|
HC RO OR SSA SJOGRENS AB
|
Facility
|
IP
|
$35.87
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200162
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.78 |
| Max. Negotiated Rate |
$32.28 |
| Rate for Payer: Aetna American Axle |
$23.32
|
| Rate for Payer: Aetna Commercial |
$30.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.32
|
| Rate for Payer: Cash Price |
$28.70
|
| Rate for Payer: Cofinity Advantage |
$25.11
|
| Rate for Payer: Cofinity Commercial |
$30.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.70
|
| Rate for Payer: Healthscope Commercial |
$32.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.90
|
| Rate for Payer: PHP Commercial |
$30.49
|
| Rate for Payer: Priority Health SBD |
$22.60
|
| Rate for Payer: UMR Bronson Commercial |
$15.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.90
|
|
|
HC RO OR SSA SJOGRENS AB
|
Facility
|
OP
|
$35.87
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200162
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.38 |
| Max. Negotiated Rate |
$32.28 |
| Rate for Payer: Aetna American Axle |
$23.32
|
| Rate for Payer: Aetna Commercial |
$30.49
|
| Rate for Payer: Aetna Medicare |
$18.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.41
|
| Rate for Payer: BCBS Complete |
$9.85
|
| Rate for Payer: BCBS MAPPO |
$17.93
|
| Rate for Payer: BCBS Trust/PPO |
$20.73
|
| Rate for Payer: BCN Commercial |
$20.73
|
| Rate for Payer: BCN Medicare Advantage |
$17.93
|
| Rate for Payer: Cash Price |
$28.70
|
| Rate for Payer: Cash Price |
$28.70
|
| Rate for Payer: Cofinity Advantage |
$25.11
|
| Rate for Payer: Cofinity Commercial |
$30.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.93
|
| Rate for Payer: Healthscope Commercial |
$32.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.90
|
| Rate for Payer: Mclaren Medicaid |
$17.93
|
| Rate for Payer: Mclaren Medicare |
$17.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.83
|
| Rate for Payer: Meridian Medicaid |
$18.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.49
|
| Rate for Payer: Nomi Health Commercial |
$26.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.90
|
| Rate for Payer: PACE Medicare |
$17.03
|
| Rate for Payer: PACE SWMI |
$17.93
|
| Rate for Payer: PHP Commercial |
$30.49
|
| Rate for Payer: PHP Medicare Advantage |
$17.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$17.93
|
| Rate for Payer: Priority Health Medicare |
$17.93
|
| Rate for Payer: Priority Health SBD |
$22.60
|
| Rate for Payer: Priority Health Tiered Network |
$14.34
|
| Rate for Payer: Railroad Medicare Medicare |
$17.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.90
|
| Rate for Payer: UHC Core |
$26.90
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17.93
|
| Rate for Payer: UHC Exchange |
$26.90
|
| Rate for Payer: UHC Medicaid |
$9.38
|
| Rate for Payer: UHCCP Medicaid |
$9.38
|
| Rate for Payer: UMR Bronson Commercial |
$13.27
|
| Rate for Payer: VA VA |
$17.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.90
|
|
|
HC ROPIVACAINE HYDROCHLORIDE 1 MG
|
Facility
|
IP
|
$4.16
|
|
|
Service Code
|
CPT J2795
|
| Hospital Charge Code |
63600236
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.83 |
| Max. Negotiated Rate |
$3.74 |
| Rate for Payer: Aetna American Axle |
$2.70
|
| Rate for Payer: Aetna Commercial |
$3.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.70
|
| Rate for Payer: Cash Price |
$3.33
|
| Rate for Payer: Cofinity Advantage |
$2.91
|
| Rate for Payer: Cofinity Commercial |
$3.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.33
|
| Rate for Payer: Healthscope Commercial |
$3.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.12
|
| Rate for Payer: PHP Commercial |
$3.54
|
| Rate for Payer: Priority Health SBD |
$2.62
|
| Rate for Payer: UMR Bronson Commercial |
$1.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.12
|
|
|
HC ROPIVACAINE HYDROCHLORIDE 1 MG
|
Facility
|
OP
|
$4.16
|
|
|
Service Code
|
CPT J2795
|
| Hospital Charge Code |
63600236
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$3.74 |
| Rate for Payer: Aetna American Axle |
$2.70
|
| Rate for Payer: Aetna Commercial |
$3.54
|
| Rate for Payer: Aetna Medicare |
$2.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.70
|
| Rate for Payer: BCBS Complete |
$1.66
|
| Rate for Payer: BCBS Trust/PPO |
$0.16
|
| Rate for Payer: BCN Commercial |
$0.16
|
| Rate for Payer: Cash Price |
$3.33
|
| Rate for Payer: Cash Price |
$3.33
|
| Rate for Payer: Cofinity Advantage |
$2.91
|
| Rate for Payer: Cofinity Commercial |
