|
HC REMOVE CERUMEN INSTR BILAT
|
Facility
|
OP
|
$217.62
|
|
|
Service Code
|
CPT 69210
|
| Hospital Charge Code |
45000099
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$30.74 |
| Max. Negotiated Rate |
$195.86 |
| Rate for Payer: Aetna American Axle |
$141.45
|
| Rate for Payer: Aetna Commercial |
$184.98
|
| Rate for Payer: Aetna Medicare |
$61.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$73.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$73.47
|
| Rate for Payer: BCBS Complete |
$32.28
|
| Rate for Payer: BCBS MAPPO |
$58.78
|
| Rate for Payer: BCBS Trust/PPO |
$130.23
|
| Rate for Payer: BCN Commercial |
$130.23
|
| Rate for Payer: BCN Medicare Advantage |
$58.78
|
| Rate for Payer: Cash Price |
$174.10
|
| Rate for Payer: Cash Price |
$174.10
|
| Rate for Payer: Cash Price |
$174.10
|
| Rate for Payer: Cofinity Advantage |
$152.33
|
| Rate for Payer: Cofinity Commercial |
$187.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.78
|
| Rate for Payer: Healthscope Commercial |
$195.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$152.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.22
|
| Rate for Payer: Mclaren Medicaid |
$58.78
|
| Rate for Payer: Mclaren Medicare |
$58.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.72
|
| Rate for Payer: Meridian Medicaid |
$61.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$67.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$64.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.98
|
| Rate for Payer: Nomi Health Commercial |
$176.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$163.22
|
| Rate for Payer: PACE Medicare |
$55.84
|
| Rate for Payer: PACE SWMI |
$58.78
|
| Rate for Payer: PHP Commercial |
$184.98
|
| Rate for Payer: PHP Medicare Advantage |
$58.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$190.09
|
| Rate for Payer: Priority Health Medicare |
$58.78
|
| Rate for Payer: Priority Health SBD |
$137.10
|
| Rate for Payer: Priority Health Tiered Network |
$152.07
|
| Rate for Payer: Railroad Medicare Medicare |
$58.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$58.78
|
| Rate for Payer: UHC Medicaid |
$30.74
|
| Rate for Payer: UHCCP Medicaid |
$125.00
|
| Rate for Payer: UMR Bronson Commercial |
$80.52
|
| Rate for Payer: VA VA |
$58.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.22
|
|
|
HC REMOVE CERUMEN INSTR BILAT
|
Facility
|
IP
|
$217.62
|
|
|
Service Code
|
CPT 69210
|
| Hospital Charge Code |
45000099
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$95.75 |
| Max. Negotiated Rate |
$195.86 |
| Rate for Payer: Aetna American Axle |
$141.45
|
| Rate for Payer: Aetna Commercial |
$184.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.45
|
| Rate for Payer: Cash Price |
$174.10
|
| Rate for Payer: Cofinity Advantage |
$152.33
|
| Rate for Payer: Cofinity Commercial |
$187.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.10
|
| Rate for Payer: Healthscope Commercial |
$195.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$152.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$163.22
|
| Rate for Payer: PHP Commercial |
$184.98
|
| Rate for Payer: Priority Health SBD |
$137.10
|
| Rate for Payer: UMR Bronson Commercial |
$95.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.22
|
|
|
HC REMOVE CERUMEN INSTR UNILATERAL
|
Facility
|
IP
|
$145.69
|
|
|
Service Code
|
CPT 69210
|
| Hospital Charge Code |
45000017
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$64.10 |
| Max. Negotiated Rate |
$131.12 |
| Rate for Payer: Aetna American Axle |
$94.70
|
| Rate for Payer: Aetna American Axle |
$142.05
|
| Rate for Payer: Aetna Commercial |
$123.84
|
| Rate for Payer: Aetna Commercial |
$185.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.05
|
| Rate for Payer: Cash Price |
$116.55
|
| Rate for Payer: Cash Price |
$174.83
|
| Rate for Payer: Cofinity Advantage |
$152.98
|
| Rate for Payer: Cofinity Advantage |
$101.98
|
| Rate for Payer: Cofinity Commercial |
$187.94
|
| Rate for Payer: Cofinity Commercial |
$125.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.83
|
| Rate for Payer: Healthscope Commercial |
$131.12
|
| Rate for Payer: Healthscope Commercial |
$196.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$152.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$101.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$109.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$109.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$163.91
|
| Rate for Payer: PHP Commercial |
$123.84
|
| Rate for Payer: PHP Commercial |
$185.76
|
| Rate for Payer: Priority Health SBD |
$137.68
|
| Rate for Payer: Priority Health SBD |
$91.78
|
| Rate for Payer: UMR Bronson Commercial |
$64.10
|
| Rate for Payer: UMR Bronson Commercial |
$96.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$109.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.91
|
|
|
HC REMOVE CERUMEN INSTR UNILATERAL
|
Facility
|
OP
|
$145.69
|
|
|
Service Code
|
CPT 69210
|
| Hospital Charge Code |
45000017
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$30.74 |
| Max. Negotiated Rate |
$190.09 |
| Rate for Payer: Aetna American Axle |
$94.70
|
| Rate for Payer: Aetna American Axle |
$142.05
|
| Rate for Payer: Aetna Commercial |
$123.84
|
| Rate for Payer: Aetna Commercial |
$185.76
|
| Rate for Payer: Aetna Medicare |
$61.13
|
| Rate for Payer: Aetna Medicare |
$61.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$73.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$73.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$73.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$73.47
|
| Rate for Payer: BCBS Complete |
$32.28
|
| Rate for Payer: BCBS Complete |
$32.28
|
| Rate for Payer: BCBS MAPPO |
$58.78
|
| Rate for Payer: BCBS MAPPO |
$58.78
|
| Rate for Payer: BCBS Trust/PPO |
$130.23
|
| Rate for Payer: BCBS Trust/PPO |
$130.23
|
| Rate for Payer: BCN Commercial |
$130.23
|
| Rate for Payer: BCN Commercial |
$130.23
|
| Rate for Payer: BCN Medicare Advantage |
