|
HC POST MASTECTOMY SLEEVE A
|
Facility
|
OP
|
$69.36
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000049
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$25.66 |
| Max. Negotiated Rate |
$134.97 |
| Rate for Payer: Aetna American Axle |
$45.08
|
| Rate for Payer: Aetna Commercial |
$58.96
|
| Rate for Payer: Aetna Medicare |
$34.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.08
|
| Rate for Payer: BCBS Complete |
$27.74
|
| Rate for Payer: BCBS Trust/PPO |
$134.97
|
| Rate for Payer: BCN Commercial |
$134.97
|
| Rate for Payer: Cash Price |
$55.49
|
| Rate for Payer: Cash Price |
$55.49
|
| Rate for Payer: Cofinity Commercial |
$48.55
|
| Rate for Payer: Cofinity Commercial |
$59.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$48.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.49
|
| Rate for Payer: Healthscope Commercial |
$62.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.96
|
| Rate for Payer: PHP Commercial |
$58.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.08
|
| Rate for Payer: Priority Health SBD |
$43.70
|
| Rate for Payer: UMR Bronson Commercial |
$25.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.02
|
|
|
HC POST MASTECTOMY SLEEVE A
|
Facility
|
IP
|
$69.36
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000049
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$30.52 |
| Max. Negotiated Rate |
$62.42 |
| Rate for Payer: Aetna American Axle |
$45.08
|
| Rate for Payer: Aetna Commercial |
$58.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.08
|
| Rate for Payer: Cash Price |
$55.49
|
| Rate for Payer: Cofinity Commercial |
$48.55
|
| Rate for Payer: Cofinity Commercial |
$59.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$48.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.49
|
| Rate for Payer: Healthscope Commercial |
$62.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.96
|
| Rate for Payer: PHP Commercial |
$58.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.08
|
| Rate for Payer: Priority Health SBD |
$43.70
|
| Rate for Payer: UMR Bronson Commercial |
$30.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.02
|
|
|
HC POST MASTECTOMY SLEEVE B
|
Facility
|
OP
|
$81.60
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000050
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$30.19 |
| Max. Negotiated Rate |
$134.97 |
| Rate for Payer: Aetna American Axle |
$53.04
|
| Rate for Payer: Aetna Commercial |
$69.36
|
| Rate for Payer: Aetna Medicare |
$40.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.04
|
| Rate for Payer: BCBS Complete |
$32.64
|
| Rate for Payer: BCBS Trust/PPO |
$134.97
|
| Rate for Payer: BCN Commercial |
$134.97
|
| Rate for Payer: Cash Price |
$65.28
|
| Rate for Payer: Cash Price |
$65.28
|
| Rate for Payer: Cofinity Commercial |
$57.12
|
| Rate for Payer: Cofinity Commercial |
$70.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$57.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.28
|
| Rate for Payer: Healthscope Commercial |
$73.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.36
|
| Rate for Payer: PHP Commercial |
$69.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.04
|
| Rate for Payer: Priority Health SBD |
$51.41
|
| Rate for Payer: UMR Bronson Commercial |
$30.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.20
|
|
|
HC POST MASTECTOMY SLEEVE B
|
Facility
|
IP
|
$81.60
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000050
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$35.90 |
| Max. Negotiated Rate |
$73.44 |
| Rate for Payer: Aetna American Axle |
$53.04
|
| Rate for Payer: Aetna Commercial |
$69.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.04
|
| Rate for Payer: Cash Price |
$65.28
|
| Rate for Payer: Cofinity Commercial |
$57.12
|
| Rate for Payer: Cofinity Commercial |
$70.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$57.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.28
|
| Rate for Payer: Healthscope Commercial |
$73.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.36
|
| Rate for Payer: PHP Commercial |
$69.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.04
|
| Rate for Payer: Priority Health SBD |