$3.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.33
|
| Rate for Payer: Healthscope Commercial |
$3.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.12
|
| Rate for Payer: PHP Commercial |
$3.54
|
| Rate for Payer: Priority Health SBD |
$2.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.08
|
| Rate for Payer: UHC Core |
$0.08
|
| Rate for Payer: UHC Exchange |
$0.08
|
| Rate for Payer: UMR Bronson Commercial |
$1.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.12
|
|
|
HC RO SUPERFICIAL AND/OR ORTHO
|
Facility
|
IP
|
$203.76
|
|
|
Service Code
|
CPT 77401
|
| Hospital Charge Code |
33300036
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$89.65 |
| Max. Negotiated Rate |
$183.38 |
| Rate for Payer: Aetna American Axle |
$132.44
|
| Rate for Payer: Aetna Commercial |
$173.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.44
|
| Rate for Payer: Cash Price |
$163.01
|
| Rate for Payer: Cofinity Advantage |
$142.63
|
| Rate for Payer: Cofinity Commercial |
$175.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.01
|
| Rate for Payer: Healthscope Commercial |
$183.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$142.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$152.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$152.82
|
| Rate for Payer: PHP Commercial |
$173.20
|
| Rate for Payer: Priority Health SBD |
$128.37
|
| Rate for Payer: UMR Bronson Commercial |
$89.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$152.82
|
|
|
HC RO SUPERFICIAL AND/OR ORTHO
|
Facility
|
OP
|
$203.76
|
|
|
Service Code
|
CPT 77401
|
| Hospital Charge Code |
33300036
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$75.39 |
| Max. Negotiated Rate |
$183.38 |
| Rate for Payer: Aetna American Axle |
$132.44
|
| Rate for Payer: Aetna Commercial |
$173.20
|
| Rate for Payer: Aetna Medicare |
$101.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.44
|
| Rate for Payer: BCBS Complete |
$81.50
|
| Rate for Payer: BCBS Trust/PPO |
$100.97
|
| Rate for Payer: BCN Commercial |
$100.97
|
| Rate for Payer: Cash Price |
$163.01
|
| Rate for Payer: Cash Price |
$163.01
|
| Rate for Payer: Cofinity Advantage |
$142.63
|
| Rate for Payer: Cofinity Commercial |
$175.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.01
|
| Rate for Payer: Healthscope Commercial |
$183.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$142.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$152.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$163.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$152.82
|
| Rate for Payer: PHP Commercial |
$173.20
|
| Rate for Payer: Priority Health SBD |
$128.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$132.44
|
| Rate for Payer: UHC Core |
$106.16
|
| Rate for Payer: UHC Exchange |
$80.08
|
| Rate for Payer: UMR Bronson Commercial |
$75.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$152.82
|
|
|
HC ROTABLATOR BURR
|
Facility
|
OP
|
$4,268.40
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
27200069
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$3,841.56 |
| Rate for Payer: Aetna American Axle |
$2,774.46
|
| Rate for Payer: Aetna Commercial |
$3,628.14
|
| Rate for Payer: Aetna Medicare |
$2,134.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,774.46
|
| Rate for Payer: BCBS Complete |
$1,707.36
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$3,414.72
|
| Rate for Payer: Cash Price |
$3,414.72
|
| Rate for Payer: Cofinity Advantage |
$2,987.88
|
| Rate for Payer: Cofinity Commercial |
$3,670.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,414.72
|
| Rate for Payer: Healthscope Commercial |
$3,841.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,987.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,201.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,414.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,628.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,201.30
|
| Rate for Payer: PHP Commercial |
$3,628.14
|
| Rate for Payer: Priority Health SBD |
$2,689.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,774.46
|
| Rate for Payer: UHC Core |
$2,223.84
|
| Rate for Payer: UHC Exchange |
$1,677.48
|
| Rate for Payer: UMR Bronson Commercial |
$1,579.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,201.30
|
|
|
HC ROTABLATOR BURR
|
Facility
|
IP
|
$4,268.40
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
27200069
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,878.10 |
| Max. Negotiated Rate |
$3,841.56 |
| Rate for Payer: Aetna American Axle |
