|
HC RENO 60 PER ML
|
Facility
|
OP
|
$0.41
|
|
|
Service Code
|
HCPCS Q9961
|
| Hospital Charge Code |
63600018
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: Aetna American Axle |
$0.27
|
| Rate for Payer: Aetna Commercial |
$0.35
|
| Rate for Payer: Aetna Medicare |
$0.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.27
|
| Rate for Payer: BCBS Complete |
$0.16
|
| Rate for Payer: BCBS Trust/PPO |
$0.80
|
| Rate for Payer: BCN Commercial |
$0.80
|
| Rate for Payer: Cash Price |
$0.33
|
| Rate for Payer: Cash Price |
$0.33
|
| Rate for Payer: Cofinity Advantage |
$0.29
|
| Rate for Payer: Cofinity Commercial |
$0.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.33
|
| Rate for Payer: Healthscope Commercial |
$0.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.31
|
| Rate for Payer: PHP Commercial |
$0.35
|
| Rate for Payer: Priority Health SBD |
$0.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.43
|
| Rate for Payer: UHC Core |
$0.43
|
| Rate for Payer: UHC Exchange |
$0.43
|
| Rate for Payer: UMR Bronson Commercial |
$0.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.31
|
|
|
HC RENO 60 PER ML
|
Facility
|
IP
|
$0.41
|
|
|
Service Code
|
HCPCS Q9961
|
| Hospital Charge Code |
63600018
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.37 |
| Rate for Payer: Aetna American Axle |
$0.27
|
| Rate for Payer: Aetna Commercial |
$0.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.27
|
| Rate for Payer: Cash Price |
$0.33
|
| Rate for Payer: Cofinity Advantage |
$0.29
|
| Rate for Payer: Cofinity Commercial |
$0.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.33
|
| Rate for Payer: Healthscope Commercial |
$0.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.31
|
| Rate for Payer: PHP Commercial |
$0.35
|
| Rate for Payer: Priority Health SBD |
$0.26
|
| Rate for Payer: UMR Bronson Commercial |
$0.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.31
|
|
|
HC REPAIR COMPLEX EYELID/NOSE/EAR/LIP 1.1-2.5 CM
|
Facility
|
IP
|
$1,612.62
|
|
|
Service Code
|
CPT 13151
|
| Hospital Charge Code |
76100443
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$709.55 |
| Max. Negotiated Rate |
$1,451.36 |
| Rate for Payer: Aetna American Axle |
$1,048.20
|
| Rate for Payer: Aetna Commercial |
$1,370.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,048.20
|
| Rate for Payer: Cash Price |
$1,290.10
|
| Rate for Payer: Cofinity Advantage |
$1,128.83
|
| Rate for Payer: Cofinity Commercial |
$1,386.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,290.10
|
| Rate for Payer: Healthscope Commercial |
$1,451.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,128.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,209.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,370.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,209.46
|
| Rate for Payer: PHP Commercial |
$1,370.73
|
| Rate for Payer: Priority Health SBD |
$1,015.95
|
| Rate for Payer: UMR Bronson Commercial |
$709.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,209.46
|
|
|
HC REPAIR COMPLEX EYELID/NOSE/EAR/LIP 1.1-2.5 CM
|
Facility
|
OP
|
$1,612.62
|
|
|
Service Code
|
CPT 13151
|
| Hospital Charge Code |
76100443
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$385.14 |
| Max. Negotiated Rate |
$2,381.49 |
| Rate for Payer: Aetna American Axle |
$1,048.20
|
| Rate for Payer: Aetna Commercial |
$1,370.73
|
| Rate for Payer: Aetna Medicare |
$765.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,048.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$920.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$920.51
|
| Rate for Payer: BCBS Complete |
$404.44
|
| Rate for Payer: BCBS MAPPO |
$736.41
|
| Rate for Payer: BCBS Trust/PPO |
$787.19
|
| Rate for Payer: BCN Commercial |
$787.19
|
| Rate for Payer: BCN Medicare Advantage |
$736.41
|
| Rate for Payer: Cash Price |
$1,290.10
|
| Rate for Payer: Cash Price |
$1,290.10
|
| Rate for Payer: Cash Price |
$1,290.10
|
| Rate for Payer: Cofinity Advantage |
$1,128.83
|
| Rate for Payer: Cofinity Commercial |
$1,386.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,290.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$736.41
|
| Rate for Payer: Healthscope Commercial |
$1,451.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,128.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,209.46
|
| Rate for Payer: Mclaren Medicaid |
$736.41
|
| Rate for Payer: Mclaren Medicare |
$736.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$773.23
|
| Rate for Payer: Meridian Medicaid |
$773.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$846.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$810.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,370.73
|
| Rate for Payer: Nomi Health Commercial |
$2,209.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,209.46
|
| Rate for Payer: PACE Medicare |
$699.59
|
| Rate for Payer: PACE SWMI |
$736.41
|
| Rate for Payer: PHP Commercial |
$1,370.73
|
| Rate for Payer: PHP Medicare Advantage |
$736.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$385.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,381.49
|
| Rate for Payer: Priority Health Medicare |
$736.41
|
| Rate for Payer: Priority Health SBD |
$1,015.95
|
| Rate for Payer: Priority Health Tiered Network |
$1,905.19
|
| Rate for Payer: Railroad Medicare Medicare |
$736.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,048.20
|
| Rate for Payer: UHC Core |
$840.18
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$736.41