$58.78
|
| Rate for Payer: BCN Medicare Advantage |
$58.78
|
| Rate for Payer: Cash Price |
$174.83
|
| Rate for Payer: Cash Price |
$116.55
|
| Rate for Payer: Cash Price |
$174.83
|
| Rate for Payer: Cash Price |
$116.55
|
| Rate for Payer: Cash Price |
$116.55
|
| Rate for Payer: Cash Price |
$174.83
|
| Rate for Payer: Cofinity Advantage |
$101.98
|
| Rate for Payer: Cofinity Advantage |
$152.98
|
| Rate for Payer: Cofinity Commercial |
$187.94
|
| Rate for Payer: Cofinity Commercial |
$125.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.78
|
| Rate for Payer: Healthscope Commercial |
$196.69
|
| Rate for Payer: Healthscope Commercial |
$131.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$152.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$101.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$109.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.91
|
| Rate for Payer: Mclaren Medicaid |
$58.78
|
| Rate for Payer: Mclaren Medicaid |
$58.78
|
| Rate for Payer: Mclaren Medicare |
$58.78
|
| Rate for Payer: Mclaren Medicare |
$58.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.72
|
| Rate for Payer: Meridian Medicaid |
$61.72
|
| Rate for Payer: Meridian Medicaid |
$61.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$67.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$67.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$64.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$64.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.76
|
| Rate for Payer: Nomi Health Commercial |
$176.34
|
| Rate for Payer: Nomi Health Commercial |
$176.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$163.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$109.27
|
| Rate for Payer: PACE Medicare |
$55.84
|
| Rate for Payer: PACE Medicare |
$55.84
|
| Rate for Payer: PACE SWMI |
$58.78
|
| Rate for Payer: PACE SWMI |
$58.78
|
| Rate for Payer: PHP Commercial |
$185.76
|
| Rate for Payer: PHP Commercial |
$123.84
|
| Rate for Payer: PHP Medicare Advantage |
$58.78
|
| Rate for Payer: PHP Medicare Advantage |
$58.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$190.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$190.09
|
| Rate for Payer: Priority Health Medicare |
$58.78
|
| Rate for Payer: Priority Health Medicare |
$58.78
|
| Rate for Payer: Priority Health SBD |
$137.68
|
| Rate for Payer: Priority Health SBD |
$91.78
|
| Rate for Payer: Priority Health Tiered Network |
$152.07
|
| Rate for Payer: Priority Health Tiered Network |
$152.07
|
| Rate for Payer: Railroad Medicare Medicare |
$58.78
|
| Rate for Payer: Railroad Medicare Medicare |
$58.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$142.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94.70
|
| Rate for Payer: UHC Core |
$113.86
|
| Rate for Payer: UHC Core |
$75.90
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$58.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$58.78
|
| Rate for Payer: UHC Exchange |
$85.89
|
| Rate for Payer: UHC Exchange |
$57.26
|
| Rate for Payer: UHC Medicaid |
$30.74
|
| Rate for Payer: UHC Medicaid |
$30.74
|
| Rate for Payer: UHCCP Medicaid |
$30.74
|
| Rate for Payer: UHCCP Medicaid |
$30.74
|
| Rate for Payer: UMR Bronson Commercial |
$53.91
|
| Rate for Payer: UMR Bronson Commercial |
$80.86
|
| Rate for Payer: VA VA |
$58.78
|
| Rate for Payer: VA VA |
$58.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$109.27
|
|
|
HC REMOVE CERUMEN IRR OR LAVAGE BILAT
|
Facility
|
IP
|
$217.62
|
|
|
Service Code
|
CPT 69209
|
| Hospital Charge Code |
45000098
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$95.75 |
| Max. Negotiated Rate |
$195.86 |
| Rate for Payer: Aetna American Axle |
$141.45
|
| Rate for Payer: Aetna Commercial |
$184.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.45
|
| Rate for Payer: Cash Price |
$174.10
|
| Rate for Payer: Cofinity Advantage |
$152.33
|
| Rate for Payer: Cofinity Commercial |
$187.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.10
|
| Rate for Payer: Healthscope Commercial |
$195.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$152.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$163.22
|
| Rate for Payer: PHP Commercial |
$184.98
|
| Rate for Payer: Priority Health SBD |
$137.10
|
| Rate for Payer: UMR Bronson Commercial |
$95.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.22
|
|
|
HC REMOVE CERUMEN IRR OR LAVAGE BILAT
|
Facility
|
OP
|
$217.62
|
|
|
Service Code
|
CPT 69209
|
| Hospital Charge Code |
45000098
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$30.74 |
| Max. Negotiated Rate |
$195.86 |
| Rate for Payer: Aetna American Axle |
$141.45
|
| Rate for Payer: Aetna Commercial |
$184.98
|
| Rate for Payer: Aetna Medicare |
$61.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$73.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$73.47
|
| Rate for Payer: BCBS Complete |
$32.28
|
| Rate for Payer: BCBS MAPPO |
$58.78
|
| Rate for Payer: BCBS Trust/PPO |
$85.31
|
| Rate for Payer: BCN Commercial |
$85.31
|
| Rate for Payer: BCN Medicare Advantage |
$58.78
|
| Rate for Payer: Cash Price |
$174.10
|
| Rate for Payer: Cash Price |
$174.10
|
| Rate for Payer: Cash Price |
$174.10
|
| Rate for Payer: Cofinity Advantage |
$152.33
|
| Rate for Payer: Cofinity Commercial |
$187.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.78
|
| Rate for Payer: Healthscope Commercial |
$195.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$152.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.22
|
| Rate for Payer: Mclaren Medicaid |
$58.78
|
| Rate for Payer: Mclaren Medicare |
$58.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.72
|
| Rate for Payer: Meridian Medicaid |
$61.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$67.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$64.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.98
|
| Rate for Payer: Nomi Health Commercial |
$176.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$163.22
|
| Rate for Payer: PACE Medicare |