$2,774.46
|
| Rate for Payer: Aetna Commercial |
$3,628.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,774.46
|
| Rate for Payer: Cash Price |
$3,414.72
|
| Rate for Payer: Cofinity Advantage |
$2,987.88
|
| Rate for Payer: Cofinity Commercial |
$3,670.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,414.72
|
| Rate for Payer: Healthscope Commercial |
$3,841.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,987.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,201.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,628.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,201.30
|
| Rate for Payer: PHP Commercial |
$3,628.14
|
| Rate for Payer: Priority Health SBD |
$2,689.09
|
| Rate for Payer: UMR Bronson Commercial |
$1,878.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,201.30
|
|
|
HC ROTAVIRUS ANTIGEN
|
Facility
|
OP
|
$111.95
|
|
|
Service Code
|
CPT 87425
|
| Hospital Charge Code |
30600145
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.27 |
| Max. Negotiated Rate |
$100.75 |
| Rate for Payer: Aetna American Axle |
$72.77
|
| Rate for Payer: Aetna Commercial |
$95.16
|
| Rate for Payer: Aetna Medicare |
$12.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.97
|
| Rate for Payer: BCBS Complete |
$6.58
|
| Rate for Payer: BCBS MAPPO |
$11.98
|
| Rate for Payer: BCBS Trust/PPO |
$13.86
|
| Rate for Payer: BCN Commercial |
$13.86
|
| Rate for Payer: BCN Medicare Advantage |
$11.98
|
| Rate for Payer: Cash Price |
$89.56
|
| Rate for Payer: Cash Price |
$89.56
|
| Rate for Payer: Cofinity Advantage |
$78.36
|
| Rate for Payer: Cofinity Commercial |
$96.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.98
|
| Rate for Payer: Healthscope Commercial |
$100.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$78.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.96
|
| Rate for Payer: Mclaren Medicaid |
$11.98
|
| Rate for Payer: Mclaren Medicare |
$11.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.58
|
| Rate for Payer: Meridian Medicaid |
$12.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.78
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.16
|
| Rate for Payer: Nomi Health Commercial |
$17.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.96
|
| Rate for Payer: PACE Medicare |
$11.38
|
| Rate for Payer: PACE SWMI |
$11.98
|
| Rate for Payer: PHP Commercial |
$95.16
|
| Rate for Payer: PHP Medicare Advantage |
$11.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11.98
|
| Rate for Payer: Priority Health Medicare |
$11.98
|
| Rate for Payer: Priority Health SBD |
$70.53
|
| Rate for Payer: Priority Health Tiered Network |
$9.58
|
| Rate for Payer: Railroad Medicare Medicare |
$11.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.97
|
| Rate for Payer: UHC Core |
$17.97
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11.98
|
| Rate for Payer: UHC Exchange |
$17.97
|
| Rate for Payer: UHC Medicaid |
$6.27
|
| Rate for Payer: UHCCP Medicaid |
$6.27
|
| Rate for Payer: UMR Bronson Commercial |
$41.42
|
| Rate for Payer: VA VA |
$11.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.96
|
|
|
HC ROTAVIRUS ANTIGEN
|
Facility
|
IP
|
$111.95
|
|
|
Service Code
|
CPT 87425
|
| Hospital Charge Code |
30600145
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$49.26 |
| Max. Negotiated Rate |
$100.75 |
| Rate for Payer: Aetna American Axle |
$72.77
|
| Rate for Payer: Aetna Commercial |
$95.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.77
|
| Rate for Payer: Cash Price |
$89.56
|
| Rate for Payer: Cofinity Advantage |
$78.36
|
| Rate for Payer: Cofinity Commercial |
$96.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.56
|
| Rate for Payer: Healthscope Commercial |
$100.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$78.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.96
|
| Rate for Payer: PHP Commercial |
$95.16
|
| Rate for Payer: Priority Health SBD |
$70.53
|
| Rate for Payer: UMR Bronson Commercial |
$49.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.96
|
|
|
HC ROTAVIRUS ATTEN 2 DOSE SCHED LIVE ORAL
|
Facility
|
OP
|
$182.10
|
|
|
Service Code
|
CPT 90681
|
| Hospital Charge Code |
63600121
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$67.38 |
| Max. Negotiated Rate |
$467.91 |
| Rate for Payer: Aetna American Axle |
$118.36
|
| Rate for Payer: Aetna Commercial |
$154.78
|
| Rate for Payer: Aetna Medicare |
$91.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.36
|
| Rate for Payer: BCBS Complete |
$72.84
|
| Rate for Payer: BCBS Trust/PPO |
