|
HC POUCH WOUND 6 X 4
|
Facility
|
IP
|
$57.86
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000621
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$25.46 |
| Max. Negotiated Rate |
$52.07 |
| Rate for Payer: Aetna American Axle |
$37.61
|
| Rate for Payer: Aetna Commercial |
$49.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.61
|
| Rate for Payer: Cash Price |
$46.29
|
| Rate for Payer: Cofinity Advantage |
$40.50
|
| Rate for Payer: Cofinity Commercial |
$49.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.29
|
| Rate for Payer: Healthscope Commercial |
$52.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$40.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.40
|
| Rate for Payer: PHP Commercial |
$49.18
|
| Rate for Payer: Priority Health SBD |
$36.45
|
| Rate for Payer: UMR Bronson Commercial |
$25.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.40
|
|
|
HC POUCH WOUND 6 X 4
|
Facility
|
OP
|
$57.86
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000621
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$21.41 |
| Max. Negotiated Rate |
$53.14 |
| Rate for Payer: Aetna American Axle |
$37.61
|
| Rate for Payer: Aetna Commercial |
$49.18
|
| Rate for Payer: Aetna Medicare |
$28.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.61
|
| Rate for Payer: BCBS Complete |
$23.14
|
| Rate for Payer: BCBS Trust/PPO |
$53.14
|
| Rate for Payer: BCN Commercial |
$53.14
|
| Rate for Payer: Cash Price |
$46.29
|
| Rate for Payer: Cash Price |
$46.29
|
| Rate for Payer: Cofinity Advantage |
$40.50
|
| Rate for Payer: Cofinity Commercial |
$49.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.29
|
| Rate for Payer: Healthscope Commercial |
$52.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$40.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.40
|
| Rate for Payer: PHP Commercial |
$49.18
|
| Rate for Payer: Priority Health SBD |
$36.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.61
|
| Rate for Payer: UHC Core |
$30.15
|
| Rate for Payer: UHC Exchange |
$22.74
|
| Rate for Payer: UMR Bronson Commercial |
$21.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.40
|
|
|
HC POUCH WOUND 9 X 6
|
Facility
|
IP
|
$104.65
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000620
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$46.05 |
| Max. Negotiated Rate |
$94.19 |
| Rate for Payer: Aetna American Axle |
$68.02
|
| Rate for Payer: Aetna Commercial |
$88.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.02
|
| Rate for Payer: Cash Price |
$83.72
|
| Rate for Payer: Cofinity Advantage |
$73.25
|
| Rate for Payer: Cofinity Commercial |
$90.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.72
|
| Rate for Payer: Healthscope Commercial |
$94.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$73.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.49
|
| Rate for Payer: PHP Commercial |
$88.95
|
| Rate for Payer: Priority Health SBD |
$65.93
|
| Rate for Payer: UMR Bronson Commercial |
$46.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.49
|
|
|
HC POUCH WOUND 9 X 6
|
Facility
|
OP
|
$104.65
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000620
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$38.72 |
| Max. Negotiated Rate |
$94.19 |
| Rate for Payer: Aetna American Axle |
$68.02
|
| Rate for Payer: Aetna Commercial |
$88.95
|
| Rate for Payer: Aetna Medicare |
$52.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.02
|
| Rate for Payer: BCBS Complete |
$41.86
|
| Rate for Payer: BCBS Trust/PPO |
$53.14
|
| Rate for Payer: BCN Commercial |
$53.14
|
| Rate for Payer: Cash Price |
$83.72
|
| Rate for Payer: Cash Price |
$83.72
|
| Rate for Payer: Cofinity Advantage |
$73.25
|
| Rate for Payer: Cofinity Commercial |
$90.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.72
|
| Rate for Payer: Healthscope Commercial |
$94.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$73.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$83.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.49
|
| Rate for Payer: PHP Commercial |
$88.95
|
| Rate for Payer: Priority Health SBD |
$65.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.02