|
| Rate for Payer: UHC Exchange |
$633.76
|
| Rate for Payer: UHC Medicaid |
$385.14
|
| Rate for Payer: UHCCP Medicaid |
$385.14
|
| Rate for Payer: UMR Bronson Commercial |
$596.67
|
| Rate for Payer: VA VA |
$736.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,209.46
|
|
|
HC REPAIR COMPLEX EYELID/NOSE/EAR/LIP 2.6-7.5 CM
|
Facility
|
OP
|
$1,612.62
|
|
|
Service Code
|
CPT 13152
|
| Hospital Charge Code |
76100444
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$385.14 |
| Max. Negotiated Rate |
$2,381.49 |
| Rate for Payer: Aetna American Axle |
$1,048.20
|
| Rate for Payer: Aetna Commercial |
$1,370.73
|
| Rate for Payer: Aetna Medicare |
$765.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,048.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$920.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$920.51
|
| Rate for Payer: BCBS Complete |
$404.44
|
| Rate for Payer: BCBS MAPPO |
$736.41
|
| Rate for Payer: BCBS Trust/PPO |
$1,636.56
|
| Rate for Payer: BCN Commercial |
$1,636.56
|
| Rate for Payer: BCN Medicare Advantage |
$736.41
|
| Rate for Payer: Cash Price |
$1,290.10
|
| Rate for Payer: Cash Price |
$1,290.10
|
| Rate for Payer: Cash Price |
$1,290.10
|
| Rate for Payer: Cofinity Advantage |
$1,128.83
|
| Rate for Payer: Cofinity Commercial |
$1,386.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,290.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$736.41
|
| Rate for Payer: Healthscope Commercial |
$1,451.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,128.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,209.46
|
| Rate for Payer: Mclaren Medicaid |
$736.41
|
| Rate for Payer: Mclaren Medicare |
$736.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$773.23
|
| Rate for Payer: Meridian Medicaid |
$773.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$846.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$810.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,370.73
|
| Rate for Payer: Nomi Health Commercial |
$2,209.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,209.46
|
| Rate for Payer: PACE Medicare |
$699.59
|
| Rate for Payer: PACE SWMI |
$736.41
|
| Rate for Payer: PHP Commercial |
$1,370.73
|
| Rate for Payer: PHP Medicare Advantage |
$736.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$385.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,381.49
|
| Rate for Payer: Priority Health Medicare |
$736.41
|
| Rate for Payer: Priority Health SBD |
$1,015.95
|
| Rate for Payer: Priority Health Tiered Network |
$1,905.19
|
| Rate for Payer: Railroad Medicare Medicare |
$736.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,048.20
|
| Rate for Payer: UHC Core |
$840.18
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$736.41
|
| Rate for Payer: UHC Exchange |
$633.76
|
| Rate for Payer: UHC Medicaid |
$385.14
|
| Rate for Payer: UHCCP Medicaid |
$385.14
|
| Rate for Payer: UMR Bronson Commercial |
$596.67
|
| Rate for Payer: VA VA |
$736.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,209.46
|
|
|
HC REPAIR COMPLEX EYELID/NOSE/EAR/LIP 2.6-7.5 CM
|
Facility
|
IP
|
$1,612.62
|
|
|
Service Code
|
CPT 13152
|
| Hospital Charge Code |
76100444
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$709.55 |
| Max. Negotiated Rate |
$1,451.36 |
| Rate for Payer: Aetna American Axle |
$1,048.20
|
| Rate for Payer: Aetna Commercial |
$1,370.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,048.20
|
| Rate for Payer: Cash Price |
$1,290.10
|
| Rate for Payer: Cofinity Advantage |
$1,128.83
|
| Rate for Payer: Cofinity Commercial |
$1,386.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,290.10
|
| Rate for Payer: Healthscope Commercial |
$1,451.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,128.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,209.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,370.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,209.46
|
| Rate for Payer: PHP Commercial |
$1,370.73
|
| Rate for Payer: Priority Health SBD |
$1,015.95
|
| Rate for Payer: UMR Bronson Commercial |
$709.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,209.46
|
|
|
HC REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 2.6-7.5 CM
|
Facility
|
IP
|
$1,695.85
|
|
|
Service Code
|
CPT 13132
|
| Hospital Charge Code |
76100379
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$746.17 |
| Max. Negotiated Rate |
$1,526.27 |
| Rate for Payer: Aetna American Axle |
$1,102.30
|
| Rate for Payer: Aetna Commercial |
$1,441.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,102.30
|
| Rate for Payer: Cash Price |
$1,356.68
|
| Rate for Payer: Cofinity Advantage |
$1,187.10
|
| Rate for Payer: Cofinity Commercial |
$1,458.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,356.68
|
| Rate for Payer: Healthscope Commercial |
$1,526.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,187.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,271.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,441.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,271.89
|
| Rate for Payer: PHP Commercial |
$1,441.47
|
| Rate for Payer: Priority Health SBD |
$1,068.39
|
| Rate for Payer: UMR Bronson Commercial |
$746.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,271.89
|
|
|
HC REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 2.6-7.5 CM
|
Facility
|
OP
|
$1,695.85
|
|
|
Service Code
|
CPT 13132
|
| Hospital Charge Code |
76100379
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$211.84 |