$467.91
|
| Rate for Payer: BCN Commercial |
$467.91
|
| Rate for Payer: Cash Price |
$145.68
|
| Rate for Payer: Cash Price |
$145.68
|
| Rate for Payer: Cofinity Advantage |
$127.47
|
| Rate for Payer: Cofinity Commercial |
$156.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.68
|
| Rate for Payer: Healthscope Commercial |
$163.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$127.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$136.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$145.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$136.57
|
| Rate for Payer: PHP Commercial |
$154.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$167.46
|
| Rate for Payer: Priority Health SBD |
$114.72
|
| Rate for Payer: Priority Health Tiered Network |
$133.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$308.24
|
| Rate for Payer: UHC Core |
$308.24
|
| Rate for Payer: UHC Exchange |
$308.24
|
| Rate for Payer: UMR Bronson Commercial |
$67.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$136.57
|
|
|
HC ROTAVIRUS ATTEN 2 DOSE SCHED LIVE ORAL
|
Facility
|
IP
|
$182.10
|
|
|
Service Code
|
CPT 90681
|
| Hospital Charge Code |
63600121
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$80.12 |
| Max. Negotiated Rate |
$163.89 |
| Rate for Payer: Aetna American Axle |
$118.36
|
| Rate for Payer: Aetna Commercial |
$154.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.36
|
| Rate for Payer: Cash Price |
$145.68
|
| Rate for Payer: Cofinity Advantage |
$127.47
|
| Rate for Payer: Cofinity Commercial |
$156.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.68
|
| Rate for Payer: Healthscope Commercial |
$163.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$127.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$136.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$136.57
|
| Rate for Payer: PHP Commercial |
$154.78
|
| Rate for Payer: Priority Health SBD |
$114.72
|
| Rate for Payer: UMR Bronson Commercial |
$80.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$136.57
|
|
|
HC ROTAVIRUS VACCINE, PENTAVALENT (RV5), 3 DOSE SCHEDULE, LIVE ORAL
|
Facility
|
OP
|
$78.96
|
|
|
Service Code
|
CPT 90680
|
| Hospital Charge Code |
63600076
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.22 |
| Max. Negotiated Rate |
$326.98 |
| Rate for Payer: Aetna American Axle |
$51.32
|
| Rate for Payer: Aetna Commercial |
$67.12
|
| Rate for Payer: Aetna Medicare |
$39.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.32
|
| Rate for Payer: BCBS Complete |
$31.58
|
| Rate for Payer: BCBS Trust/PPO |
$326.98
|
| Rate for Payer: BCN Commercial |
$326.98
|
| Rate for Payer: Cash Price |
$63.17
|
| Rate for Payer: Cash Price |
$63.17
|
| Rate for Payer: Cofinity Advantage |
$55.27
|
| Rate for Payer: Cofinity Commercial |
$67.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.17
|
| Rate for Payer: Healthscope Commercial |
$71.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$55.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$63.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.22
|
| Rate for Payer: PHP Commercial |
$67.12
|
| Rate for Payer: Priority Health SBD |
$49.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$203.18
|
| Rate for Payer: UHC Core |
$203.18
|
| Rate for Payer: UHC Exchange |
$203.18
|
| Rate for Payer: UMR Bronson Commercial |
$29.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.22
|
|
|
HC ROTAVIRUS VACCINE, PENTAVALENT (RV5), 3 DOSE SCHEDULE, LIVE ORAL
|
Facility
|
IP
|
$78.96
|
|
|
Service Code
|
CPT 90680
|
| Hospital Charge Code |
63600076
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.74 |
| Max. Negotiated Rate |
$71.06 |
| Rate for Payer: Aetna American Axle |
$51.32
|
| Rate for Payer: Aetna Commercial |
$67.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.32
|
| Rate for Payer: Cash Price |
$63.17
|
| Rate for Payer: Cofinity Advantage |
$55.27
|
| Rate for Payer: Cofinity Commercial |
$67.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.17
|
| Rate for Payer: Healthscope Commercial |
$71.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$55.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.22
|
| Rate for Payer: PHP Commercial |
$67.12
|
| Rate for Payer: Priority Health SBD |
$49.74
|
| Rate for Payer: UMR Bronson Commercial |
$34.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.22
|
|
|
HC RO TREATMENT DEVICE INTERMED
|
Facility
|
IP
|
$531.66
|
|
|
Service Code
|
CPT 77333
|
| Hospital Charge Code |
33300037
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$233.93 |
