|
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: 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 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 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
|
IP
|
$137.02
|
|
| Hospital Charge Code |
76900005
|
|
Hospital Revenue Code
|
769
|
| Min. Negotiated Rate |
$60.29 |
| Max. Negotiated Rate |
$123.32 |
| Rate for Payer: Aetna American Axle |
$89.06
|
| Rate for Payer: Aetna Commercial |
$116.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.06
|
| 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 |
$102.76
|
| 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 |
$60.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$102.76
|
|
|
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 |
$102.76
|
| 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 |
$102.76
|
|
|
HC OBSERVATION PER HOUR
|
Facility
|
IP
|
$145.08
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200023
|
|
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 OBSERVATION PER HOUR
|
Facility
|
OP
|
$145.08
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200023
|
|
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 OBS OVERFLOW PER HR
|
Facility
|
OP
|
$137.02
|
|
| Hospital Charge Code |
76900002
|
|
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 |
$102.76
|
| 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 |
$102.76
|
|
|
HC OBS OVERFLOW PER HR
|
Facility
|
IP
|
$137.02
|
|
| Hospital Charge Code |
76900002
|
|
Hospital Revenue Code
|
769
|
| Min. Negotiated Rate |
$60.29 |
| Max. Negotiated Rate |
$123.32 |
| Rate for Payer: Aetna American Axle |
$89.06
|
| Rate for Payer: Aetna Commercial |
$116.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.06
|
| 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 |
$102.76
|
| 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 |
$60.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$102.76
|
|
|
HC OB SURGERY ADDL 15 MIN
|
Facility
|
IP
|
$274.02
|
|
| Hospital Charge Code |
36000104
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$120.57 |
| Max. Negotiated Rate |
$246.62 |
| Rate for Payer: Aetna American Axle |
$178.11
|
| Rate for Payer: Aetna Commercial |
$232.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.11
|
| Rate for Payer: Cash Price |
$219.22
|
| Rate for Payer: Cofinity Commercial |
$191.81
|
| Rate for Payer: Cofinity Commercial |
$235.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$191.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.22
|
| Rate for Payer: Healthscope Commercial |
$246.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$191.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$205.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$232.92
|
| Rate for Payer: PHP Commercial |
$232.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.11
|
| Rate for Payer: Priority Health SBD |
$172.63
|
| Rate for Payer: UMR Bronson Commercial |
$120.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$205.52
|
|
|
HC OB SURGERY ADDL 15 MIN
|
Facility
|
OP
|
$274.02
|
|
| Hospital Charge Code |
36000104
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$101.39 |
| Max. Negotiated Rate |
$246.62 |
| Rate for Payer: Aetna American Axle |
$178.11
|
| Rate for Payer: Aetna Commercial |
$232.92
|
| Rate for Payer: Aetna Medicare |
$137.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.11
|
| Rate for Payer: BCBS Complete |
$109.61
|
| Rate for Payer: Cash Price |
$219.22
|
| Rate for Payer: Cofinity Commercial |
$191.81
|
| Rate for Payer: Cofinity Commercial |
$235.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$191.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.22
|
| Rate for Payer: Healthscope Commercial |
$246.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$191.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$205.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$232.92
|
| Rate for Payer: PHP Commercial |
$232.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.11
|
| Rate for Payer: Priority Health SBD |
$172.63
|
| Rate for Payer: UMR Bronson Commercial |
$101.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$205.52
|
|
|
HC OB SURGERY INITIAL 30 MIN
|
Facility
|
OP
|
$1,453.56
|
|
| Hospital Charge Code |
36000077
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$537.82 |
| Max. Negotiated Rate |
$1,308.20 |
| Rate for Payer: Aetna American Axle |
$944.81
|
| Rate for Payer: Aetna Commercial |
$1,235.53
|
| Rate for Payer: Aetna Medicare |
$726.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$944.81
|
| Rate for Payer: BCBS Complete |
$581.42
|
| Rate for Payer: Cash Price |
$1,162.85
|
| Rate for Payer: Cofinity Commercial |
$1,017.49
|
| Rate for Payer: Cofinity Commercial |
$1,250.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,017.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,162.85
|
| Rate for Payer: Healthscope Commercial |
$1,308.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,017.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,090.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,235.53