$51.41
|
| Rate for Payer: UMR Bronson Commercial |
$35.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.20
|
|
|
HC POST MASTECTOMY SLEEVE C
|
Facility
|
IP
|
$220.32
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000051
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$96.94 |
| Max. Negotiated Rate |
$198.29 |
| Rate for Payer: Aetna American Axle |
$143.21
|
| Rate for Payer: Aetna Commercial |
$187.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.21
|
| Rate for Payer: Cash Price |
$176.26
|
| Rate for Payer: Cofinity Commercial |
$154.22
|
| Rate for Payer: Cofinity Commercial |
$189.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$154.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.26
|
| Rate for Payer: Healthscope Commercial |
$198.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$154.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$165.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$187.27
|
| Rate for Payer: PHP Commercial |
$187.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.21
|
| Rate for Payer: Priority Health SBD |
$138.80
|
| Rate for Payer: UMR Bronson Commercial |
$96.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$165.24
|
|
|
HC POST MASTECTOMY SLEEVE C
|
Facility
|
OP
|
$220.32
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000051
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$81.52 |
| Max. Negotiated Rate |
$198.29 |
| Rate for Payer: Aetna American Axle |
$143.21
|
| Rate for Payer: Aetna Commercial |
$187.27
|
| Rate for Payer: Aetna Medicare |
$110.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.21
|
| Rate for Payer: BCBS Complete |
$88.13
|
| Rate for Payer: BCBS Trust/PPO |
$134.97
|
| Rate for Payer: BCN Commercial |
$134.97
|
| Rate for Payer: Cash Price |
$176.26
|
| Rate for Payer: Cash Price |
$176.26
|
| Rate for Payer: Cofinity Commercial |
$154.22
|
| Rate for Payer: Cofinity Commercial |
$189.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$154.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.26
|
| Rate for Payer: Healthscope Commercial |
$198.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$154.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$165.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$187.27
|
| Rate for Payer: PHP Commercial |
$187.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.21
|
| Rate for Payer: Priority Health SBD |
$138.80
|
| Rate for Payer: UMR Bronson Commercial |
$81.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$165.24
|
|
|
HC POST MASTECTOMY SLEEVE D
|
Facility
|
OP
|
$250.92
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000052
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$92.84 |
| Max. Negotiated Rate |
$225.83 |
| Rate for Payer: Aetna American Axle |
$163.10
|
| Rate for Payer: Aetna Commercial |
$213.28
|
| Rate for Payer: Aetna Medicare |
$125.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$163.10
|
| Rate for Payer: BCBS Complete |
$100.37
|
| Rate for Payer: BCBS Trust/PPO |
$134.97
|
| Rate for Payer: BCN Commercial |
$134.97
|
| Rate for Payer: Cash Price |
$200.74
|
| Rate for Payer: Cash Price |
$200.74
|
| Rate for Payer: Cofinity Commercial |
$175.64
|
| Rate for Payer: Cofinity Commercial |
$215.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$175.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.74
|
| Rate for Payer: Healthscope Commercial |
$225.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$175.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$188.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.28
|
| Rate for Payer: PHP Commercial |
$213.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.10
|
| Rate for Payer: Priority Health SBD |
$158.08
|
| Rate for Payer: UMR Bronson Commercial |
$92.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$188.19
|
|
|
HC POST MASTECTOMY SLEEVE D
|
Facility
|
IP
|
$250.92
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000052
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$110.40 |
| Max. Negotiated Rate |
$225.83 |
| Rate for Payer: Aetna American Axle |
$163.10
|
| Rate for Payer: Aetna Commercial |