| Max. Negotiated Rate |
$1,526.27 |
| Rate for Payer: Aetna American Axle |
$1,102.30
|
| Rate for Payer: Aetna Commercial |
$1,441.47
|
| Rate for Payer: Aetna Medicare |
$421.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,102.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$506.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$506.31
|
| Rate for Payer: BCBS Complete |
$222.45
|
| Rate for Payer: BCBS MAPPO |
$405.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,143.34
|
| Rate for Payer: BCN Commercial |
$1,143.34
|
| Rate for Payer: BCN Medicare Advantage |
$405.05
|
| Rate for Payer: Cash Price |
$1,356.68
|
| Rate for Payer: Cash Price |
$1,356.68
|
| Rate for Payer: Cash Price |
$1,356.68
|
| Rate for Payer: Cofinity Advantage |
$1,187.10
|
| Rate for Payer: Cofinity Commercial |
$1,458.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,356.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$405.05
|
| Rate for Payer: Healthscope Commercial |
$1,526.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,187.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,271.89
|
| Rate for Payer: Mclaren Medicaid |
$405.05
|
| Rate for Payer: Mclaren Medicare |
$405.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$425.30
|
| Rate for Payer: Meridian Medicaid |
$425.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$465.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$445.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,441.47
|
| Rate for Payer: Nomi Health Commercial |
$1,215.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,271.89
|
| Rate for Payer: PACE Medicare |
$384.80
|
| Rate for Payer: PACE SWMI |
$405.05
|
| Rate for Payer: PHP Commercial |
$1,441.47
|
| Rate for Payer: PHP Medicare Advantage |
$405.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,309.90
|
| Rate for Payer: Priority Health Medicare |
$405.05
|
| Rate for Payer: Priority Health SBD |
$1,068.39
|
| Rate for Payer: Priority Health Tiered Network |
$1,047.92
|
| Rate for Payer: Railroad Medicare Medicare |
$405.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,102.30
|
| Rate for Payer: UHC Core |
$883.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$405.05
|
| Rate for Payer: UHC Exchange |
$666.47
|
| Rate for Payer: UHC Medicaid |
$211.84
|
| Rate for Payer: UHCCP Medicaid |
$211.84
|
| Rate for Payer: UMR Bronson Commercial |
$627.46
|
| Rate for Payer: VA VA |
$405.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,271.89
|
|
|
HC REPAIR COMPLEX SCALP/ARM/LEG 1.1-2.5 CM
|
Facility
|
OP
|
$1,927.80
|
|
|
Service Code
|
CPT 13120
|
| Hospital Charge Code |
76100531
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$211.84 |
| Max. Negotiated Rate |
$1,735.02 |
| Rate for Payer: Aetna American Axle |
$1,253.07
|
| Rate for Payer: Aetna Commercial |
$1,638.63
|
| Rate for Payer: Aetna Medicare |
$421.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,253.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$506.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$506.31
|
| Rate for Payer: BCBS Complete |
$222.45
|
| Rate for Payer: BCBS MAPPO |
$405.05
|
| Rate for Payer: BCBS Trust/PPO |
$460.69
|
| Rate for Payer: BCN Commercial |
$460.69
|
| Rate for Payer: BCN Medicare Advantage |
$405.05
|
| Rate for Payer: Cash Price |
$1,542.24
|
| Rate for Payer: Cash Price |
$1,542.24
|
| Rate for Payer: Cash Price |
$1,542.24
|
| Rate for Payer: Cofinity Advantage |
$1,349.46
|
| Rate for Payer: Cofinity Commercial |
$1,657.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,542.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$405.05
|
| Rate for Payer: Healthscope Commercial |
$1,735.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,349.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,445.85
|
| Rate for Payer: Mclaren Medicaid |
$405.05
|
| Rate for Payer: Mclaren Medicare |
$405.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$425.30
|
| Rate for Payer: Meridian Medicaid |
$425.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$465.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$445.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,638.63
|
| Rate for Payer: Nomi Health Commercial |
$1,215.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,445.85
|
| Rate for Payer: PACE Medicare |
$384.80
|
| Rate for Payer: PACE SWMI |
$405.05
|
| Rate for Payer: PHP Commercial |
$1,638.63
|
| Rate for Payer: PHP Medicare Advantage |
$405.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,309.90
|
| Rate for Payer: Priority Health Medicare |
$405.05
|
| Rate for Payer: Priority Health SBD |
$1,214.51
|
| Rate for Payer: Priority Health Tiered Network |
$1,047.92
|
| Rate for Payer: Railroad Medicare Medicare |
$405.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,253.07
|
| Rate for Payer: UHC Core |
$1,004.38
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$405.05
|
| Rate for Payer: UHC Exchange |
$757.63
|
| Rate for Payer: UHC Medicaid |
$211.84
|
| Rate for Payer: UHCCP Medicaid |
$211.84
|
| Rate for Payer: UMR Bronson Commercial |
$713.29
|
| Rate for Payer: VA VA |
$405.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,445.85
|
|
|
HC REPAIR COMPLEX SCALP/ARM/LEG 1.1-2.5 CM
|
Facility
|
IP
|
$1,927.80
|
|
|
Service Code
|
CPT 13120
|
| Hospital Charge Code |
76100531
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$848.23 |
| Max. Negotiated Rate |
$1,735.02 |
| Rate for Payer: Aetna American Axle |