|
| Rate for Payer: PHP Commercial |
$1,235.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$944.81
|
| Rate for Payer: Priority Health SBD |
$915.74
|
| Rate for Payer: UMR Bronson Commercial |
$537.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,090.17
|
|
|
HC OB SURGERY INITIAL 30 MIN
|
Facility
|
IP
|
$1,453.56
|
|
| Hospital Charge Code |
36000077
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$639.57 |
| Max. Negotiated Rate |
$1,308.20 |
| Rate for Payer: Aetna American Axle |
$944.81
|
| Rate for Payer: Aetna Commercial |
$1,235.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$944.81
|
| Rate for Payer: Cash Price |
$1,162.85
|
| Rate for Payer: Cofinity Commercial |
$1,017.49
|
| Rate for Payer: Cofinity Commercial |
$1,250.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,017.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,162.85
|
| Rate for Payer: Healthscope Commercial |
$1,308.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,017.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,090.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,235.53
|
| Rate for Payer: PHP Commercial |
$1,235.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$944.81
|
| Rate for Payer: Priority Health SBD |
$915.74
|
| Rate for Payer: UMR Bronson Commercial |
$639.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,090.17
|
|
|
HC OB VAC DEL KIT DISP (OB)
|
Facility
|
OP
|
$257.77
|
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$95.37 |
| Max. Negotiated Rate |
$231.99 |
| Rate for Payer: Aetna American Axle |
$167.55
|
| Rate for Payer: Aetna Commercial |
$219.10
|
| Rate for Payer: Aetna Medicare |
$128.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.55
|
| Rate for Payer: BCBS Complete |
$103.11
|
| Rate for Payer: Cash Price |
$206.22
|
| Rate for Payer: Cofinity Commercial |
$180.44
|
| Rate for Payer: Cofinity Commercial |
$221.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$180.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.22
|
| Rate for Payer: Healthscope Commercial |
$231.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$180.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$193.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.10
|
| Rate for Payer: PHP Commercial |
$219.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.55
|
| Rate for Payer: Priority Health SBD |
$162.40
|
| Rate for Payer: UMR Bronson Commercial |
$95.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$193.33
|
|
|
HC OB VAC DEL KIT DISP (OB)
|
Facility
|
IP
|
$257.77
|
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$113.42 |
| Max. Negotiated Rate |
$231.99 |
| Rate for Payer: Aetna American Axle |
$167.55
|
| Rate for Payer: Aetna Commercial |
$219.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.55
|
| Rate for Payer: Cash Price |
$206.22
|
| Rate for Payer: Cofinity Commercial |
$180.44
|
| Rate for Payer: Cofinity Commercial |
$221.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$180.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.22
|
| Rate for Payer: Healthscope Commercial |
$231.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$180.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$193.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.10
|
| Rate for Payer: PHP Commercial |
$219.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.55
|
| Rate for Payer: Priority Health SBD |
$162.40
|
| Rate for Payer: UMR Bronson Commercial |
$113.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$193.33
|
|
|
HC OCCLUSION CATH
|
Facility
|
OP
|
$4,754.63
|
|
|
Service Code
|
HCPCS C2628
|
| Hospital Charge Code |
27200344
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,759.21 |
| Max. Negotiated Rate |
$4,279.17 |
| Rate for Payer: Aetna American Axle |
$3,090.51
|
| Rate for Payer: Aetna Commercial |
$4,041.44
|
| Rate for Payer: Aetna Medicare |
$2,377.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,090.51
|
| Rate for Payer: BCBS Complete |
$1,901.85
|
| Rate for Payer: Cash Price |
$3,803.70
|
| Rate for Payer: Cofinity Commercial |
$3,328.24
|
| Rate for Payer: Cofinity Commercial |
$4,088.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,328.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,803.70
|
| Rate for Payer: Healthscope Commercial |
$4,279.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,328.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,565.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,041.44
|
| Rate for Payer: PHP Commercial |
$4,041.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,090.51
|
| Rate for Payer: Priority Health SBD |
$2,995.42
|
| Rate for Payer: UMR Bronson Commercial |
$1,759.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,565.97
|
|
|
HC OCCLUSION CATH
|
Facility
|
IP
|
$4,754.63
|
|
|
Service Code
|
HCPCS C2628
|
| Hospital Charge Code |
27200344
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,092.04 |
| Max. Negotiated Rate |
$4,279.17 |
| Rate for Payer: Aetna American Axle |
$3,090.51
|