|
| Rate for Payer: UHC Core |
$54.52
|
| Rate for Payer: UHC Exchange |
$41.13
|
| Rate for Payer: UMR Bronson Commercial |
$38.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.49
|
|
|
HC POWDER MICANOZOLE
|
Facility
|
OP
|
$20.39
|
|
| Hospital Charge Code |
27000625
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.54 |
| Max. Negotiated Rate |
$18.35 |
| Rate for Payer: Aetna American Axle |
$13.25
|
| Rate for Payer: Aetna Commercial |
$17.33
|
| Rate for Payer: Aetna Medicare |
$10.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.25
|
| Rate for Payer: BCBS Complete |
$8.16
|
| Rate for Payer: Cash Price |
$16.31
|
| Rate for Payer: Cofinity Advantage |
$14.27
|
| Rate for Payer: Cofinity Commercial |
$17.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.31
|
| Rate for Payer: Healthscope Commercial |
$18.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.29
|
| Rate for Payer: PHP Commercial |
$17.33
|
| Rate for Payer: Priority Health SBD |
$12.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.25
|
| Rate for Payer: UHC Core |
$10.62
|
| Rate for Payer: UHC Exchange |
$8.01
|
| Rate for Payer: UMR Bronson Commercial |
$7.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.29
|
|
|
HC POWDER MICANOZOLE
|
Facility
|
IP
|
$20.39
|
|
| Hospital Charge Code |
27000625
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.97 |
| Max. Negotiated Rate |
$18.35 |
| Rate for Payer: Aetna American Axle |
$13.25
|
| Rate for Payer: Aetna Commercial |
$17.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.25
|
| Rate for Payer: Cash Price |
$16.31
|
| Rate for Payer: Cofinity Advantage |
$14.27
|
| Rate for Payer: Cofinity Commercial |
$17.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.31
|
| Rate for Payer: Healthscope Commercial |
$18.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.29
|
| Rate for Payer: PHP Commercial |
$17.33
|
| Rate for Payer: Priority Health SBD |
$12.85
|
| Rate for Payer: UMR Bronson Commercial |
$8.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.29
|
|
|
HC POWDER OSTOMY
|
Facility
|
IP
|
$26.19
|
|
| Hospital Charge Code |
27000139
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.52 |
| Max. Negotiated Rate |
$23.57 |
| Rate for Payer: Aetna American Axle |
$17.02
|
| Rate for Payer: Aetna Commercial |
$22.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.02
|
| Rate for Payer: Cash Price |
$20.95
|
| Rate for Payer: Cofinity Advantage |
$18.33
|
| Rate for Payer: Cofinity Commercial |
$22.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.95
|
| Rate for Payer: Healthscope Commercial |
$23.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.64
|
| Rate for Payer: PHP Commercial |
$22.26
|
| Rate for Payer: Priority Health SBD |
$16.50
|
| Rate for Payer: UMR Bronson Commercial |
$11.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.64
|
|
|
HC POWDER OSTOMY
|
Facility
|
OP
|
$26.19
|
|
| Hospital Charge Code |
27000139
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.69 |
| Max. Negotiated Rate |
$23.57 |
| Rate for Payer: Aetna American Axle |
$17.02
|
| Rate for Payer: Aetna Commercial |
$22.26
|
| Rate for Payer: Aetna Medicare |
$13.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.02
|
| Rate for Payer: BCBS Complete |
$10.48
|
| Rate for Payer: Cash Price |
$20.95
|
| Rate for Payer: Cofinity Advantage |
$18.33
|
| Rate for Payer: Cofinity Commercial |
$22.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.95
|
| Rate for Payer: Healthscope Commercial |
$23.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.64
|
| Rate for Payer: PHP Commercial |
$22.26
|
| Rate for Payer: Priority Health SBD |
$16.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.02
|
| Rate for Payer: UHC Core |
$13.64
|
| Rate for Payer: UHC Exchange |
$10.29
|
| Rate for Payer: UMR Bronson Commercial |
$9.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.64
|
|
|
HC POWER CVC
|
Facility
|
OP
|
$563.75
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200235
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$208.59 |
| Max. Negotiated Rate |
$507.38 |
| Rate for Payer: Aetna American Axle |