$1,253.07
|
| Rate for Payer: Aetna Commercial |
$1,638.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,253.07
|
| Rate for Payer: Cash Price |
$1,542.24
|
| Rate for Payer: Cofinity Advantage |
$1,349.46
|
| Rate for Payer: Cofinity Commercial |
$1,657.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,542.24
|
| Rate for Payer: Healthscope Commercial |
$1,735.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,349.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,445.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,638.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,445.85
|
| Rate for Payer: PHP Commercial |
$1,638.63
|
| Rate for Payer: Priority Health SBD |
$1,214.51
|
| Rate for Payer: UMR Bronson Commercial |
$848.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,445.85
|
|
|
HC REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5CM
|
Facility
|
OP
|
$1,603.27
|
|
|
Service Code
|
CPT 13121
|
| Hospital Charge Code |
76100554
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$211.84 |
| Max. Negotiated Rate |
$1,442.94 |
| Rate for Payer: Aetna American Axle |
$1,042.13
|
| Rate for Payer: Aetna Commercial |
$1,362.78
|
| Rate for Payer: Aetna Medicare |
$421.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,042.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$506.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$506.31
|
| Rate for Payer: BCBS Complete |
$222.45
|
| Rate for Payer: BCBS MAPPO |
$405.05
|
| Rate for Payer: BCBS Trust/PPO |
$787.19
|
| Rate for Payer: BCN Commercial |
$787.19
|
| Rate for Payer: BCN Medicare Advantage |
$405.05
|
| Rate for Payer: Cash Price |
$1,282.62
|
| Rate for Payer: Cash Price |
$1,282.62
|
| Rate for Payer: Cash Price |
$1,282.62
|
| Rate for Payer: Cofinity Advantage |
$1,122.29
|
| Rate for Payer: Cofinity Commercial |
$1,378.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,282.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$405.05
|
| Rate for Payer: Healthscope Commercial |
$1,442.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,122.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,202.45
|
| Rate for Payer: Mclaren Medicaid |
$405.05
|
| Rate for Payer: Mclaren Medicare |
$405.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$425.30
|
| Rate for Payer: Meridian Medicaid |
$425.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$465.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$445.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,362.78
|
| Rate for Payer: Nomi Health Commercial |
$1,215.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,202.45
|
| Rate for Payer: PACE Medicare |
$384.80
|
| Rate for Payer: PACE SWMI |
$405.05
|
| Rate for Payer: PHP Commercial |
$1,362.78
|
| Rate for Payer: PHP Medicare Advantage |
$405.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,309.90
|
| Rate for Payer: Priority Health Medicare |
$405.05
|
| Rate for Payer: Priority Health SBD |
$1,010.06
|
| Rate for Payer: Priority Health Tiered Network |
$1,047.92
|
| Rate for Payer: Railroad Medicare Medicare |
$405.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,042.13
|
| Rate for Payer: UHC Core |
$835.30
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$405.05
|
| Rate for Payer: UHC Exchange |
$630.09
|
| Rate for Payer: UHC Medicaid |
$211.84
|
| Rate for Payer: UHCCP Medicaid |
$211.84
|
| Rate for Payer: UMR Bronson Commercial |
$593.21
|
| Rate for Payer: VA VA |
$405.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,202.45
|
|
|
HC REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5CM
|
Facility
|
IP
|
$1,603.27
|
|
|
Service Code
|
CPT 13121
|
| Hospital Charge Code |
76100554
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$705.44 |
| Max. Negotiated Rate |
$1,442.94 |
| Rate for Payer: Aetna American Axle |
$1,042.13
|
| Rate for Payer: Aetna Commercial |
$1,362.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,042.13
|
| Rate for Payer: Cash Price |
$1,282.62
|
| Rate for Payer: Cofinity Advantage |
$1,122.29
|
| Rate for Payer: Cofinity Commercial |
$1,378.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,282.62
|
| Rate for Payer: Healthscope Commercial |
$1,442.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,122.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,202.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,362.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,202.45
|
| Rate for Payer: PHP Commercial |
$1,362.78
|
| Rate for Payer: Priority Health SBD |
$1,010.06
|
| Rate for Payer: UMR Bronson Commercial |
$705.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,202.45
|
|
|
HC REPAIR COMPLEX SCALP/ARM/LEG EA ADDL 5 CM/<
|
Facility
|
OP
|
$3,431.75
|
|
|
Service Code
|
CPT 13122
|
| Hospital Charge Code |
76100555
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,269.75 |
| Max. Negotiated Rate |
$3,088.57 |
| Rate for Payer: Aetna American Axle |
$2,230.64
|
| Rate for Payer: Aetna Commercial |
$2,916.99
|
| Rate for Payer: Aetna Medicare |
$1,715.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,230.64
|
| Rate for Payer: BCBS Complete |
$1,372.70
|
| Rate for Payer: BCBS Trust/PPO |
$1,684.94
|
| Rate for Payer: BCN Commercial |
$1,684.94
|
| Rate for Payer: Cash Price |
$2,745.40
|
| Rate for Payer: Cash Price |
$2,745.40
|
| Rate for Payer: Cash Price |
$2,745.40
|
| Rate for Payer: Cofinity Advantage |
$2,402.22
|
| Rate for Payer: Cofinity Commercial |