| Rate for Payer: Aetna Commercial |
$4,041.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,090.51
|
| Rate for Payer: Cash Price |
$3,803.70
|
| Rate for Payer: Cofinity Commercial |
$3,328.24
|
| Rate for Payer: Cofinity Commercial |
$4,088.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,328.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,803.70
|
| Rate for Payer: Healthscope Commercial |
$4,279.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,328.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,565.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,041.44
|
| Rate for Payer: PHP Commercial |
$4,041.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,090.51
|
| Rate for Payer: Priority Health SBD |
$2,995.42
|
| Rate for Payer: UMR Bronson Commercial |
$2,092.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,565.97
|
|
|
HC OCCULT BLOOD OTHER SOURCES
|
Facility
|
OP
|
$30.70
|
|
|
Service Code
|
CPT 82271
|
| Hospital Charge Code |
30100122
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.85 |
| Max. Negotiated Rate |
$184.20 |
| Rate for Payer: UHC Dual Complete DSNP |
$5.32
|
| Rate for Payer: UHC Exchange |
$5.32
|
| Rate for Payer: UHC Medicare Advantage |
$5.32
|
| Rate for Payer: UHCCP Medicaid |
$2.85
|
| Rate for Payer: UMR Bronson Commercial |
$11.36
|
| Rate for Payer: VA VA |
$5.32
|
| Rate for Payer: Aetna American Axle |
$19.96
|
| Rate for Payer: Aetna Commercial |
$26.10
|
| Rate for Payer: Aetna Medicare |
$5.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.65
|
| Rate for Payer: BCBS Complete |
$2.99
|
| Rate for Payer: BCBS MAPPO |
$5.32
|
| Rate for Payer: BCBS Trust/PPO |
$5.13
|
| Rate for Payer: BCN Commercial |
$5.13
|
| Rate for Payer: BCN Medicare Advantage |
$5.32
|
| Rate for Payer: Cash Price |
$24.56
|
| Rate for Payer: Cash Price |
$24.56
|
| Rate for Payer: Cofinity Commercial |
$26.40
|
| Rate for Payer: Cofinity Commercial |
$21.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.32
|
| Rate for Payer: Healthscope Commercial |
$27.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.02
|
| Rate for Payer: Mclaren Medicaid |
$2.85
|
| Rate for Payer: Mclaren Medicare |
$5.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.59
|
| Rate for Payer: Meridian Medicaid |
$2.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.10
|
| Rate for Payer: Nomi Health Commercial |
$7.98
|
| Rate for Payer: PACE Medicare |
$5.05
|
| Rate for Payer: PACE SWMI |
$5.32
|
| Rate for Payer: PHP Commercial |
$26.10
|
| Rate for Payer: PHP Medicare Advantage |
$5.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.32
|
| Rate for Payer: Priority Health Medicare |
$5.32
|
| Rate for Payer: Priority Health Narrow Network |
$4.26
|
| Rate for Payer: Priority Health SBD |
$19.34
|
| Rate for Payer: Railroad Medicare Medicare |
$5.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.38
|
| Rate for Payer: UHC Core |
$184.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.02
|
|
|
HC OCCULT BLOOD OTHER SOURCES
|
Facility
|
IP
|
$30.70
|
|
|
Service Code
|
CPT 82271
|
| Hospital Charge Code |
30100122
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.51 |
| Max. Negotiated Rate |
$27.63 |
| Rate for Payer: Aetna American Axle |
$19.96
|
| Rate for Payer: Aetna Commercial |
$26.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.96
|
| Rate for Payer: Cash Price |
$24.56
|
| Rate for Payer: Cofinity Commercial |
$21.49
|
| Rate for Payer: Cofinity Commercial |
$26.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.56
|
| Rate for Payer: Healthscope Commercial |
$27.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.10
|
| Rate for Payer: PHP Commercial |
$26.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.96
|
| Rate for Payer: Priority Health SBD |
$19.34
|
| Rate for Payer: UMR Bronson Commercial |
$13.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.02
|
|
|
HC OCT CATHETER
|
Facility
|
IP
|
$2,580.29
|
|
|
Service Code
|
HCPCS C1753
|
| Hospital Charge Code |
27200243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,135.33 |
| Max. Negotiated Rate |
$2,322.26 |
| Rate for Payer: Aetna American Axle |
$1,677.19
|
| Rate for Payer: Aetna Commercial |
$2,193.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,677.19
|
| Rate for Payer: Cash Price |
$2,064.23
|
| Rate for Payer: Cofinity Commercial |
$1,806.20
|
| Rate for Payer: Cofinity Commercial |
$2,219.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,806.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,064.23
|
| Rate for Payer: Healthscope Commercial |
$2,322.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,806.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,935.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,193.25
|
| Rate for Payer: PHP Commercial |
$2,193.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,677.19
|
| Rate for Payer: Priority Health SBD |
$1,625.58
|
| Rate for Payer: UMR Bronson Commercial |
$1,135.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,935.22
|
|
|
HC OCT CATHETER
|
Facility
|
OP
|
$2,580.29
|
|
|
Service Code
|