$213.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$163.10
|
| Rate for Payer: Cash Price |
$200.74
|
| Rate for Payer: Cofinity Commercial |
$175.64
|
| Rate for Payer: Cofinity Commercial |
$215.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$175.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.74
|
| Rate for Payer: Healthscope Commercial |
$225.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$175.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$188.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.28
|
| Rate for Payer: PHP Commercial |
$213.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.10
|
| Rate for Payer: Priority Health SBD |
$158.08
|
| Rate for Payer: UMR Bronson Commercial |
$110.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$188.19
|
|
|
HC POST-OP
|
Facility
|
OP
|
$18.07
|
|
| Hospital Charge Code |
27000136
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.69 |
| Max. Negotiated Rate |
$16.26 |
| Rate for Payer: Aetna American Axle |
$11.75
|
| Rate for Payer: Aetna Commercial |
$15.36
|
| Rate for Payer: Aetna Medicare |
$9.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.75
|
| Rate for Payer: BCBS Complete |
$7.23
|
| Rate for Payer: Cash Price |
$14.46
|
| Rate for Payer: Cofinity Commercial |
$12.65
|
| Rate for Payer: Cofinity Commercial |
$15.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.46
|
| Rate for Payer: Healthscope Commercial |
$16.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.36
|
| Rate for Payer: PHP Commercial |
$15.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.75
|
| Rate for Payer: Priority Health SBD |
$11.38
|
| Rate for Payer: UMR Bronson Commercial |
$6.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.55
|
|
|
HC POST-OP
|
Facility
|
IP
|
$18.07
|
|
| Hospital Charge Code |
27000136
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.95 |
| Max. Negotiated Rate |
$16.26 |
| Rate for Payer: PHP Commercial |
$15.36
|
| Rate for Payer: Aetna American Axle |
$11.75
|
| Rate for Payer: Aetna Commercial |
$15.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.75
|
| Rate for Payer: Cash Price |
$14.46
|
| Rate for Payer: Cofinity Commercial |
$12.65
|
| Rate for Payer: Cofinity Commercial |
$15.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.46
|
| Rate for Payer: Healthscope Commercial |
$16.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.75
|
| Rate for Payer: Priority Health SBD |
$11.38
|
| Rate for Payer: UMR Bronson Commercial |
$7.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.55
|
|
|
HC POST TIBIAL NEUROSTIMULATION PERC NEEDLE ELECTRODE
|
Facility
|
IP
|
$386.21
|
|
|
Service Code
|
CPT 64566
|
| Hospital Charge Code |
76100208
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$169.93 |
| Max. Negotiated Rate |
$347.59 |
| Rate for Payer: Aetna American Axle |
$251.04
|
| Rate for Payer: Aetna Commercial |
$328.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$251.04
|
| Rate for Payer: Cash Price |
$308.97
|
| Rate for Payer: Cofinity Commercial |
$270.35
|
| Rate for Payer: Cofinity Commercial |
$332.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$270.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$308.97
|
| Rate for Payer: Healthscope Commercial |
$347.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$270.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$289.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$328.28
|
| Rate for Payer: PHP Commercial |
$328.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$251.04
|
| Rate for Payer: Priority Health SBD |
$243.31
|
| Rate for Payer: UMR Bronson Commercial |
$169.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$289.66
|
|
|
HC POST TIBIAL NEUROSTIMULATION PERC NEEDLE ELECTRODE
|
Facility
|
OP
|
$386.21
|
|
|
Service Code
|
CPT 64566
|
| Hospital Charge Code |
76100208
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$29.28 |
| Max. Negotiated Rate |
$909.03 |
| Rate for Payer: Aetna American Axle |
$251.04
|
| Rate for Payer: Aetna Commercial |
$328.28
|
| Rate for Payer: Aetna Medicare |