$55.84
|
| Rate for Payer: PACE SWMI |
$58.78
|
| Rate for Payer: PHP Commercial |
$184.98
|
| Rate for Payer: PHP Medicare Advantage |
$58.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$190.09
|
| Rate for Payer: Priority Health Medicare |
$58.78
|
| Rate for Payer: Priority Health SBD |
$137.10
|
| Rate for Payer: Priority Health Tiered Network |
$152.07
|
| Rate for Payer: Railroad Medicare Medicare |
$58.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$58.78
|
| Rate for Payer: UHC Medicaid |
$30.74
|
| Rate for Payer: UHCCP Medicaid |
$125.00
|
| Rate for Payer: UMR Bronson Commercial |
$80.52
|
| Rate for Payer: VA VA |
$58.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.22
|
|
|
HC REMOVE CERUMEN IRR OR LAVAGE UNILATERAL
|
Facility
|
IP
|
$145.69
|
|
|
Service Code
|
HCPCS 69209
|
| Hospital Charge Code |
45000082
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$64.10 |
| Max. Negotiated Rate |
$131.12 |
| Rate for Payer: Aetna American Axle |
$94.70
|
| Rate for Payer: Aetna Commercial |
$123.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.70
|
| Rate for Payer: Cash Price |
$116.55
|
| Rate for Payer: Cofinity Advantage |
$101.98
|
| Rate for Payer: Cofinity Commercial |
$125.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.55
|
| Rate for Payer: Healthscope Commercial |
$131.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$101.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$109.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$109.27
|
| Rate for Payer: PHP Commercial |
$123.84
|
| Rate for Payer: Priority Health SBD |
$91.78
|
| Rate for Payer: UMR Bronson Commercial |
$64.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$109.27
|
|
|
HC REMOVE CERUMEN IRR OR LAVAGE UNILATERAL
|
Facility
|
OP
|
$145.69
|
|
|
Service Code
|
HCPCS 69209
|
| Hospital Charge Code |
45000082
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$30.74 |
| Max. Negotiated Rate |
$190.09 |
| Rate for Payer: Aetna American Axle |
$94.70
|
| Rate for Payer: Aetna Commercial |
$123.84
|
| Rate for Payer: Aetna Medicare |
$61.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$73.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$73.47
|
| Rate for Payer: BCBS Complete |
$32.28
|
| Rate for Payer: BCBS MAPPO |
$58.78
|
| Rate for Payer: BCBS Trust/PPO |
$85.31
|
| Rate for Payer: BCN Commercial |
$85.31
|
| Rate for Payer: BCN Medicare Advantage |
$58.78
|
| Rate for Payer: Cash Price |
$116.55
|
| Rate for Payer: Cash Price |
$116.55
|
| Rate for Payer: Cash Price |
$116.55
|
| Rate for Payer: Cofinity Advantage |
$101.98
|
| Rate for Payer: Cofinity Commercial |
$125.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.78
|
| Rate for Payer: Healthscope Commercial |
$131.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$101.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$109.27
|
| Rate for Payer: Mclaren Medicaid |
$58.78
|
| Rate for Payer: Mclaren Medicare |
$58.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.72
|
| Rate for Payer: Meridian Medicaid |
$61.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$67.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$64.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.84
|
| Rate for Payer: Nomi Health Commercial |
$176.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$109.27
|
| Rate for Payer: PACE Medicare |
$55.84
|
| Rate for Payer: PACE SWMI |
$58.78
|
| Rate for Payer: PHP Commercial |
$123.84
|
| Rate for Payer: PHP Medicare Advantage |
$58.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$190.09
|
| Rate for Payer: Priority Health Medicare |
$58.78
|
| Rate for Payer: Priority Health SBD |
$91.78
|
| Rate for Payer: Priority Health Tiered Network |
$152.07
|
| Rate for Payer: Railroad Medicare Medicare |
$58.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94.70
|
| Rate for Payer: UHC Core |
$75.90
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$58.78
|
| Rate for Payer: UHC Exchange |
$57.26
|
| Rate for Payer: UHC Medicaid |
$30.74
|
| Rate for Payer: UHCCP Medicaid |
$30.74
|
| Rate for Payer: UMR Bronson Commercial |
$53.91
|
| Rate for Payer: VA VA |
$58.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$109.27
|
|
|
HC REMOVE EAR CANAL LESION(S)
|
Facility
|
IP
|
$10,769.70
|
|
|
Service Code
|
CPT 69145
|
| Hospital Charge Code |
76100481
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$4,738.67 |
| Max. Negotiated Rate |
$9,692.73 |
| Rate for Payer: Aetna American Axle |
$7,000.31
|
| Rate for Payer: Aetna American Axle |
$4,666.87
|
| Rate for Payer: Aetna Commercial |
$9,154.25
|
| Rate for Payer: Aetna Commercial |
$6,102.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,000.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,666.87
|
| Rate for Payer: Cash Price |
$8,615.76
|
| Rate for Payer: Cash Price |
$5,743.84
|
| Rate for Payer: Cofinity Advantage |
$5,025.86
|
| Rate for Payer: Cofinity Advantage |
$7,538.79
|
| Rate for Payer: Cofinity Commercial |
$6,174.63
|
| Rate for Payer: Cofinity Commercial |
$9,261.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,615.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,743.84
|
| Rate for Payer: Healthscope Commercial |
$9,692.73
|
| Rate for Payer: Healthscope Commercial |
$6,461.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,025.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7,538.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,077.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,384.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,154.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,102.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8,077.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,384.85
|
| Rate for Payer: PHP Commercial |
$9,154.25
|
| Rate for Payer: PHP Commercial |
$6,102.83
|
| Rate for Payer: Priority Health SBD |
$4,523.27
|
| Rate for Payer: Priority Health SBD |
$6,784.91
|
| Rate for Payer: UMR Bronson Commercial |
$4,738.67
|
