HOUR
|
Facility
|
OP
|
$137.02
|
|
| Hospital Charge Code |
76900005
|
|
Hospital Revenue Code
|
769
|
| Min. Negotiated Rate |
$50.70 |
| Max. Negotiated Rate |
$123.32 |
| Rate for Payer: Aetna American Axle |
$89.06
|
| Rate for Payer: Aetna Commercial |
$116.47
|
| Rate for Payer: Aetna Medicare |
$68.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.06
|
| Rate for Payer: BCBS Complete |
$54.81
|
| Rate for Payer: Cash Price |
$109.62
|
| Rate for Payer: Cofinity Commercial |
$117.84
|
| Rate for Payer: Cofinity Commercial |
$95.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$95.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.62
|
| Rate for Payer: Healthscope Commercial |
$123.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$95.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$102.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.47
|
| Rate for Payer: PHP Commercial |
$116.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.06
|
| Rate for Payer: Priority Health SBD |
$86.32
|
| Rate for Payer: UMR Bronson Commercial |
$50.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$102.77
|
|