$300.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$251.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$361.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$361.52
|
| Rate for Payer: BCBS Complete |
$162.77
|
| Rate for Payer: BCBS MAPPO |
$289.22
|
| Rate for Payer: BCBS Trust/PPO |
$147.80
|
| Rate for Payer: BCN Commercial |
$147.80
|
| Rate for Payer: BCN Medicare Advantage |
$289.22
|
| Rate for Payer: Cash Price |
$308.97
|
| Rate for Payer: Cash Price |
$308.97
|
| Rate for Payer: Cash Price |
$308.97
|
| Rate for Payer: Cofinity Commercial |
$332.14
|
| Rate for Payer: Cofinity Commercial |
$270.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$270.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$308.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$289.22
|
| Rate for Payer: Healthscope Commercial |
$347.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$270.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$289.66
|
| Rate for Payer: Mclaren Medicaid |
$155.02
|
| Rate for Payer: Mclaren Medicare |
$289.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$303.68
|
| Rate for Payer: Meridian Medicaid |
$162.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$332.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$328.28
|
| Rate for Payer: Nomi Health Commercial |
$607.36
|
| Rate for Payer: PACE Medicare |
$274.76
|
| Rate for Payer: PACE SWMI |
$289.22
|
| Rate for Payer: PHP Commercial |
$328.28
|
| Rate for Payer: PHP Medicare Advantage |
$289.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$155.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$251.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$909.03
|
| Rate for Payer: Priority Health Medicare |
$289.22
|
| Rate for Payer: Priority Health Narrow Network |
$727.22
|
| Rate for Payer: Priority Health SBD |
$243.31
|
| Rate for Payer: Railroad Medicare Medicare |
$289.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.21
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$289.22
|
| Rate for Payer: UHC Exchange |
$29.28
|
| Rate for Payer: UHC Medicare Advantage |
$289.22
|
| Rate for Payer: UHCCP Medicaid |
$155.02
|
| Rate for Payer: UMR Bronson Commercial |
$142.90
|
| Rate for Payer: VA VA |
$289.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$289.66
|
|
|
HC POTASSIUM LEVEL
|
Facility
|
IP
|
$20.81
|
|
|
Service Code
|
CPT 84132
|
| Hospital Charge Code |
30100396
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.16 |
| Max. Negotiated Rate |
$18.73 |
| Rate for Payer: Aetna American Axle |
$13.53
|
| Rate for Payer: Aetna Commercial |
$17.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.53
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$14.57
|
| Rate for Payer: Cofinity Commercial |
$17.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Healthscope Commercial |
$18.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: PHP Commercial |
$17.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: Priority Health SBD |
$13.11
|
| Rate for Payer: UMR Bronson Commercial |
$9.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.61
|
|
|
HC POTASSIUM LEVEL
|
Facility
|
OP
|
$20.81
|
|
|
Service Code
|
CPT 84132
|
| Hospital Charge Code |
30100396
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$18.73 |
| Rate for Payer: Aetna American Axle |
$13.53
|
| Rate for Payer: Aetna Commercial |
$17.69
|
| Rate for Payer: Aetna Medicare |
$4.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.95
|
| Rate for Payer: BCBS Complete |
$2.68
|
| Rate for Payer: BCBS MAPPO |
$4.76
|
| Rate for Payer: BCN Medicare Advantage |
$4.76
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$17.90
|
| Rate for Payer: Cofinity Commercial |
$14.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.76
|
| Rate for Payer: Healthscope Commercial |
$18.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.61
|
| Rate for Payer: Mclaren Medicaid |
$2.55
|
| Rate for Payer: Mclaren Medicare |
$4.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.00
|
| Rate for Payer: Meridian Medicaid |
$2.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: Nomi Health Commercial |
$7.14
|
| Rate for Payer: PACE Medicare |
$4.52
|
| Rate for Payer: PACE SWMI |
$4.76
|
| Rate for Payer: PHP Commercial |