| Rate for Payer: UMR Bronson Commercial |
$3,159.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,077.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,384.85
|
|
|
HC REMOVE EAR CANAL LESION(S)
|
Facility
|
OP
|
$10,769.70
|
|
|
Service Code
|
CPT 69145
|
| Hospital Charge Code |
76100481
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,513.70 |
| Max. Negotiated Rate |
$9,692.73 |
| Rate for Payer: Aetna American Axle |
$7,000.31
|
| Rate for Payer: Aetna American Axle |
$4,666.87
|
| Rate for Payer: Aetna Commercial |
$9,154.25
|
| Rate for Payer: Aetna Commercial |
$6,102.83
|
| Rate for Payer: Aetna Medicare |
$3,010.04
|
| Rate for Payer: Aetna Medicare |
$3,010.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,000.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,666.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,617.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,617.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,617.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,617.84
|
| Rate for Payer: BCBS Complete |
$1,589.53
|
| Rate for Payer: BCBS Complete |
$1,589.53
|
| Rate for Payer: BCBS MAPPO |
$2,894.27
|
| Rate for Payer: BCBS MAPPO |
$2,894.27
|
| Rate for Payer: BCBS Trust/PPO |
$1,940.82
|
| Rate for Payer: BCBS Trust/PPO |
$1,940.82
|
| Rate for Payer: BCN Commercial |
$1,940.82
|
| Rate for Payer: BCN Commercial |
$1,940.82
|
| Rate for Payer: BCN Medicare Advantage |
$2,894.27
|
| Rate for Payer: BCN Medicare Advantage |
$2,894.27
|
| Rate for Payer: Cash Price |
$5,743.84
|
| Rate for Payer: Cash Price |
$8,615.76
|
| Rate for Payer: Cash Price |
$5,743.84
|
| Rate for Payer: Cash Price |
$8,615.76
|
| Rate for Payer: Cash Price |
$8,615.76
|
| Rate for Payer: Cash Price |
$5,743.84
|
| Rate for Payer: Cofinity Advantage |
$7,538.79
|
| Rate for Payer: Cofinity Advantage |
$5,025.86
|
| Rate for Payer: Cofinity Commercial |
$6,174.63
|
| Rate for Payer: Cofinity Commercial |
$9,261.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,743.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,615.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,894.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,894.27
|
| Rate for Payer: Healthscope Commercial |
$6,461.82
|
| Rate for Payer: Healthscope Commercial |
$9,692.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,025.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7,538.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,077.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,384.85
|
| Rate for Payer: Mclaren Medicaid |
$2,894.27
|
| Rate for Payer: Mclaren Medicaid |
$2,894.27
|
| Rate for Payer: Mclaren Medicare |
$2,894.27
|
| Rate for Payer: Mclaren Medicare |
$2,894.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,038.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,038.98
|
| Rate for Payer: Meridian Medicaid |
$3,038.98
|
| Rate for Payer: Meridian Medicaid |
$3,038.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,328.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,328.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,183.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,183.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,154.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,102.83
|
| Rate for Payer: Nomi Health Commercial |
$8,682.81
|
| Rate for Payer: Nomi Health Commercial |
$8,682.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,384.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8,077.27
|
| Rate for Payer: PACE Medicare |
$2,749.56
|
| Rate for Payer: PACE Medicare |
$2,749.56
|
| Rate for Payer: PACE SWMI |
$2,894.27
|
| Rate for Payer: PACE SWMI |
$2,894.27
|
| Rate for Payer: PHP Commercial |
$6,102.83
|
| Rate for Payer: PHP Commercial |
$9,154.25
|
| Rate for Payer: PHP Medicare Advantage |
$2,894.27
|
| Rate for Payer: PHP Medicare Advantage |
$2,894.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,513.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,513.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$9,359.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$9,359.82
|
| Rate for Payer: Priority Health Medicare |
$2,894.27
|
| Rate for Payer: Priority Health Medicare |
$2,894.27
|
| Rate for Payer: Priority Health SBD |
$4,523.27
|
| Rate for Payer: Priority Health SBD |
$6,784.91
|
| Rate for Payer: Priority Health Tiered Network |
$7,487.86
|
| Rate for Payer: Priority Health Tiered Network |
$7,487.86
|
| Rate for Payer: Railroad Medicare Medicare |
$2,894.27
|
| Rate for Payer: Railroad Medicare Medicare |
$2,894.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,666.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,000.31
|
| Rate for Payer: UHC Core |
$3,740.68
|
| Rate for Payer: UHC Core |
$5,611.01
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,894.27
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,894.27
|
| Rate for Payer: UHC Exchange |
$2,821.66
|
| Rate for Payer: UHC Exchange |
$4,232.49
|
| Rate for Payer: UHC Medicaid |
$1,513.70
|
| Rate for Payer: UHC Medicaid |
$1,513.70
|
| Rate for Payer: UHCCP Medicaid |
$1,513.70
|
| Rate for Payer: UHCCP Medicaid |
$1,513.70
|
| Rate for Payer: UMR Bronson Commercial |
$3,984.79
|
| Rate for Payer: UMR Bronson Commercial |
$2,656.53
|
| Rate for Payer: VA VA |
$2,894.27
|
| Rate for Payer: VA VA |
$2,894.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,384.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,077.27
|
|
|
HC REMOVE EXTERNAL URETERAL STENT
|
Facility
|
IP
|
$2,602.48
|
|
|
Service Code
|
CPT 50387
|
| Hospital Charge Code |
36100240
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,145.09 |
| Max. Negotiated Rate |
$2,342.23 |
| Rate for Payer: Aetna American Axle |
$1,691.61
|
| Rate for Payer: Aetna Commercial |
$2,212.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,691.61
|
| Rate for Payer: Cash Price |
$2,081.98
|
| Rate for Payer: Cofinity Advantage |
$1,821.74
|
| Rate for Payer: Cofinity Commercial |