$2,951.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,745.40
|
| Rate for Payer: Healthscope Commercial |
$3,088.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,402.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,573.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,745.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,916.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,573.81
|
| Rate for Payer: PHP Commercial |
$2,916.99
|
| Rate for Payer: Priority Health SBD |
$2,162.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,230.64
|
| Rate for Payer: UHC Core |
$1,787.94
|
| Rate for Payer: UHC Exchange |
$1,348.68
|
| Rate for Payer: UMR Bronson Commercial |
$1,269.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,573.81
|
|
|
HC REPAIR COMPLEX SCALP/ARM/LEG EA ADDL 5 CM/<
|
Facility
|
IP
|
$3,431.75
|
|
|
Service Code
|
CPT 13122
|
| Hospital Charge Code |
76100555
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,509.97 |
| Max. Negotiated Rate |
$3,088.57 |
| Rate for Payer: Aetna American Axle |
$2,230.64
|
| Rate for Payer: Aetna Commercial |
$2,916.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,230.64
|
| Rate for Payer: Cash Price |
$2,745.40
|
| Rate for Payer: Cofinity Advantage |
$2,402.22
|
| Rate for Payer: Cofinity Commercial |
$2,951.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,745.40
|
| Rate for Payer: Healthscope Commercial |
$3,088.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,402.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,573.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,916.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,573.81
|
| Rate for Payer: PHP Commercial |
$2,916.99
|
| Rate for Payer: Priority Health SBD |
$2,162.00
|
| Rate for Payer: UMR Bronson Commercial |
$1,509.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,573.81
|
|
|
HC REPAIR CVAC WO PORT OR PUMP
|
Facility
|
IP
|
$1,090.74
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
36100131
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$479.93 |
| Max. Negotiated Rate |
$981.67 |
| Rate for Payer: Aetna American Axle |
$708.98
|
| Rate for Payer: Aetna Commercial |
$927.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$708.98
|
| Rate for Payer: Cash Price |
$872.59
|
| Rate for Payer: Cofinity Advantage |
$763.52
|
| Rate for Payer: Cofinity Commercial |
$938.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$872.59
|
| Rate for Payer: Healthscope Commercial |
$981.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$763.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$818.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$927.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$818.05
|
| Rate for Payer: PHP Commercial |
$927.13
|
| Rate for Payer: Priority Health SBD |
$687.17
|
| Rate for Payer: UMR Bronson Commercial |
$479.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$818.05
|
|
|
HC REPAIR CVAC WO PORT OR PUMP
|
Facility
|
OP
|
$1,090.74
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
36100131
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$326.90 |
| Max. Negotiated Rate |
$2,021.35 |
| Rate for Payer: Aetna American Axle |
$708.98
|
| Rate for Payer: Aetna Commercial |
$927.13
|
| Rate for Payer: Aetna Medicare |
$650.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$708.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$781.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$781.31
|
| Rate for Payer: BCBS Complete |
$343.28
|
| Rate for Payer: BCBS MAPPO |
$625.05
|
| Rate for Payer: BCBS Trust/PPO |
$695.62
|
| Rate for Payer: BCN Commercial |
$695.62
|
| Rate for Payer: BCN Medicare Advantage |
$625.05
|
| Rate for Payer: Cash Price |
$872.59
|
| Rate for Payer: Cash Price |
$872.59
|
| Rate for Payer: Cash Price |
$872.59
|
| Rate for Payer: Cofinity Advantage |
$763.52
|
| Rate for Payer: Cofinity Commercial |
$938.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$872.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$625.05
|
| Rate for Payer: Healthscope Commercial |
$981.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$763.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$818.05
|
| Rate for Payer: Mclaren Medicaid |
$625.05
|
| Rate for Payer: Mclaren Medicare |
$625.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$656.30
|
| Rate for Payer: Meridian Medicaid |
$656.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$718.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$687.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$927.13
|
| Rate for Payer: Nomi Health Commercial |
$1,875.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$818.05
|
| Rate for Payer: PACE Medicare |
$593.80
|
| Rate for Payer: PACE SWMI |
$625.05
|
| Rate for Payer: PHP Commercial |
$927.13
|
| Rate for Payer: PHP Medicare Advantage |
$625.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$326.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,021.35
|
| Rate for Payer: Priority Health Medicare |
$625.05
|
| Rate for Payer: Priority Health SBD |
$687.17
|
| Rate for Payer: Priority Health Tiered Network |
$1,617.08
|
| Rate for Payer: Railroad Medicare Medicare |
$625.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$708.98
|
| Rate for Payer: UHC Core |
$568.28
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$625.05
|
| Rate for Payer: UHC Exchange |
$428.66
|
| Rate for Payer: UHC Medicaid |
$326.90
|
| Rate for Payer: UHCCP Medicaid |
$326.90
|