$366.44
|
| Rate for Payer: Aetna Commercial |
$479.19
|
| Rate for Payer: Aetna Medicare |
$281.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$366.44
|
| Rate for Payer: BCBS Complete |
$225.50
|
| Rate for Payer: Cash Price |
$451.00
|
| Rate for Payer: Cofinity Advantage |
$394.62
|
| Rate for Payer: Cofinity Commercial |
$484.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$451.00
|
| Rate for Payer: Healthscope Commercial |
$507.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$394.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$422.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$451.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$479.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$422.81
|
| Rate for Payer: PHP Commercial |
$479.19
|
| Rate for Payer: Priority Health SBD |
$355.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$366.44
|
| Rate for Payer: UHC Core |
$293.71
|
| Rate for Payer: UHC Exchange |
$221.55
|
| Rate for Payer: UMR Bronson Commercial |
$208.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$422.81
|
|
|
HC POWER CVC
|
Facility
|
IP
|
$563.75
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200235
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$248.05 |
| Max. Negotiated Rate |
$507.38 |
| Rate for Payer: Aetna American Axle |
$366.44
|
| Rate for Payer: Aetna Commercial |
$479.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$366.44
|
| Rate for Payer: Cash Price |
$451.00
|
| Rate for Payer: Cofinity Advantage |
$394.62
|
| Rate for Payer: Cofinity Commercial |
$484.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$451.00
|
| Rate for Payer: Healthscope Commercial |
$507.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$394.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$422.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$479.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$422.81
|
| Rate for Payer: PHP Commercial |
$479.19
|
| Rate for Payer: Priority Health SBD |
$355.16
|
| Rate for Payer: UMR Bronson Commercial |
$248.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$422.81
|
|
|
HC POWER CVC SPRINGWIRE GUIDE
|
Facility
|
OP
|
$39.48
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200236
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.61 |
| Max. Negotiated Rate |
$35.53 |
| Rate for Payer: Aetna American Axle |
$25.66
|
| Rate for Payer: Aetna Commercial |
$33.56
|
| Rate for Payer: Aetna Medicare |
$19.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.66
|
| Rate for Payer: BCBS Complete |
$15.79
|
| Rate for Payer: Cash Price |
$31.58
|
| Rate for Payer: Cofinity Advantage |
$27.64
|
| Rate for Payer: Cofinity Commercial |
$33.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.58
|
| Rate for Payer: Healthscope Commercial |
$35.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.61
|
| Rate for Payer: PHP Commercial |
$33.56
|
| Rate for Payer: Priority Health SBD |
$24.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.66
|
| Rate for Payer: UHC Core |
$20.57
|
| Rate for Payer: UHC Exchange |
$15.52
|
| Rate for Payer: UMR Bronson Commercial |
$14.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.61
|
|
|
HC POWER CVC SPRINGWIRE GUIDE
|
Facility
|
IP
|
$39.48
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200236
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.37 |
| Max. Negotiated Rate |
$35.53 |
| Rate for Payer: Aetna American Axle |
$25.66
|
| Rate for Payer: Aetna Commercial |
$33.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.66
|
| Rate for Payer: Cash Price |
$31.58
|
| Rate for Payer: Cofinity Advantage |
$27.64
|
| Rate for Payer: Cofinity Commercial |
$33.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.58
|
| Rate for Payer: Healthscope Commercial |
$35.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.61
|
| Rate for Payer: PHP Commercial |
$33.56
|
| Rate for Payer: Priority Health SBD |
$24.87
|
| Rate for Payer: UMR Bronson Commercial |
$17.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.61
|
|
|
HC POWERWAND CATHETER
|
Facility
|
IP
|
$548.74
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200241