$2,238.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,081.98
|
| Rate for Payer: Healthscope Commercial |
$2,342.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,821.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,951.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,212.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,951.86
|
| Rate for Payer: PHP Commercial |
$2,212.11
|
| Rate for Payer: Priority Health SBD |
$1,639.56
|
| Rate for Payer: UMR Bronson Commercial |
$1,145.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,951.86
|
|
|
HC REMOVE EXTERNAL URETERAL STENT
|
Facility
|
OP
|
$2,602.48
|
|
|
Service Code
|
CPT 50387
|
| Hospital Charge Code |
36100240
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$962.92 |
| Max. Negotiated Rate |
$6,735.82 |
| Rate for Payer: Aetna American Axle |
$1,691.61
|
| Rate for Payer: Aetna Commercial |
$2,212.11
|
| Rate for Payer: Aetna Medicare |
$2,166.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,691.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,603.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,603.59
|
| Rate for Payer: BCBS Complete |
$1,143.91
|
| Rate for Payer: BCBS MAPPO |
$2,082.87
|
| Rate for Payer: BCBS Trust/PPO |
$1,490.92
|
| Rate for Payer: BCN Commercial |
$1,490.92
|
| Rate for Payer: BCN Medicare Advantage |
$2,082.87
|
| Rate for Payer: Cash Price |
$2,081.98
|
| Rate for Payer: Cash Price |
$2,081.98
|
| Rate for Payer: Cash Price |
$2,081.98
|
| Rate for Payer: Cofinity Advantage |
$1,821.74
|
| Rate for Payer: Cofinity Commercial |
$2,238.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,081.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,082.87
|
| Rate for Payer: Healthscope Commercial |
$2,342.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,821.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,951.86
|
| Rate for Payer: Mclaren Medicaid |
$2,082.87
|
| Rate for Payer: Mclaren Medicare |
$2,082.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,187.01
|
| Rate for Payer: Meridian Medicaid |
$2,187.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,395.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,291.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,212.11
|
| Rate for Payer: Nomi Health Commercial |
$6,248.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,951.86
|
| Rate for Payer: PACE Medicare |
$1,978.73
|
| Rate for Payer: PACE SWMI |
$2,082.87
|
| Rate for Payer: PHP Commercial |
$2,212.11
|
| Rate for Payer: PHP Medicare Advantage |
$2,082.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,089.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,735.82
|
| Rate for Payer: Priority Health Medicare |
$2,082.87
|
| Rate for Payer: Priority Health SBD |
$1,639.56
|
| Rate for Payer: Priority Health Tiered Network |
$5,388.66
|
| Rate for Payer: Railroad Medicare Medicare |
$2,082.87
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,082.87
|
| Rate for Payer: UHC Medicaid |
$1,089.34
|
| Rate for Payer: UHCCP Medicaid |
$1,089.34
|
| Rate for Payer: UMR Bronson Commercial |
$962.92
|
| Rate for Payer: VA VA |
$2,082.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,951.86
|
|
|
HC REMOVE FB EYE
|
Facility
|
IP
|
$385.45
|
|
| Hospital Charge Code |
45000049
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$169.60 |
| Max. Negotiated Rate |
$346.90 |
| Rate for Payer: Aetna American Axle |
$250.54
|
| Rate for Payer: Aetna Commercial |
$327.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$250.54
|
| Rate for Payer: Cash Price |
$308.36
|
| Rate for Payer: Cofinity Advantage |
$269.81
|
| Rate for Payer: Cofinity Commercial |
$331.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$308.36
|
| Rate for Payer: Healthscope Commercial |
$346.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$269.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$289.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$327.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$289.09
|
| Rate for Payer: PHP Commercial |
$327.63
|
| Rate for Payer: Priority Health SBD |
$242.83
|
| Rate for Payer: UMR Bronson Commercial |
$169.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$289.09
|
|
|
HC REMOVE FB EYE
|
Facility
|
OP
|
$385.45
|
|
| Hospital Charge Code |
45000049
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$125.00 |
| Max. Negotiated Rate |
$346.90 |
| Rate for Payer: Aetna American Axle |
$250.54
|
| Rate for Payer: Aetna Commercial |
$327.63
|
| Rate for Payer: Aetna Medicare |
$192.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$250.54
|
| Rate for Payer: BCBS Complete |
$154.18
|
| Rate for Payer: Cash Price |
$308.36
|
| Rate for Payer: Cash Price |
$308.36
|
| Rate for Payer: Cofinity Advantage |
$269.81
|
| Rate for Payer: Cofinity Commercial |
$331.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$308.36
|
| Rate for Payer: Healthscope Commercial |
$346.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$269.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$289.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$308.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$327.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$289.09
|
| Rate for Payer: PHP Commercial |
$327.63
|
| Rate for Payer: Priority Health SBD |
$242.83
|
| Rate for Payer: UHCCP Medicaid |
$125.00
|
| Rate for Payer: UMR Bronson Commercial |
$142.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$289.09
|
|
|
HC REMOVE FB FOOT, SUBQ
|
Facility
|
OP
|
$971.03
|
|
|
Service Code
|
CPT 28190
|
| Hospital Charge Code |
76100265
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$359.28 |
| Max. Negotiated Rate |
$2,281.79 |
| Rate for Payer: Aetna American Axle |
$631.17
|
| Rate for Payer: Aetna Commercial |
$825.38
|
| Rate for Payer: Aetna Medicare |
$733.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$631.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$881.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$881.99
|