| Rate for Payer: UMR Bronson Commercial |
$403.57
|
| Rate for Payer: VA VA |
$625.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$818.05
|
|
|
HC REPAIR ECTROPION EXTENSIVE
|
Facility
|
OP
|
$4,403.39
|
|
|
Service Code
|
CPT 67917
|
| Hospital Charge Code |
76100568
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,238.96 |
| Max. Negotiated Rate |
$7,660.92 |
| Rate for Payer: Aetna American Axle |
$2,862.20
|
| Rate for Payer: Aetna Commercial |
$3,742.88
|
| Rate for Payer: Aetna Medicare |
$2,463.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,862.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,961.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,961.18
|
| Rate for Payer: BCBS Complete |
$1,301.02
|
| Rate for Payer: BCBS MAPPO |
$2,368.94
|
| Rate for Payer: BCBS Trust/PPO |
$1,924.63
|
| Rate for Payer: BCN Commercial |
$1,924.63
|
| Rate for Payer: BCN Medicare Advantage |
$2,368.94
|
| Rate for Payer: Cash Price |
$3,522.71
|
| Rate for Payer: Cash Price |
$3,522.71
|
| Rate for Payer: Cash Price |
$3,522.71
|
| Rate for Payer: Cofinity Advantage |
$3,082.37
|
| Rate for Payer: Cofinity Commercial |
$3,786.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,522.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,368.94
|
| Rate for Payer: Healthscope Commercial |
$3,963.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,082.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,302.54
|
| Rate for Payer: Mclaren Medicaid |
$2,368.94
|
| Rate for Payer: Mclaren Medicare |
$2,368.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,487.39
|
| Rate for Payer: Meridian Medicaid |
$2,487.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,724.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,605.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,742.88
|
| Rate for Payer: Nomi Health Commercial |
$7,106.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,302.54
|
| Rate for Payer: PACE Medicare |
$2,250.49
|
| Rate for Payer: PACE SWMI |
$2,368.94
|
| Rate for Payer: PHP Commercial |
$3,742.88
|
| Rate for Payer: PHP Medicare Advantage |
$2,368.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,238.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$7,660.92
|
| Rate for Payer: Priority Health Medicare |
$2,368.94
|
| Rate for Payer: Priority Health SBD |
$2,774.14
|
| Rate for Payer: Priority Health Tiered Network |
$6,128.74
|
| Rate for Payer: Railroad Medicare Medicare |
$2,368.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,862.20
|
| Rate for Payer: UHC Core |
$2,294.17
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,368.94
|
| Rate for Payer: UHC Exchange |
$1,730.53
|
| Rate for Payer: UHC Medicaid |
$1,238.96
|
| Rate for Payer: UHCCP Medicaid |
$1,238.96
|
| Rate for Payer: UMR Bronson Commercial |
$1,629.25
|
| Rate for Payer: VA VA |
$2,368.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,302.54
|
|
|
HC REPAIR ECTROPION EXTENSIVE
|
Facility
|
IP
|
$4,403.39
|
|
|
Service Code
|
CPT 67917
|
| Hospital Charge Code |
76100568
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,937.49 |
| Max. Negotiated Rate |
$3,963.05 |
| Rate for Payer: Aetna American Axle |
$2,862.20
|
| Rate for Payer: Aetna Commercial |
$3,742.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,862.20
|
| Rate for Payer: Cash Price |
$3,522.71
|
| Rate for Payer: Cofinity Advantage |
$3,082.37
|
| Rate for Payer: Cofinity Commercial |
$3,786.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,522.71
|
| Rate for Payer: Healthscope Commercial |
$3,963.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,082.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,302.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,742.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,302.54
|
| Rate for Payer: PHP Commercial |
$3,742.88
|
| Rate for Payer: Priority Health SBD |
$2,774.14
|
| Rate for Payer: UMR Bronson Commercial |
$1,937.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,302.54
|
|
|
HC REPAIR EXT TENDON FINGER WO GRAFT EA
|
Facility
|
IP
|
$4,729.92
|
|
|
Service Code
|
CPT 26418
|
| Hospital Charge Code |
45000093
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,081.16 |
| Max. Negotiated Rate |
$4,256.93 |
| Rate for Payer: Aetna American Axle |
$3,074.45
|
| Rate for Payer: Aetna Commercial |
$4,020.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,074.45
|
| Rate for Payer: Cash Price |
$3,783.94
|
| Rate for Payer: Cofinity Advantage |
$3,310.94
|
| Rate for Payer: Cofinity Commercial |
$4,067.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,783.94
|
| Rate for Payer: Healthscope Commercial |
$4,256.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,310.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,547.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,020.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,547.44
|
| Rate for Payer: PHP Commercial |
$4,020.43
|
| Rate for Payer: Priority Health SBD |
$2,979.85
|
| Rate for Payer: UMR Bronson Commercial |
$2,081.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,547.44
|
|
|
HC REPAIR EXT TENDON FINGER WO GRAFT EA
|
Facility
|
OP
|
$4,729.92
|
|
|
Service Code
|
CPT 26418
|
| Hospital Charge Code |
45000093
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$125.00 |
| Max. Negotiated Rate |
$5,181.40 |
| Rate for Payer: Aetna American Axle |
$3,074.45
|
| Rate for Payer: Aetna Commercial |
$4,020.43
|
| Rate for Payer: Aetna Medicare |