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$241.45 |
| Max. Negotiated Rate |
$493.87 |
| Rate for Payer: Aetna American Axle |
$356.68
|
| Rate for Payer: Aetna Commercial |
$466.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$356.68
|
| Rate for Payer: Cash Price |
$438.99
|
| Rate for Payer: Cofinity Advantage |
$384.12
|
| Rate for Payer: Cofinity Commercial |
$471.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$438.99
|
| Rate for Payer: Healthscope Commercial |
$493.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$384.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$411.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$466.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$411.56
|
| Rate for Payer: PHP Commercial |
$466.43
|
| Rate for Payer: Priority Health SBD |
$345.71
|
| Rate for Payer: UMR Bronson Commercial |
$241.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$411.56
|
|
|
HC POWERWAND CATHETER
|
Facility
|
OP
|
$548.74
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200241
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$203.03 |
| Max. Negotiated Rate |
$493.87 |
| Rate for Payer: Aetna American Axle |
$356.68
|
| Rate for Payer: Aetna Commercial |
$466.43
|
| Rate for Payer: Aetna Medicare |
$274.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$356.68
|
| Rate for Payer: BCBS Complete |
$219.50
|
| Rate for Payer: Cash Price |
$438.99
|
| Rate for Payer: Cofinity Advantage |
$384.12
|
| Rate for Payer: Cofinity Commercial |
$471.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$438.99
|
| Rate for Payer: Healthscope Commercial |
$493.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$384.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$411.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$438.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$466.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$411.56
|
| Rate for Payer: PHP Commercial |
$466.43
|
| Rate for Payer: Priority Health SBD |
$345.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$356.68
|
| Rate for Payer: UHC Core |
$285.89
|
| Rate for Payer: UHC Exchange |
$215.65
|
| Rate for Payer: UMR Bronson Commercial |
$203.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$411.56
|
|
|
HC PPM SINGLE/A LEAD
|
Facility
|
OP
|
$12,110.55
|
|
|
Service Code
|
CPT 33206
|
| Hospital Charge Code |
36100057
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,480.90 |
| Max. Negotiated Rate |
$33,679.26 |
| Rate for Payer: Aetna American Axle |
$7,871.86
|
| Rate for Payer: Aetna Commercial |
$10,293.97
|
| Rate for Payer: Aetna Medicare |
$10,830.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,871.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,018.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,018.01
|
| Rate for Payer: BCBS Complete |
$5,719.59
|
| Rate for Payer: BCBS MAPPO |
$10,414.41
|
| Rate for Payer: BCBS Trust/PPO |
$16,958.96
|
| Rate for Payer: BCN Commercial |
$16,958.96
|
| Rate for Payer: BCN Medicare Advantage |
$10,414.41
|
| Rate for Payer: Cash Price |
$9,688.44
|
| Rate for Payer: Cash Price |
$9,688.44
|
| Rate for Payer: Cash Price |
$9,688.44
|
| Rate for Payer: Cofinity Advantage |
$8,477.39
|
| Rate for Payer: Cofinity Commercial |
$10,415.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,688.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,414.41
|
| Rate for Payer: Healthscope Commercial |
$10,899.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8,477.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,082.91
|
| Rate for Payer: Mclaren Medicaid |
$10,414.41
|
| Rate for Payer: Mclaren Medicare |
$10,414.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,935.13
|
| Rate for Payer: Meridian Medicaid |
$10,935.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,976.57
|
| Rate for Payer: Molina Medicare/Medicaid |
$11,455.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,293.97
|
| Rate for Payer: Nomi Health Commercial |
$31,243.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9,082.91
|
| Rate for Payer: PACE Medicare |
$9,893.69
|
| Rate for Payer: PACE SWMI |