| Rate for Payer: BCBS Complete |
$387.51
|
| Rate for Payer: BCBS MAPPO |
$705.59
|
| Rate for Payer: BCBS Trust/PPO |
$879.35
|
| Rate for Payer: BCN Commercial |
$879.35
|
| Rate for Payer: BCN Medicare Advantage |
$705.59
|
| Rate for Payer: Cash Price |
$776.82
|
| Rate for Payer: Cash Price |
$776.82
|
| Rate for Payer: Cash Price |
$776.82
|
| Rate for Payer: Cofinity Advantage |
$679.72
|
| Rate for Payer: Cofinity Commercial |
$835.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$776.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$705.59
|
| Rate for Payer: Healthscope Commercial |
$873.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$679.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$728.27
|
| Rate for Payer: Mclaren Medicaid |
$705.59
|
| Rate for Payer: Mclaren Medicare |
$705.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$740.87
|
| Rate for Payer: Meridian Medicaid |
$740.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$811.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$776.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$825.38
|
| Rate for Payer: Nomi Health Commercial |
$2,116.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$728.27
|
| Rate for Payer: PACE Medicare |
$670.31
|
| Rate for Payer: PACE SWMI |
$705.59
|
| Rate for Payer: PHP Commercial |
$825.38
|
| Rate for Payer: PHP Medicare Advantage |
$705.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$369.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,281.79
|
| Rate for Payer: Priority Health Medicare |
$705.59
|
| Rate for Payer: Priority Health SBD |
$611.75
|
| Rate for Payer: Priority Health Tiered Network |
$1,825.43
|
| Rate for Payer: Railroad Medicare Medicare |
$705.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$631.17
|
| Rate for Payer: UHC Core |
$505.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$705.59
|
| Rate for Payer: UHC Exchange |
$381.61
|
| Rate for Payer: UHC Medicaid |
$369.02
|
| Rate for Payer: UHCCP Medicaid |
$369.02
|
| Rate for Payer: UMR Bronson Commercial |
$359.28
|
| Rate for Payer: VA VA |
$705.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$728.27
|
|
|
HC REMOVE FB FOOT, SUBQ
|
Facility
|
IP
|
$971.03
|
|
|
Service Code
|
CPT 28190
|
| Hospital Charge Code |
76100265
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$427.25 |
| Max. Negotiated Rate |
$873.93 |
| Rate for Payer: Aetna American Axle |
$631.17
|
| Rate for Payer: Aetna Commercial |
$825.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$631.17
|
| Rate for Payer: Cash Price |
$776.82
|
| Rate for Payer: Cofinity Advantage |
$679.72
|
| Rate for Payer: Cofinity Commercial |
$835.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$776.82
|
| Rate for Payer: Healthscope Commercial |
$873.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$679.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$728.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$825.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$728.27
|
| Rate for Payer: PHP Commercial |
$825.38
|
| Rate for Payer: Priority Health SBD |
$611.75
|
| Rate for Payer: UMR Bronson Commercial |
$427.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$728.27
|
|
|
HC REMOVE F/B SKIN,SIMPLE,INCISIO
|
Facility
|
OP
|
$252.40
|
|
| Hospital Charge Code |
45000048
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$93.39 |
| Max. Negotiated Rate |
$227.16 |
| Rate for Payer: Aetna American Axle |
$164.06
|
| Rate for Payer: Aetna Commercial |
$214.54
|
| Rate for Payer: Aetna Medicare |
$126.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.06
|
| Rate for Payer: BCBS Complete |
$100.96
|
| Rate for Payer: Cash Price |
$201.92
|
| Rate for Payer: Cash Price |
$201.92
|
| Rate for Payer: Cofinity Advantage |
$176.68
|
| Rate for Payer: Cofinity Commercial |
$217.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.92
|
| Rate for Payer: Healthscope Commercial |
$227.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$176.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$189.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$201.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$214.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$189.30
|
| Rate for Payer: PHP Commercial |
$214.54
|
| Rate for Payer: Priority Health SBD |
$159.01
|
| Rate for Payer: UHCCP Medicaid |
$125.00
|
| Rate for Payer: UMR Bronson Commercial |
$93.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$189.30
|
|
|
HC REMOVE F/B SKIN,SIMPLE,INCISIO
|
Facility
|
IP
|
$252.40
|
|
| Hospital Charge Code |
45000048
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$111.06 |
| Max. Negotiated Rate |
$227.16 |
| Rate for Payer: Aetna American Axle |
$164.06
|
| Rate for Payer: Aetna Commercial |
$214.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.06
|
| Rate for Payer: Cash Price |
$201.92
|
| Rate for Payer: Cofinity Advantage |
$176.68
|
| Rate for Payer: Cofinity Commercial |
$217.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.92
|
| Rate for Payer: Healthscope Commercial |
$227.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$176.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$189.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$214.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$189.30
|
| Rate for Payer: PHP Commercial |
$214.54
|
| Rate for Payer: Priority Health SBD |
$159.01
|
| Rate for Payer: UMR Bronson Commercial |
$111.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$189.30
|
|
|
HC REMOVE FB UPPER ARM/ELBOW SUBQ
|
Facility
|
IP
|
$1,750.99
|
|
|
Service Code
|
CPT 24200
|
| Hospital Charge Code |
76100159
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$770.44 |
| Max. Negotiated Rate |
$1,575.89 |
| Rate for Payer: Aetna American Axle |
$1,138.14
|
| Rate for Payer: Aetna Commercial |
$1,488.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,138.14
|
| Rate for Payer: Cash Price |
$1,400.79
|
| Rate for Payer: Cofinity Advantage |
$1,225.69
|