$1,666.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,074.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,002.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,002.76
|
| Rate for Payer: BCBS Complete |
$879.93
|
| Rate for Payer: BCBS MAPPO |
$1,602.21
|
| Rate for Payer: BCBS Trust/PPO |
$3,040.59
|
| Rate for Payer: BCN Commercial |
$3,040.59
|
| Rate for Payer: BCN Medicare Advantage |
$1,602.21
|
| Rate for Payer: Cash Price |
$3,783.94
|
| Rate for Payer: Cash Price |
$3,783.94
|
| Rate for Payer: Cash Price |
$3,783.94
|
| Rate for Payer: Cofinity Advantage |
$3,310.94
|
| Rate for Payer: Cofinity Commercial |
$4,067.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,783.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,602.21
|
| Rate for Payer: Healthscope Commercial |
$4,256.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,310.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,547.44
|
| Rate for Payer: Mclaren Medicaid |
$1,602.21
|
| Rate for Payer: Mclaren Medicare |
$1,602.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,682.32
|
| Rate for Payer: Meridian Medicaid |
$1,682.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,842.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,762.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,020.43
|
| Rate for Payer: Nomi Health Commercial |
$4,806.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,547.44
|
| Rate for Payer: PACE Medicare |
$1,522.10
|
| Rate for Payer: PACE SWMI |
$1,602.21
|
| Rate for Payer: PHP Commercial |
$4,020.43
|
| Rate for Payer: PHP Medicare Advantage |
$1,602.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$837.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,181.40
|
| Rate for Payer: Priority Health Medicare |
$1,602.21
|
| Rate for Payer: Priority Health SBD |
$2,979.85
|
| Rate for Payer: Priority Health Tiered Network |
$4,145.12
|
| Rate for Payer: Railroad Medicare Medicare |
$1,602.21
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,602.21
|
| Rate for Payer: UHC Medicaid |
$837.96
|
| Rate for Payer: UHCCP Medicaid |
$125.00
|
| Rate for Payer: UMR Bronson Commercial |
$1,750.07
|
| Rate for Payer: VA VA |
$1,602.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,547.44
|
|
|
HC REPAIR FINGER TENDON
|
Facility
|
OP
|
$4,377.79
|
|
|
Service Code
|
CPT 26432
|
| Hospital Charge Code |
76100358
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$837.96 |
| Max. Negotiated Rate |
$5,181.40 |
| Rate for Payer: Aetna American Axle |
$2,845.56
|
| Rate for Payer: Aetna Commercial |
$3,721.12
|
| Rate for Payer: Aetna Medicare |
$1,666.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,845.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,002.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,002.76
|
| Rate for Payer: BCBS Complete |
$879.93
|
| Rate for Payer: BCBS MAPPO |
$1,602.21
|
| Rate for Payer: BCBS Trust/PPO |
$1,744.87
|
| Rate for Payer: BCN Commercial |
$1,744.87
|
| Rate for Payer: BCN Medicare Advantage |
$1,602.21
|
| Rate for Payer: Cash Price |
$3,502.23
|
| Rate for Payer: Cash Price |
$3,502.23
|
| Rate for Payer: Cash Price |
$3,502.23
|
| Rate for Payer: Cofinity Advantage |
$3,064.45
|
| Rate for Payer: Cofinity Commercial |
$3,764.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,502.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,602.21
|
| Rate for Payer: Healthscope Commercial |
$3,940.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,064.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,283.34
|
| Rate for Payer: Mclaren Medicaid |
$1,602.21
|
| Rate for Payer: Mclaren Medicare |
$1,602.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,682.32
|
| Rate for Payer: Meridian Medicaid |
$1,682.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,842.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,762.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,721.12
|
| Rate for Payer: Nomi Health Commercial |
$4,806.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,283.34
|
| Rate for Payer: PACE Medicare |
$1,522.10
|
| Rate for Payer: PACE SWMI |
$1,602.21
|
| Rate for Payer: PHP Commercial |
$3,721.12
|
| Rate for Payer: PHP Medicare Advantage |
$1,602.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$837.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,181.40
|
| Rate for Payer: Priority Health Medicare |
$1,602.21
|
| Rate for Payer: Priority Health SBD |
$2,758.01
|
| Rate for Payer: Priority Health Tiered Network |
$4,145.12
|
| Rate for Payer: Railroad Medicare Medicare |
$1,602.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,845.56
|
| Rate for Payer: UHC Core |
$2,280.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,602.21
|
| Rate for Payer: UHC Exchange |
$1,720.47
|
| Rate for Payer: UHC Medicaid |
$837.96
|
| Rate for Payer: UHCCP Medicaid |
$837.96
|
| Rate for Payer: UMR Bronson Commercial |
$1,619.78
|
| Rate for Payer: VA VA |
$1,602.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,283.34
|
|
|
HC REPAIR FINGER TENDON
|
Facility
|
IP
|
$4,377.79
|
|
|
Service Code
|
CPT 26432
|
| Hospital Charge Code |
76100358
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,926.23 |
| Max. Negotiated Rate |
$3,940.01 |
| Rate for Payer: Aetna American Axle |
$2,845.56
|
| Rate for Payer: Aetna Commercial |
$3,721.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,845.56
|
| Rate for Payer: Cash Price |
$3,502.23
|
| Rate for Payer: Cofinity Advantage |
$3,064.45
|