| Max. Negotiated Rate |
$478.49 |
| Rate for Payer: Aetna American Axle |
$345.58
|
| Rate for Payer: Aetna Commercial |
$451.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$345.58
|
| Rate for Payer: Cash Price |
$425.33
|
| Rate for Payer: Cofinity Advantage |
$372.16
|
| Rate for Payer: Cofinity Commercial |
$457.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$425.33
|
| Rate for Payer: Healthscope Commercial |
$478.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$372.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$398.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$451.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$398.75
|
| Rate for Payer: PHP Commercial |
$451.91
|
| Rate for Payer: Priority Health SBD |
$334.95
|
| Rate for Payer: UMR Bronson Commercial |
$233.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$398.75
|
|
|
HC RO TREATMENT DEVICE INTERMED
|
Facility
|
OP
|
$531.66
|
|
|
Service Code
|
CPT 77333
|
| Hospital Charge Code |
33300037
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$22.73 |
| Max. Negotiated Rate |
$478.49 |
| Rate for Payer: Aetna American Axle |
$345.58
|
| Rate for Payer: Aetna Commercial |
$451.91
|
| Rate for Payer: Aetna Medicare |
$139.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$345.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$167.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$167.41
|
| Rate for Payer: BCBS Complete |
$73.55
|
| Rate for Payer: BCBS MAPPO |
$133.93
|
| Rate for Payer: BCBS Trust/PPO |
$22.73
|
| Rate for Payer: BCN Commercial |
$22.73
|
| Rate for Payer: BCN Medicare Advantage |
$133.93
|
| Rate for Payer: Cash Price |
$425.33
|
| Rate for Payer: Cash Price |
$425.33
|
| Rate for Payer: Cofinity Advantage |
$372.16
|
| Rate for Payer: Cofinity Commercial |
$457.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$425.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$133.93
|
| Rate for Payer: Healthscope Commercial |
$478.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$372.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$398.75
|
| Rate for Payer: Mclaren Medicaid |
$133.93
|
| Rate for Payer: Mclaren Medicare |
$133.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$140.63
|
| Rate for Payer: Meridian Medicaid |
$140.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$154.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$147.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$451.91
|
| Rate for Payer: Nomi Health Commercial |
$401.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$398.75
|
| Rate for Payer: PACE Medicare |
$127.23
|
| Rate for Payer: PACE SWMI |
$133.93
|
| Rate for Payer: PHP Commercial |
$451.91
|
| Rate for Payer: PHP Medicare Advantage |
$133.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$70.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$433.11
|
| Rate for Payer: Priority Health Medicare |
$133.93
|
| Rate for Payer: Priority Health SBD |
$334.95
|
| Rate for Payer: Priority Health Tiered Network |
$346.49
|
| Rate for Payer: Railroad Medicare Medicare |
$133.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$345.58
|
| Rate for Payer: UHC Core |
$276.99
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$133.93
|
| Rate for Payer: UHC Exchange |
$208.94
|
| Rate for Payer: UHC Medicaid |
$70.05
|
| Rate for Payer: UHCCP Medicaid |
$70.05
|
| Rate for Payer: UMR Bronson Commercial |
$196.71
|
| Rate for Payer: VA VA |
$133.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$398.75
|
|
|
HC RO TREATMENT DEVICE SIMPLE
|
Facility
|
IP
|
$422.36
|
|
|
Service Code
|
CPT 77332
|
| Hospital Charge Code |
33300038
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$185.84 |
| Max. Negotiated Rate |
$380.12 |
| Rate for Payer: Aetna American Axle |
$274.53
|
| Rate for Payer: Aetna Commercial |
$359.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$274.53
|
| Rate for Payer: Cash Price |
$337.89
|
| Rate for Payer: Cofinity Advantage |
$295.65
|
| Rate for Payer: Cofinity Commercial |
$363.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$337.89
|
| Rate for Payer: Healthscope Commercial |
$380.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$295.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$316.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$359.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$316.77
|
| Rate for Payer: PHP Commercial |
$359.01
|
| Rate for Payer: Priority Health SBD |
$266.09
|
| Rate for Payer: UMR Bronson Commercial |