$10,414.41
|
| Rate for Payer: PHP Commercial |
$10,293.97
|
| Rate for Payer: PHP Medicare Advantage |
$10,414.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,446.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$33,679.26
|
| Rate for Payer: Priority Health Medicare |
$10,414.41
|
| Rate for Payer: Priority Health SBD |
$7,629.65
|
| Rate for Payer: Priority Health Tiered Network |
$26,943.41
|
| Rate for Payer: Railroad Medicare Medicare |
$10,414.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10,414.41
|
| Rate for Payer: UHC Medicaid |
$5,446.74
|
| Rate for Payer: UHCCP Medicaid |
$5,446.74
|
| Rate for Payer: UMR Bronson Commercial |
$4,480.90
|
| Rate for Payer: VA VA |
$10,414.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,082.91
|
|
|
HC PPM SINGLE/A LEAD
|
Facility
|
IP
|
$12,110.55
|
|
|
Service Code
|
CPT 33206
|
| Hospital Charge Code |
36100057
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,328.64 |
| Max. Negotiated Rate |
$10,899.50 |
| Rate for Payer: Aetna American Axle |
$7,871.86
|
| Rate for Payer: Aetna Commercial |
$10,293.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,871.86
|
| Rate for Payer: Cash Price |
$9,688.44
|
| Rate for Payer: Cofinity Advantage |
$8,477.39
|
| Rate for Payer: Cofinity Commercial |
$10,415.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,688.44
|
| Rate for Payer: Healthscope Commercial |
$10,899.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8,477.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,082.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,293.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9,082.91
|
| Rate for Payer: PHP Commercial |
$10,293.97
|
| Rate for Payer: Priority Health SBD |
$7,629.65
|
| Rate for Payer: UMR Bronson Commercial |
$5,328.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,082.91
|
|
|
HC PPM SINGLE/V LEAD
|
Facility
|
IP
|
$13,713.41
|
|
|
Service Code
|
CPT 33207
|
| Hospital Charge Code |
36100058
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,033.90 |
| Max. Negotiated Rate |
$12,342.07 |
| Rate for Payer: Aetna American Axle |
$8,913.72
|
| Rate for Payer: Aetna Commercial |
$11,656.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,913.72
|
| Rate for Payer: Cash Price |
$10,970.73
|
| Rate for Payer: Cofinity Advantage |
$9,599.39
|
| Rate for Payer: Cofinity Commercial |
$11,793.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,970.73
|
| Rate for Payer: Healthscope Commercial |
$12,342.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9,599.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10,285.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,656.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10,285.06
|
| Rate for Payer: PHP Commercial |
$11,656.40
|
| Rate for Payer: Priority Health SBD |
$8,639.45
|
| Rate for Payer: UMR Bronson Commercial |
$6,033.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10,285.06
|
|
|
HC PPM SINGLE/V LEAD
|
Facility
|
OP
|
$13,713.41
|
|
|
Service Code
|
CPT 33207
|
| Hospital Charge Code |
36100058
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,073.96 |
| Max. Negotiated Rate |
$33,679.26 |
| Rate for Payer: Aetna American Axle |
$8,913.72
|
| Rate for Payer: Aetna Commercial |
$11,656.40
|
| Rate for Payer: Aetna Medicare |
$10,830.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,913.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,018.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,018.01
|
| Rate for Payer: BCBS Complete |
$5,719.59
|
| Rate for Payer: BCBS MAPPO |
$10,414.41
|
| Rate for Payer: BCBS Trust/PPO |
$15,613.27
|
| Rate for Payer: BCN Commercial |
$15,613.27
|
| Rate for Payer: BCN Medicare Advantage |
$10,414.41
|
| Rate for Payer: Cash Price |
$10,970.73
|
| Rate for Payer: Cash Price |
$10,970.73
|
| Rate for Payer: Cash Price |
$10,970.73
|
| Rate for Payer: Cofinity Advantage |
$9,599.39
|
| Rate for Payer: Cofinity Commercial |
$11,793.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,970.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,414.41
|
| Rate for Payer: Healthscope Commercial |