| Rate for Payer: Cofinity Commercial |
$3,764.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,502.23
|
| Rate for Payer: Healthscope Commercial |
$3,940.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,064.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,283.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,721.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,283.34
|
| Rate for Payer: PHP Commercial |
$3,721.12
|
| Rate for Payer: Priority Health SBD |
$2,758.01
|
| Rate for Payer: UMR Bronson Commercial |
$1,926.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,283.34
|
|
|
HC REPAIR INTERMEDIATE N/H/F/XTRNL GENT 12.6-20CM
|
Facility
|
IP
|
$1,054.00
|
|
|
Service Code
|
CPT 12045
|
| Hospital Charge Code |
76100567
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$463.76 |
| Max. Negotiated Rate |
$948.60 |
| Rate for Payer: Aetna American Axle |
$685.10
|
| Rate for Payer: Aetna Commercial |
$895.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$685.10
|
| Rate for Payer: Cash Price |
$843.20
|
| Rate for Payer: Cofinity Advantage |
$737.80
|
| Rate for Payer: Cofinity Commercial |
$906.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$843.20
|
| Rate for Payer: Healthscope Commercial |
$948.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$737.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$790.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$895.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$790.50
|
| Rate for Payer: PHP Commercial |
$895.90
|
| Rate for Payer: Priority Health SBD |
$664.02
|
| Rate for Payer: UMR Bronson Commercial |
$463.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$790.50
|
|
|
HC REPAIR INTERMEDIATE N/H/F/XTRNL GENT 12.6-20CM
|
Facility
|
OP
|
$1,054.00
|
|
|
Service Code
|
CPT 12045
|
| Hospital Charge Code |
76100567
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$385.14 |
| Max. Negotiated Rate |
$2,381.49 |
| Rate for Payer: Aetna American Axle |
$685.10
|
| Rate for Payer: Aetna Commercial |
$895.90
|
| Rate for Payer: Aetna Medicare |
$765.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$685.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$920.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$920.51
|
| Rate for Payer: BCBS Complete |
$404.44
|
| Rate for Payer: BCBS MAPPO |
$736.41
|
| Rate for Payer: BCBS Trust/PPO |
$460.69
|
| Rate for Payer: BCN Commercial |
$460.69
|
| Rate for Payer: BCN Medicare Advantage |
$736.41
|
| Rate for Payer: Cash Price |
$843.20
|
| Rate for Payer: Cash Price |
$843.20
|
| Rate for Payer: Cash Price |
$843.20
|
| Rate for Payer: Cofinity Advantage |
$737.80
|
| Rate for Payer: Cofinity Commercial |
$906.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$843.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$736.41
|
| Rate for Payer: Healthscope Commercial |
$948.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$737.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$790.50
|
| Rate for Payer: Mclaren Medicaid |
$736.41
|
| Rate for Payer: Mclaren Medicare |
$736.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$773.23
|
| Rate for Payer: Meridian Medicaid |
$773.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$846.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$810.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$895.90
|
| Rate for Payer: Nomi Health Commercial |
$2,209.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$790.50
|
| Rate for Payer: PACE Medicare |
$699.59
|
| Rate for Payer: PACE SWMI |
$736.41
|
| Rate for Payer: PHP Commercial |
$895.90
|
| Rate for Payer: PHP Medicare Advantage |
$736.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$385.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,381.49
|
| Rate for Payer: Priority Health Medicare |
$736.41
|
| Rate for Payer: Priority Health SBD |
$664.02
|
| Rate for Payer: Priority Health Tiered Network |
$1,905.19
|
| Rate for Payer: Railroad Medicare Medicare |
$736.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$685.10
|
| Rate for Payer: UHC Core |
$549.13
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$736.41
|
| Rate for Payer: UHC Exchange |
$414.22
|
| Rate for Payer: UHC Medicaid |
$385.14
|
| Rate for Payer: UHCCP Medicaid |
$385.14
|
| Rate for Payer: UMR Bronson Commercial |
$389.98
|
| Rate for Payer: VA VA |
$736.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$790.50
|
|
|
HC REPAIR LIP AND BORDER
|
Facility
|
IP
|
$1,569.00
|
|
|
Service Code
|
CPT 40650
|
| Hospital Charge Code |
76100539
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$690.36 |
| Max. Negotiated Rate |
$1,412.10 |
| Rate for Payer: Aetna American Axle |
$1,019.85
|
| Rate for Payer: Aetna Commercial |
$1,333.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,019.85
|
| Rate for Payer: Cash Price |
$1,255.20
|
| Rate for Payer: Cofinity Advantage |
$1,098.30
|
| Rate for Payer: Cofinity Commercial |
$1,349.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,255.20
|
| Rate for Payer: Healthscope Commercial |
$1,412.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,098.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,176.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,333.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,176.75
|
| Rate for Payer: PHP Commercial |
$1,333.65
|
| Rate for Payer: Priority Health SBD |
$988.47
|
| Rate for Payer: UMR Bronson Commercial |
$690.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,176.75
|
|