| Rate for Payer: Cofinity Commercial |
$1,505.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,400.79
|
| Rate for Payer: Healthscope Commercial |
$1,575.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,225.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,313.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,488.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,313.24
|
| Rate for Payer: PHP Commercial |
$1,488.34
|
| Rate for Payer: Priority Health SBD |
$1,103.12
|
| Rate for Payer: UMR Bronson Commercial |
$770.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,313.24
|
|
|
HC REMOVE FB UPPER ARM/ELBOW SUBQ
|
Facility
|
OP
|
$1,750.99
|
|
|
Service Code
|
CPT 24200
|
| Hospital Charge Code |
76100159
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$217.42 |
| Max. Negotiated Rate |
$5,321.93 |
| Rate for Payer: Aetna American Axle |
$1,138.14
|
| Rate for Payer: Aetna Commercial |
$1,488.34
|
| Rate for Payer: Aetna Medicare |
$1,711.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,138.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,057.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,057.07
|
| Rate for Payer: BCBS Complete |
$903.80
|
| Rate for Payer: BCBS MAPPO |
$1,645.66
|
| Rate for Payer: BCBS Trust/PPO |
$217.42
|
| Rate for Payer: BCN Commercial |
$217.42
|
| Rate for Payer: BCN Medicare Advantage |
$1,645.66
|
| Rate for Payer: Cash Price |
$1,400.79
|
| Rate for Payer: Cash Price |
$1,400.79
|
| Rate for Payer: Cash Price |
$1,400.79
|
| Rate for Payer: Cofinity Advantage |
$1,225.69
|
| Rate for Payer: Cofinity Commercial |
$1,505.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,400.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,645.66
|
| Rate for Payer: Healthscope Commercial |
$1,575.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,225.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,313.24
|
| Rate for Payer: Mclaren Medicaid |
$1,645.66
|
| Rate for Payer: Mclaren Medicare |
$1,645.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,727.94
|
| Rate for Payer: Meridian Medicaid |
$1,727.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,892.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,810.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,488.34
|
| Rate for Payer: Nomi Health Commercial |
$4,936.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,313.24
|
| Rate for Payer: PACE Medicare |
$1,563.38
|
| Rate for Payer: PACE SWMI |
$1,645.66
|
| Rate for Payer: PHP Commercial |
$1,488.34
|
| Rate for Payer: PHP Medicare Advantage |
$1,645.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$860.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,321.93
|
| Rate for Payer: Priority Health Medicare |
$1,645.66
|
| Rate for Payer: Priority Health SBD |
$1,103.12
|
| Rate for Payer: Priority Health Tiered Network |
$4,257.54
|
| Rate for Payer: Railroad Medicare Medicare |
$1,645.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,138.14
|
| Rate for Payer: UHC Core |
$912.27
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,645.66
|
| Rate for Payer: UHC Exchange |
$688.14
|
| Rate for Payer: UHC Medicaid |
$860.68
|
| Rate for Payer: UHCCP Medicaid |
$860.68
|
| Rate for Payer: UMR Bronson Commercial |
$647.87
|
| Rate for Payer: VA VA |
$1,645.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,313.24
|
|
|
HC REMOVE FB XTRNL AUDITORY CANAL ANES
|
Facility
|
OP
|
$4,260.44
|
|
|
Service Code
|
CPT 69205
|
| Hospital Charge Code |
76100482
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$860.68 |
| Max. Negotiated Rate |
$5,321.93 |
| Rate for Payer: Aetna American Axle |
$2,769.29
|
| Rate for Payer: Aetna Commercial |
$3,621.37
|
| Rate for Payer: Aetna Medicare |
$1,711.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,769.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,057.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,057.07
|
| Rate for Payer: BCBS Complete |
$903.80
|
| Rate for Payer: BCBS MAPPO |
$1,645.66
|
| Rate for Payer: BCBS Trust/PPO |
$2,355.68
|
| Rate for Payer: BCN Commercial |
$2,355.68
|
| Rate for Payer: BCN Medicare Advantage |
$1,645.66
|
| Rate for Payer: Cash Price |
$3,408.35
|
| Rate for Payer: Cash Price |
$3,408.35
|
| Rate for Payer: Cash Price |
$3,408.35
|
| Rate for Payer: Cofinity Advantage |
$2,982.31
|
| Rate for Payer: Cofinity Commercial |
$3,663.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,408.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,645.66
|
| Rate for Payer: Healthscope Commercial |
$3,834.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,982.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,195.33
|
| Rate for Payer: Mclaren Medicaid |
$1,645.66
|
| Rate for Payer: Mclaren Medicare |
$1,645.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,727.94
|
| Rate for Payer: Meridian Medicaid |
$1,727.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,892.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,810.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,621.37
|
| Rate for Payer: Nomi Health Commercial |
$4,936.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,195.33
|
| Rate for Payer: PACE Medicare |
$1,563.38
|
| Rate for Payer: PACE SWMI |
$1,645.66
|
| Rate for Payer: PHP Commercial |
$3,621.37
|
| Rate for Payer: PHP Medicare Advantage |
$1,645.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$860.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,321.93
|
| Rate for Payer: Priority Health Medicare |
$1,645.66
|
| Rate for Payer: Priority Health SBD |
$2,684.08
|
| Rate for Payer: Priority Health Tiered Network |
$4,257.54
|
| Rate for Payer: Railroad Medicare Medicare |
$1,645.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,769.29
|
| Rate for Payer: UHC Core |
$2,219.69
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,645.66
|
| Rate for Payer: UHC Exchange |
$1,674.35
|
| Rate for Payer: UHC Medicaid |
$860.68
|
| Rate for Payer: UHCCP Medicaid |
$860.68
|
| Rate for Payer: UMR Bronson Commercial |