$185.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$316.77
|
|
|
HC RO TREATMENT DEVICE SIMPLE
|
Facility
|
OP
|
$422.36
|
|
|
Service Code
|
CPT 77332
|
| Hospital Charge Code |
33300038
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$70.05 |
| Max. Negotiated Rate |
$433.11 |
| Rate for Payer: Aetna American Axle |
$274.53
|
| Rate for Payer: Aetna Commercial |
$359.01
|
| Rate for Payer: Aetna Medicare |
$139.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$274.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$167.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$167.41
|
| Rate for Payer: BCBS Complete |
$73.55
|
| Rate for Payer: BCBS MAPPO |
$133.93
|
| Rate for Payer: BCBS Trust/PPO |
$129.68
|
| Rate for Payer: BCN Commercial |
$129.68
|
| Rate for Payer: BCN Medicare Advantage |
$133.93
|
| Rate for Payer: Cash Price |
$337.89
|
| Rate for Payer: Cash Price |
$337.89
|
| Rate for Payer: Cofinity Advantage |
$295.65
|
| Rate for Payer: Cofinity Commercial |
$363.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$337.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$133.93
|
| Rate for Payer: Healthscope Commercial |
$380.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$295.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$316.77
|
| Rate for Payer: Mclaren Medicaid |
$133.93
|
| Rate for Payer: Mclaren Medicare |
$133.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$140.63
|
| Rate for Payer: Meridian Medicaid |
$140.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$154.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$147.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$359.01
|
| Rate for Payer: Nomi Health Commercial |
$401.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$316.77
|
| Rate for Payer: PACE Medicare |
$127.23
|
| Rate for Payer: PACE SWMI |
$133.93
|
| Rate for Payer: PHP Commercial |
$359.01
|
| Rate for Payer: PHP Medicare Advantage |
$133.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$70.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$433.11
|
| Rate for Payer: Priority Health Medicare |
$133.93
|
| Rate for Payer: Priority Health SBD |
$266.09
|
| Rate for Payer: Priority Health Tiered Network |
$346.49
|
| Rate for Payer: Railroad Medicare Medicare |
$133.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$274.53
|
| Rate for Payer: UHC Core |
$220.05
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$133.93
|
| Rate for Payer: UHC Exchange |
$165.99
|
| Rate for Payer: UHC Medicaid |
$70.05
|
| Rate for Payer: UHCCP Medicaid |
$70.05
|
| Rate for Payer: UMR Bronson Commercial |
$156.27
|
| Rate for Payer: VA VA |
$133.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$316.77
|
|
|
HC RO TRTMNT >1 MEV COMPLEX
|
Facility
|
OP
|
$715.25
|
|
|
Service Code
|
CPT 77412
|
| Hospital Charge Code |
33300049
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$264.64 |
| Max. Negotiated Rate |
$1,780.43 |
| Rate for Payer: Aetna American Axle |
$464.91
|
| Rate for Payer: Aetna Commercial |
$607.96
|
| Rate for Payer: Aetna Medicare |
$572.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$464.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$688.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$688.20
|
| Rate for Payer: BCBS Complete |
$302.37
|
| Rate for Payer: BCBS MAPPO |
$550.56
|
| Rate for Payer: BCBS Trust/PPO |
$313.19
|
| Rate for Payer: BCN Commercial |
$313.19
|
| Rate for Payer: BCN Medicare Advantage |
$550.56
|
| Rate for Payer: Cash Price |
$572.20
|
| Rate for Payer: Cash Price |
$572.20
|
| Rate for Payer: Cofinity Advantage |
$500.68
|
| Rate for Payer: Cofinity Commercial |
$615.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$572.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$550.56
|
| Rate for Payer: Healthscope Commercial |
$643.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$500.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$536.44
|
| Rate for Payer: Mclaren Medicaid |
$550.56
|
| Rate for Payer: Mclaren Medicare |
$550.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$578.09
|
| Rate for Payer: Meridian Medicaid |
$578.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$633.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$605.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$607.96
|
| Rate for Payer: Nomi Health Commercial |
$1,651.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$536.44
|
| Rate for Payer: PACE Medicare |
$523.03
|
| Rate for Payer: PACE SWMI |
$550.56