$17.69
|
| Rate for Payer: PHP Medicare Advantage |
$4.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.76
|
| Rate for Payer: Priority Health Medicare |
$4.76
|
| Rate for Payer: Priority Health Narrow Network |
$3.81
|
| Rate for Payer: Priority Health SBD |
$13.11
|
| Rate for Payer: Railroad Medicare Medicare |
$4.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.76
|
| Rate for Payer: UHC Exchange |
$4.76
|
| Rate for Payer: UHC Medicare Advantage |
$4.76
|
| Rate for Payer: UHCCP Medicaid |
$2.55
|
| Rate for Payer: UMR Bronson Commercial |
$7.70
|
| Rate for Payer: VA VA |
$4.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.61
|
|
|
HC POTASSIUM OTHER SOURCE
|
Facility
|
OP
|
$21.22
|
|
|
Service Code
|
CPT 84999
|
| Hospital Charge Code |
30100556
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.85 |
| Max. Negotiated Rate |
$19.10 |
| Rate for Payer: Cofinity Commercial |
$18.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.98
|
| Rate for Payer: Healthscope Commercial |
$19.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.04
|
| Rate for Payer: PHP Commercial |
$18.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.79
|
| Rate for Payer: Priority Health SBD |
$13.37
|
| Rate for Payer: UMR Bronson Commercial |
$7.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.92
|
| Rate for Payer: Aetna American Axle |
$13.79
|
| Rate for Payer: Aetna Commercial |
$18.04
|
| Rate for Payer: Aetna Medicare |
$10.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.79
|
| Rate for Payer: BCBS Complete |
$8.49
|
| Rate for Payer: BCBS Trust/PPO |
$12.81
|
| Rate for Payer: BCN Commercial |
$12.81
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cofinity Commercial |
$14.85
|
|
|
HC POTASSIUM OTHER SOURCE
|
Facility
|
IP
|
$21.22
|
|
|
Service Code
|
CPT 84999
|
| Hospital Charge Code |
30100556
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.34 |
| Max. Negotiated Rate |
$19.10 |
| Rate for Payer: Aetna American Axle |
$13.79
|
| Rate for Payer: Aetna Commercial |
$18.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.79
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cofinity Commercial |
$14.85
|
| Rate for Payer: Cofinity Commercial |
$18.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.98
|
| Rate for Payer: Healthscope Commercial |
$19.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.04
|
| Rate for Payer: PHP Commercial |
$18.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.79
|
| Rate for Payer: Priority Health SBD |
$13.37
|
| Rate for Payer: UMR Bronson Commercial |
$9.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.92
|
|
|
HC POTASSIUM URINE
|
Facility
|
IP
|
$36.92
|
|
|
Service Code
|
CPT 84133
|
| Hospital Charge Code |
30100397
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.24 |
| Max. Negotiated Rate |
$33.23 |
| Rate for Payer: Aetna American Axle |
$24.00
|
| Rate for Payer: Aetna Commercial |
$31.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.00
|
| Rate for Payer: Cash Price |
$29.54
|
| Rate for Payer: Cofinity Commercial |
$25.84
|
| Rate for Payer: Cofinity Commercial |
$31.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$25.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.54
|
| Rate for Payer: Healthscope Commercial |
$33.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.38
|
| Rate for Payer: PHP Commercial |
$31.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.00
|
| Rate for Payer: Priority Health SBD |
$23.26
|
| Rate for Payer: UMR Bronson Commercial |
$16.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.69
|
|
|
HC POTASSIUM URINE
|
Facility
|
OP
|
$36.92
|
|
|
Service Code
|
CPT 84133
|
| Hospital Charge Code |
30100397
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.54 |
| Max. Negotiated Rate |
$33.23 |
| Rate for Payer: UHC Medicare Advantage |
$4.73
|
| Rate for Payer: UHCCP Medicaid |
$2.54
|
| Rate for Payer: UMR Bronson Commercial |
$13.66
|
| Rate for Payer: VA VA |
$4.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.69
|
| Rate for Payer: Aetna American Axle |
$24.00
|
| Rate for Payer: Aetna Commercial |
$31.38
|
| Rate for Payer: Aetna Medicare |