$12,342.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9,599.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10,285.06
|
| Rate for Payer: Mclaren Medicaid |
$10,414.41
|
| Rate for Payer: Mclaren Medicare |
$10,414.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,935.13
|
| Rate for Payer: Meridian Medicaid |
$10,935.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,976.57
|
| Rate for Payer: Molina Medicare/Medicaid |
$11,455.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,656.40
|
| Rate for Payer: Nomi Health Commercial |
$31,243.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10,285.06
|
| Rate for Payer: PACE Medicare |
$9,893.69
|
| Rate for Payer: PACE SWMI |
$10,414.41
|
| Rate for Payer: PHP Commercial |
$11,656.40
|
| Rate for Payer: PHP Medicare Advantage |
$10,414.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,446.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$33,679.26
|
| Rate for Payer: Priority Health Medicare |
$10,414.41
|
| Rate for Payer: Priority Health SBD |
$8,639.45
|
| Rate for Payer: Priority Health Tiered Network |
$26,943.41
|
| Rate for Payer: Railroad Medicare Medicare |
$10,414.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10,414.41
|
| Rate for Payer: UHC Medicaid |
$5,446.74
|
| Rate for Payer: UHCCP Medicaid |
$5,446.74
|
| Rate for Payer: UMR Bronson Commercial |
$5,073.96
|
| Rate for Payer: VA VA |
$10,414.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10,285.06
|
|
|
HC PPU OBSERVATION PER HOUR
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200007
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$59.20 |
| Max. Negotiated Rate |
$1,608.00 |
| Rate for Payer: Aetna American Axle |
$104.00
|
| Rate for Payer: Aetna Commercial |
$136.00
|
| Rate for Payer: Aetna Medicare |
$80.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.00
|
| Rate for Payer: BCBS Complete |
$64.00
|
| Rate for Payer: BCBS Trust/PPO |
$107.13
|
| Rate for Payer: BCN Commercial |
$107.13
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cofinity Advantage |
$112.00
|
| Rate for Payer: Cofinity Commercial |
$137.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.00
|
| Rate for Payer: Healthscope Commercial |
$144.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$112.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$120.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$128.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.00
|
| Rate for Payer: PHP Commercial |
$136.00
|
| Rate for Payer: Priority Health SBD |
$100.80
|
| Rate for Payer: UHC Medicaid |
$1,608.00
|
| Rate for Payer: UHCCP Medicaid |
$850.00
|
| Rate for Payer: UMR Bronson Commercial |
$59.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$120.00
|
|
|
HC PPU OBSERVATION PER HOUR
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200007
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$70.40 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Aetna American Axle |
$104.00
|
| Rate for Payer: Aetna Commercial |
$136.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cofinity Advantage |
$112.00
|
| Rate for Payer: Cofinity Commercial |
$137.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.00
|
| Rate for Payer: Healthscope Commercial |
$144.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$112.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$120.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.00
|
| Rate for Payer: PHP Commercial |
$136.00
|
| Rate for Payer: Priority Health SBD |
$100.80
|
| Rate for Payer: UMR Bronson Commercial |
$70.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$120.00
|
|
|
HC PRADER WILLI MOL ANALYSIS
|
Facility
|
IP
|
$447.37
|
|
|
Service Code
|
CPT 81331
|
| Hospital Charge Code |
31000103
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$196.84 |
| Max. Negotiated Rate |
$402.63 |
| Rate for Payer: Aetna American Axle |
$290.79
|
| Rate for Payer: Aetna Commercial |
$380.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$290.79
|
| Rate for Payer: Cash Price |
$357.90
|
| Rate for Payer: Cofinity Advantage |
$313.16
|
| Rate for Payer: Cofinity Commercial |
$384.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$357.90