$1,576.36
|
| Rate for Payer: VA VA |
$1,645.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,195.33
|
|
|
HC REMOVE FB XTRNL AUDITORY CANAL ANES
|
Facility
|
IP
|
$4,260.44
|
|
|
Service Code
|
CPT 69205
|
| Hospital Charge Code |
76100482
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,874.59 |
| Max. Negotiated Rate |
$3,834.40 |
| Rate for Payer: Aetna American Axle |
$2,769.29
|
| Rate for Payer: Aetna Commercial |
$3,621.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,769.29
|
| Rate for Payer: Cash Price |
$3,408.35
|
| Rate for Payer: Cofinity Advantage |
$2,982.31
|
| Rate for Payer: Cofinity Commercial |
$3,663.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,408.35
|
| Rate for Payer: Healthscope Commercial |
$3,834.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,982.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,195.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,621.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,195.33
|
| Rate for Payer: PHP Commercial |
$3,621.37
|
| Rate for Payer: Priority Health SBD |
$2,684.08
|
| Rate for Payer: UMR Bronson Commercial |
$1,874.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,195.33
|
|
|
HC REMOVE FOREIGN BODY COMPLIC
|
Facility
|
OP
|
$2,184.69
|
|
|
Service Code
|
CPT 10121
|
| Hospital Charge Code |
76100225
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$808.34 |
| Max. Negotiated Rate |
$5,321.93 |
| Rate for Payer: Aetna American Axle |
$1,420.05
|
| Rate for Payer: Aetna Commercial |
$1,856.99
|
| Rate for Payer: Aetna Medicare |
$1,711.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,420.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,057.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,057.07
|
| Rate for Payer: BCBS Complete |
$903.80
|
| Rate for Payer: BCBS MAPPO |
$1,645.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,888.78
|
| Rate for Payer: BCN Commercial |
$1,888.78
|
| Rate for Payer: BCN Medicare Advantage |
$1,645.66
|
| Rate for Payer: Cash Price |
$1,747.75
|
| Rate for Payer: Cash Price |
$1,747.75
|
| Rate for Payer: Cash Price |
$1,747.75
|
| Rate for Payer: Cofinity Advantage |
$1,529.28
|
| Rate for Payer: Cofinity Commercial |
$1,878.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,747.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,645.66
|
| Rate for Payer: Healthscope Commercial |
$1,966.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,529.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,638.52
|
| Rate for Payer: Mclaren Medicaid |
$1,645.66
|
| Rate for Payer: Mclaren Medicare |
$1,645.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,727.94
|
| Rate for Payer: Meridian Medicaid |
$1,727.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,892.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,810.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,856.99
|
| Rate for Payer: Nomi Health Commercial |
$4,936.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,638.52
|
| Rate for Payer: PACE Medicare |
$1,563.38
|
| Rate for Payer: PACE SWMI |
$1,645.66
|
| Rate for Payer: PHP Commercial |
$1,856.99
|
| Rate for Payer: PHP Medicare Advantage |
$1,645.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$860.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,321.93
|
| Rate for Payer: Priority Health Medicare |
$1,645.66
|
| Rate for Payer: Priority Health SBD |
$1,376.35
|
| Rate for Payer: Priority Health Tiered Network |
$4,257.54
|
| Rate for Payer: Railroad Medicare Medicare |
$1,645.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,420.05
|
| Rate for Payer: UHC Core |
$1,138.22
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,645.66
|
| Rate for Payer: UHC Exchange |
$858.58
|
| Rate for Payer: UHC Medicaid |
$860.68
|
| Rate for Payer: UHCCP Medicaid |
$860.68
|
| Rate for Payer: UMR Bronson Commercial |
$808.34
|
| Rate for Payer: VA VA |
$1,645.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,638.52
|
|
|
HC REMOVE FOREIGN BODY COMPLIC
|
Facility
|
IP
|
$2,184.69
|
|
|
Service Code
|
CPT 10121
|
| Hospital Charge Code |
76100225
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$961.26 |
| Max. Negotiated Rate |
$1,966.22 |
| Rate for Payer: Aetna American Axle |
$1,420.05
|
| Rate for Payer: Aetna Commercial |
$1,856.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,420.05
|
| Rate for Payer: Cash Price |
$1,747.75
|
| Rate for Payer: Cofinity Advantage |
$1,529.28
|
| Rate for Payer: Cofinity Commercial |
$1,878.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,747.75
|
| Rate for Payer: Healthscope Commercial |
$1,966.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,529.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,638.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,856.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,638.52
|
| Rate for Payer: PHP Commercial |
$1,856.99
|
| Rate for Payer: Priority Health SBD |
$1,376.35
|
| Rate for Payer: UMR Bronson Commercial |
$961.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,638.52
|
|
|
HC REMOVE FOREIGN BODY EYE EXTERNAL
|
Facility
|
IP
|
$116.12
|
|
|
Service Code
|
CPT 65205
|
| Hospital Charge Code |
45000015
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$51.09 |
| Max. Negotiated Rate |
$104.51 |
| Rate for Payer: Aetna American Axle |
$75.48
|
| Rate for Payer: Aetna Commercial |
$98.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.48
|
| Rate for Payer: Cash Price |
$92.90
|
| Rate for Payer: Cofinity Advantage |
$81.28
|
| Rate for Payer: Cofinity Commercial |
$99.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.90
|
| Rate for Payer: Healthscope Commercial |
$104.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$81.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$87.09
|
| Rate for Payer: PHP Commercial |
$98.70
|
| Rate for Payer: Priority Health SBD |
$73.16
|
| Rate for Payer: UMR Bronson Commercial |
$51.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.09
|
|