$4.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.91
|
| Rate for Payer: BCBS Complete |
$2.66
|
| Rate for Payer: BCBS MAPPO |
$4.73
|
| Rate for Payer: BCBS Trust/PPO |
$4.56
|
| Rate for Payer: BCN Commercial |
$4.56
|
| Rate for Payer: BCN Medicare Advantage |
$4.73
|
| Rate for Payer: Cash Price |
$29.54
|
| Rate for Payer: Cash Price |
$29.54
|
| Rate for Payer: Cofinity Commercial |
$31.75
|
| Rate for Payer: Cofinity Commercial |
$25.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$25.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.73
|
| Rate for Payer: Healthscope Commercial |
$33.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.69
|
| Rate for Payer: Mclaren Medicaid |
$2.54
|
| Rate for Payer: Mclaren Medicare |
$4.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.97
|
| Rate for Payer: Meridian Medicaid |
$2.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.38
|
| Rate for Payer: Nomi Health Commercial |
$7.10
|
| Rate for Payer: PACE Medicare |
$4.49
|
| Rate for Payer: PACE SWMI |
$4.73
|
| Rate for Payer: PHP Commercial |
$31.38
|
| Rate for Payer: PHP Medicare Advantage |
$4.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.73
|
| Rate for Payer: Priority Health Medicare |
$4.73
|
| Rate for Payer: Priority Health Narrow Network |
$3.78
|
| Rate for Payer: Priority Health SBD |
$23.26
|
| Rate for Payer: Railroad Medicare Medicare |
$4.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.73
|
| Rate for Payer: UHC Exchange |
$4.73
|
|
|
HC POUCH 1 PIECE OPEN END W/WAFER
|
Facility
|
IP
|
$10.20
|
|
| Hospital Charge Code |
27000022
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.49 |
| Max. Negotiated Rate |
$9.18 |
| Rate for Payer: Aetna American Axle |
$6.63
|
| Rate for Payer: Aetna Commercial |
$8.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.63
|
| Rate for Payer: Cash Price |
$8.16
|
| Rate for Payer: Cofinity Commercial |
$7.14
|
| Rate for Payer: Cofinity Commercial |
$8.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.16
|
| Rate for Payer: Healthscope Commercial |
$9.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.67
|
| Rate for Payer: PHP Commercial |
$8.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.63
|
| Rate for Payer: Priority Health SBD |
$6.43
|
| Rate for Payer: UMR Bronson Commercial |
$4.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.65
|
|
|
HC POUCH 1 PIECE OPEN END W/WAFER
|
Facility
|
OP
|
$10.20
|
|
| Hospital Charge Code |
27000022
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.77 |
| Max. Negotiated Rate |
$9.18 |
| Rate for Payer: Aetna American Axle |
$6.63
|
| Rate for Payer: Aetna Commercial |
$8.67
|
| Rate for Payer: Aetna Medicare |
$5.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.63
|
| Rate for Payer: BCBS Complete |
$4.08
|
| Rate for Payer: Cash Price |
$8.16
|
| Rate for Payer: Cofinity Commercial |
$7.14
|
| Rate for Payer: Cofinity Commercial |
$8.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.16
|
| Rate for Payer: Healthscope Commercial |
$9.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.67
|
| Rate for Payer: PHP Commercial |
$8.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.63
|
| Rate for Payer: Priority Health SBD |
$6.43
|
| Rate for Payer: UMR Bronson Commercial |
$3.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.65
|
|
|
HC POUCH 2-PIECE
|
Facility
|
IP
|
$17.28
|
|
| Hospital Charge Code |
27000137
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.60 |
| Max. Negotiated Rate |
$15.55 |
| Rate for Payer: Aetna American Axle |
$11.23
|
| Rate for Payer: Aetna Commercial |
$14.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.23
|
| Rate for Payer: Cash Price |
$13.82
|
| Rate for Payer: Cofinity Commercial |
$12.10
|
| Rate for Payer: Cofinity Commercial |
$14.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.82
|
| Rate for Payer: Healthscope Commercial |
$15.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.69
|
| Rate for Payer: PHP Commercial |
$14.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.23
|
| Rate for Payer: Priority Health SBD |
$10.89
|
| Rate for Payer: UMR Bronson Commercial |