|
| Rate for Payer: Healthscope Commercial |
$402.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$313.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$335.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$380.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$335.53
|
| Rate for Payer: PHP Commercial |
$380.26
|
| Rate for Payer: Priority Health SBD |
$281.84
|
| Rate for Payer: UMR Bronson Commercial |
$196.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$335.53
|
|
|
HC PRADER WILLI MOL ANALYSIS
|
Facility
|
OP
|
$447.37
|
|
|
Service Code
|
CPT 81331
|
| Hospital Charge Code |
31000103
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$26.71 |
| Max. Negotiated Rate |
$402.63 |
| Rate for Payer: Aetna American Axle |
$290.79
|
| Rate for Payer: Aetna Commercial |
$380.26
|
| Rate for Payer: Aetna Medicare |
$53.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$290.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$63.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$63.84
|
| Rate for Payer: BCBS Complete |
$28.05
|
| Rate for Payer: BCBS MAPPO |
$51.07
|
| Rate for Payer: BCBS Trust/PPO |
$59.03
|
| Rate for Payer: BCN Commercial |
$59.03
|
| Rate for Payer: BCN Medicare Advantage |
$51.07
|
| Rate for Payer: Cash Price |
$357.90
|
| Rate for Payer: Cash Price |
$357.90
|
| Rate for Payer: Cofinity Advantage |
$313.16
|
| Rate for Payer: Cofinity Commercial |
$384.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$357.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.07
|
| Rate for Payer: Healthscope Commercial |
$402.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$313.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$335.53
|
| Rate for Payer: Mclaren Medicaid |
$51.07
|
| Rate for Payer: Mclaren Medicare |
$51.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53.62
|
| Rate for Payer: Meridian Medicaid |
$53.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$56.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$380.26
|
| Rate for Payer: Nomi Health Commercial |
$153.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$335.53
|
| Rate for Payer: PACE Medicare |
$48.52
|
| Rate for Payer: PACE SWMI |
$51.07
|
| Rate for Payer: PHP Commercial |
$380.26
|
| Rate for Payer: PHP Medicare Advantage |
$51.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$51.07
|
| Rate for Payer: Priority Health Medicare |
$51.07
|
| Rate for Payer: Priority Health SBD |
$281.84
|
| Rate for Payer: Priority Health Tiered Network |
$40.86
|
| Rate for Payer: Railroad Medicare Medicare |
$51.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.61
|
| Rate for Payer: UHC Core |
$76.61
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$51.07
|
| Rate for Payer: UHC Exchange |
$76.61
|
| Rate for Payer: UHC Medicaid |
$26.71
|
| Rate for Payer: UHCCP Medicaid |
$26.71
|
| Rate for Payer: UMR Bronson Commercial |
$165.53
|
| Rate for Payer: VA VA |
$51.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$335.53
|
|
|
HC PREALBUMIN
|
Facility
|
IP
|
$70.75
|
|
|
Service Code
|
CPT 84134
|
| Hospital Charge Code |
30100398
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.13 |
| Max. Negotiated Rate |
$63.67 |
| Rate for Payer: Aetna American Axle |
$45.99
|
| Rate for Payer: Aetna Commercial |
$60.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.99
|
| Rate for Payer: Cash Price |
$56.60
|
| Rate for Payer: Cofinity Advantage |
$49.52
|
| Rate for Payer: Cofinity Commercial |
$60.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.60
|
| Rate for Payer: Healthscope Commercial |
$63.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.06
|
| Rate for Payer: PHP Commercial |
$60.14
|
| Rate for Payer: Priority Health SBD |
$44.57
|
| Rate for Payer: UMR Bronson Commercial |
$31.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.06
|
|
|
HC PREALBUMIN
|
Facility
|
OP
|
$70.75
|
|
|
Service Code
|
CPT 84134
|
| Hospital Charge Code |
30100398
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.63 |
| Max. Negotiated Rate |
$63.67 |
| Rate for Payer: Aetna American Axle |
$45.99
|
| Rate for Payer: Aetna Commercial |
