|
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
|
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 |
$149.02
|
| 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
|
|
|
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 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 |
$208.48 |
| 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 |
$208.48
|
| 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 |
$208.48 |
| Rate for Payer: Aetna American Axle |
$150.57
|
| Rate for Payer: Aetna Commercial |
$196.90
|
| Rate for Payer: Aetna Medicare |
$115.82
|
| 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 |
$208.48
|
| 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
|
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 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 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 |
$71.96
|
| 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 |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$5.04
|
| Rate for Payer: BCN Commercial |
$5.04
|
| 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: Nomi Health Commercial |
$7.83
|
| 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 HMO/PPO/Tiered Network |
$5.37
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$4.30
|
| Rate for Payer: Priority Health SBD |
$16.00
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$5.22
|
| 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
|
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 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: 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 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 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 |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$5.04
|
| Rate for Payer: BCN Commercial |
$5.04
|
| 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: Nomi Health Commercial |
$7.83
|
| 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 HMO/PPO/Tiered Network |
$5.37
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$4.30
|
| Rate for Payer: Priority Health SBD |
$16.00
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$5.22
|
| 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 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 |
$11.71 |
| 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 |
$27.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.22
|
| Rate for Payer: BCBS Complete |
$21.68
|
| Rate for Payer: BCBS Trust/PPO |
$11.71
|
| Rate for Payer: BCN Commercial |
$11.71
|
| Rate for Payer: Cash Price |
$43.35
|
| 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
|
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 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 |
$1,631.04 |
| 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: BCBS Trust/PPO |
$1,631.04
|
| Rate for Payer: BCN Commercial |
$1,631.04
|
| Rate for Payer: Cash Price |
$25.54
|
| 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 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 |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$5.04
|
| Rate for Payer: BCN Commercial |
$5.04
|
| 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: Nomi Health Commercial |
$7.83
|
| 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 HMO/PPO/Tiered Network |
$5.37
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$4.30
|
| Rate for Payer: Priority Health SBD |
$16.00
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$5.22
|
| 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 |
$2,987.98
|
| 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 |
$2,987.98
|
|