$7.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.96
|
|
|
HC POUCH 2-PIECE
|
Facility
|
OP
|
$17.28
|
|
| Hospital Charge Code |
27000137
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.39 |
| Max. Negotiated Rate |
$15.55 |
| Rate for Payer: Aetna American Axle |
$11.23
|
| Rate for Payer: Aetna Commercial |
$14.69
|
| Rate for Payer: Aetna Medicare |
$8.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.23
|
| Rate for Payer: BCBS Complete |
$6.91
|
| Rate for Payer: Cash Price |
$13.82
|
| Rate for Payer: Cofinity Commercial |
$12.10
|
| Rate for Payer: Cofinity Commercial |
$14.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.82
|
| Rate for Payer: Healthscope Commercial |
$15.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.69
|
| Rate for Payer: PHP Commercial |
$14.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.23
|
| Rate for Payer: Priority Health SBD |
$10.89
|
| Rate for Payer: UMR Bronson Commercial |
$6.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.96
|
|
|
HC POUCH WOUND 11 X 5
|
Facility
|
IP
|
$112.87
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000619
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$49.66 |
| Max. Negotiated Rate |
$101.58 |
| Rate for Payer: Aetna American Axle |
$73.37
|
| Rate for Payer: Aetna Commercial |
$95.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.37
|
| Rate for Payer: Cash Price |
$90.30
|
| Rate for Payer: Cofinity Commercial |
$79.01
|
| Rate for Payer: Cofinity Commercial |
$97.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$79.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.30
|
| Rate for Payer: Healthscope Commercial |
$101.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$79.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.94
|
| Rate for Payer: PHP Commercial |
$95.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.37
|
| Rate for Payer: Priority Health SBD |
$71.11
|
| Rate for Payer: UMR Bronson Commercial |
$49.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.65
|
|
|
HC POUCH WOUND 11 X 5
|
Facility
|
OP
|
$112.87
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000619
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$41.76 |
| Max. Negotiated Rate |
$101.58 |
| Rate for Payer: Aetna American Axle |
$73.37
|
| Rate for Payer: Aetna Commercial |
$95.94
|
| Rate for Payer: Aetna Medicare |
$56.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.37
|
| Rate for Payer: BCBS Complete |
$45.15
|
| Rate for Payer: BCBS Trust/PPO |
$51.92
|
| Rate for Payer: BCN Commercial |
$51.92
|
| Rate for Payer: Cash Price |
$90.30
|
| Rate for Payer: Cash Price |
$90.30
|
| Rate for Payer: Cofinity Commercial |
$79.01
|
| Rate for Payer: Cofinity Commercial |
$97.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$79.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.30
|
| Rate for Payer: Healthscope Commercial |
$101.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$79.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.94
|
| Rate for Payer: PHP Commercial |
$95.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.37
|
| Rate for Payer: Priority Health SBD |
$71.11
|
| Rate for Payer: UMR Bronson Commercial |
$41.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.65
|
|
|
HC POUCH WOUND 1 X 1
|
Facility
|
IP
|
$30.45
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000623
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.40 |
| Max. Negotiated Rate |
$27.40 |
| Rate for Payer: Aetna American Axle |
$19.79
|
| Rate for Payer: Aetna Commercial |
$25.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.79
|
| Rate for Payer: Cash Price |
$24.36
|
| Rate for Payer: Cofinity Commercial |
$21.32
|
| Rate for Payer: Cofinity Commercial |
$26.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.36
|
| Rate for Payer: Healthscope Commercial |
$27.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.88
|
| Rate for Payer: PHP Commercial |
$25.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.79
|
| Rate for Payer: Priority Health SBD |
$19.18
|
| Rate for Payer: UMR Bronson Commercial |
$13.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.84
|
|