$60.14
|
| Rate for Payer: Aetna Medicare |
$15.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.24
|
| Rate for Payer: BCBS Complete |
$8.01
|
| Rate for Payer: BCBS MAPPO |
$14.59
|
| Rate for Payer: BCBS Trust/PPO |
$16.86
|
| Rate for Payer: BCN Commercial |
$16.86
|
| Rate for Payer: BCN Medicare Advantage |
$14.59
|
| Rate for Payer: Cash Price |
$56.60
|
| Rate for Payer: Cash Price |
$56.60
|
| Rate for Payer: Cofinity Advantage |
$49.52
|
| Rate for Payer: Cofinity Commercial |
$60.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.59
|
| Rate for Payer: Healthscope Commercial |
$63.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.06
|
| Rate for Payer: Mclaren Medicaid |
$14.59
|
| Rate for Payer: Mclaren Medicare |
$14.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.32
|
| Rate for Payer: Meridian Medicaid |
$15.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.78
|
| Rate for Payer: Molina Medicare/Medicaid |
$16.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.14
|
| Rate for Payer: Nomi Health Commercial |
$21.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.06
|
| Rate for Payer: PACE Medicare |
$13.86
|
| Rate for Payer: PACE SWMI |
$14.59
|
| Rate for Payer: PHP Commercial |
$60.14
|
| Rate for Payer: PHP Medicare Advantage |
$14.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$14.59
|
| Rate for Payer: Priority Health Medicare |
$14.59
|
| Rate for Payer: Priority Health SBD |
$44.57
|
| Rate for Payer: Priority Health Tiered Network |
$11.67
|
| Rate for Payer: Railroad Medicare Medicare |
$14.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.89
|
| Rate for Payer: UHC Core |
$21.89
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14.59
|
| Rate for Payer: UHC Exchange |
$21.89
|
| Rate for Payer: UHC Medicaid |
$7.63
|
| Rate for Payer: UHCCP Medicaid |
$7.63
|
| Rate for Payer: UMR Bronson Commercial |
$26.18
|
| Rate for Payer: VA VA |
$14.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.06
|
|
|
HC PREGNANCY TEST SERUM
|
Facility
|
OP
|
$31.83
|
|
|
Service Code
|
CPT 84703
|
| Hospital Charge Code |
30100467
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.93 |
| Max. Negotiated Rate |
$28.65 |
| Rate for Payer: Aetna American Axle |
$20.69
|
| Rate for Payer: Aetna Commercial |
$27.06
|
| Rate for Payer: Aetna Medicare |
$7.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.40
|
| Rate for Payer: BCBS Complete |
$4.13
|
| Rate for Payer: BCBS MAPPO |
$7.52
|
| Rate for Payer: BCBS Trust/PPO |
$8.69
|
| Rate for Payer: BCN Commercial |
$8.69
|
| Rate for Payer: BCN Medicare Advantage |
$7.52
|
| Rate for Payer: Cash Price |
$25.46
|
| Rate for Payer: Cash Price |
$25.46
|
| Rate for Payer: Cofinity Advantage |
$22.28
|
| Rate for Payer: Cofinity Commercial |
$27.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.52
|
| Rate for Payer: Healthscope Commercial |
$28.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.87
|
| Rate for Payer: Mclaren Medicaid |
$7.52
|
| Rate for Payer: Mclaren Medicare |
$7.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.90
|
| Rate for Payer: Meridian Medicaid |
$7.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.06
|
| Rate for Payer: Nomi Health Commercial |
$11.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.87
|
| Rate for Payer: PACE Medicare |
$7.14
|
| Rate for Payer: PACE SWMI |
$7.52
|
| Rate for Payer: PHP Commercial |
$27.06
|
| Rate for Payer: PHP Medicare Advantage |
$7.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$7.52
|
| Rate for Payer: Priority Health Medicare |
$7.52
|
| Rate for Payer: Priority Health SBD |
$20.05
|
| Rate for Payer: Priority Health Tiered Network |
$6.02
|
| Rate for Payer: Railroad Medicare Medicare |
$7.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.28
|
| Rate for Payer: UHC Core |
$11.28
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7.52
|
| Rate for Payer: UHC Exchange |
$11.28
|
| Rate for Payer: UHC Medicaid |
$3.93
|
| Rate for Payer: UHCCP Medicaid |
$3.93
|
| Rate for Payer: UMR Bronson Commercial |
$11.78
|
| Rate for Payer: VA VA |
$7.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.87
|
|