HCPCS C1753
|
| Hospital Charge Code |
27200243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$954.71 |
| Max. Negotiated Rate |
$2,322.26 |
| Rate for Payer: Aetna American Axle |
$1,677.19
|
| Rate for Payer: Aetna Commercial |
$2,193.25
|
| Rate for Payer: Aetna Medicare |
$1,290.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,677.19
|
| Rate for Payer: BCBS Complete |
$1,032.12
|
| Rate for Payer: Cash Price |
$2,064.23
|
| Rate for Payer: Cofinity Commercial |
$1,806.20
|
| Rate for Payer: Cofinity Commercial |
$2,219.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,806.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,064.23
|
| Rate for Payer: Healthscope Commercial |
$2,322.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,806.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,935.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,193.25
|
| Rate for Payer: PHP Commercial |
$2,193.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,677.19
|
| Rate for Payer: Priority Health SBD |
$1,625.58
|
| Rate for Payer: UMR Bronson Commercial |
$954.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,935.22
|
|
|
HC OCTOPUS SET CARDIOPLEGIA
|
Facility
|
OP
|
$45.90
|
|
| Hospital Charge Code |
27000106
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.98 |
| Max. Negotiated Rate |
$41.31 |
| Rate for Payer: Aetna American Axle |
$29.84
|
| Rate for Payer: Aetna Commercial |
$39.02
|
| Rate for Payer: Aetna Medicare |
$22.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.84
|
| Rate for Payer: BCBS Complete |
$18.36
|
| Rate for Payer: Cash Price |
$36.72
|
| Rate for Payer: Cofinity Commercial |
$32.13
|
| Rate for Payer: Cofinity Commercial |
$39.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$32.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.72
|
| Rate for Payer: Healthscope Commercial |
$41.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.02
|
| Rate for Payer: PHP Commercial |
$39.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.84
|
| Rate for Payer: Priority Health SBD |
$28.92
|
| Rate for Payer: UMR Bronson Commercial |
$16.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.42
|
|
|
HC OCTOPUS SET CARDIOPLEGIA
|
Facility
|
IP
|
$45.90
|
|
| Hospital Charge Code |
27000106
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$20.20 |
| Max. Negotiated Rate |
$41.31 |
| Rate for Payer: Aetna American Axle |
$29.84
|
| Rate for Payer: Aetna Commercial |
$39.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.84
|
| Rate for Payer: Cash Price |
$36.72
|
| Rate for Payer: Cofinity Commercial |
$32.13
|
| Rate for Payer: Cofinity Commercial |
$39.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$32.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.72
|
| Rate for Payer: Healthscope Commercial |
$41.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.02
|
| Rate for Payer: PHP Commercial |
$39.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.84
|
| Rate for Payer: Priority Health SBD |
$28.92
|
| Rate for Payer: UMR Bronson Commercial |
$20.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.42
|
|
|
HC OCULAR INSTRMNT SCREEN BILAT
|
Facility
|
IP
|
$52.02
|
|
|
Service Code
|
CPT 99174
|
| Hospital Charge Code |
51000105
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$22.89 |
| Max. Negotiated Rate |
$46.82 |
| Rate for Payer: Aetna American Axle |
$33.81
|
| Rate for Payer: Aetna Commercial |
$44.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.81
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$36.41
|
| Rate for Payer: Cofinity Commercial |
$44.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$36.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Healthscope Commercial |
$46.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$36.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: PHP Commercial |
$44.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: Priority Health SBD |
$32.77
|
| Rate for Payer: UMR Bronson Commercial |
$22.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.02
|
|
|
HC OCULAR INSTRMNT SCREEN BILAT
|
Facility
|
OP
|
$52.02
|
|
|
Service Code
|
CPT 99174
|
| Hospital Charge Code |
51000105
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$19.25 |
| Max. Negotiated Rate |
$46.82 |
| Rate for Payer: Aetna American Axle |
$33.81
|
| Rate for Payer: Aetna Commercial |
$44.22
|
| Rate for Payer: Aetna Medicare |
$26.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.81
|
| Rate for Payer: BCBS Complete |
$20.81
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$36.41
|
| Rate for Payer: Cofinity Commercial |
$44.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$36.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Healthscope Commercial |
$46.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$36.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: PHP Commercial |
$44.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: Priority Health SBD |
$32.77
|
| Rate for Payer: UMR Bronson Commercial |
$19.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.02
|
|