|
| Rate for Payer: PHP Commercial |
$607.96
|
| Rate for Payer: PHP Medicare Advantage |
$550.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$287.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,780.43
|
| Rate for Payer: Priority Health Medicare |
$550.56
|
| Rate for Payer: Priority Health SBD |
$450.61
|
| Rate for Payer: Priority Health Tiered Network |
$1,424.34
|
| Rate for Payer: Railroad Medicare Medicare |
$550.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$464.91
|
| Rate for Payer: UHC Core |
$372.65
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$550.56
|
| Rate for Payer: UHC Exchange |
$281.09
|
| Rate for Payer: UHC Medicaid |
$287.94
|
| Rate for Payer: UHCCP Medicaid |
$287.94
|
| Rate for Payer: UMR Bronson Commercial |
$264.64
|
| Rate for Payer: VA VA |
$550.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$536.44
|
|
|
HC RO TRTMNT >1 MEV COMPLEX
|
Facility
|
IP
|
$715.25
|
|
|
Service Code
|
CPT 77412
|
| Hospital Charge Code |
33300049
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$314.71 |
| Max. Negotiated Rate |
$643.73 |
| Rate for Payer: Aetna American Axle |
$464.91
|
| Rate for Payer: Aetna Commercial |
$607.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$464.91
|
| Rate for Payer: Cash Price |
$572.20
|
| Rate for Payer: Cofinity Advantage |
$500.68
|
| Rate for Payer: Cofinity Commercial |
$615.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$572.20
|
| Rate for Payer: Healthscope Commercial |
$643.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$500.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$536.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$607.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$536.44
|
| Rate for Payer: PHP Commercial |
$607.96
|
| Rate for Payer: Priority Health SBD |
$450.61
|
| Rate for Payer: UMR Bronson Commercial |
$314.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$536.44
|
|
|
HC RO TRTMNT > 1 MEV INTERMEDIATE
|
Facility
|
OP
|
$429.97
|
|
|
Service Code
|
CPT 77407
|
| Hospital Charge Code |
33300052
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$159.09 |
| Max. Negotiated Rate |
$1,242.83 |
| Rate for Payer: Aetna American Axle |
$279.48
|
| Rate for Payer: Aetna Commercial |
$365.47
|
| Rate for Payer: Aetna Medicare |
$399.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$279.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$480.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$480.39
|
| Rate for Payer: BCBS Complete |
$211.06
|
| Rate for Payer: BCBS MAPPO |
$384.31
|
| Rate for Payer: BCBS Trust/PPO |
$177.80
|
| Rate for Payer: BCN Commercial |
$177.80
|
| Rate for Payer: BCN Medicare Advantage |
$384.31
|
| Rate for Payer: Cash Price |
$343.98
|
| Rate for Payer: Cash Price |
$343.98
|
| Rate for Payer: Cofinity Advantage |
$300.98
|
| Rate for Payer: Cofinity Commercial |
$369.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$343.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$384.31
|
| Rate for Payer: Healthscope Commercial |
$386.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$300.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$322.48
|
| Rate for Payer: Mclaren Medicaid |
$384.31
|
| Rate for Payer: Mclaren Medicare |
$384.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$403.53
|
| Rate for Payer: Meridian Medicaid |
$403.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$441.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$422.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$365.47
|
| Rate for Payer: Nomi Health Commercial |
$1,152.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$322.48
|
| Rate for Payer: PACE Medicare |
$365.09
|
| Rate for Payer: PACE SWMI |
$384.31
|
| Rate for Payer: PHP Commercial |
$365.47
|
| Rate for Payer: PHP Medicare Advantage |
$384.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$200.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,242.83
|
| Rate for Payer: Priority Health Medicare |
$384.31
|
| Rate for Payer: Priority Health SBD |
$270.88
|
| Rate for Payer: Priority Health Tiered Network |
$994.26
|
| Rate for Payer: Railroad Medicare Medicare |
$384.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$279.48
|
| Rate for Payer: UHC Core |
$224.01
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$384.31
|
| Rate for Payer: UHC Exchange |
$168.98
|
| Rate for Payer: UHC Medicaid |
$200.99
|
| Rate for Payer: UHCCP Medicaid |
$200.99
|
| Rate for Payer: UMR Bronson Commercial |
$159.09
|
| Rate for Payer: VA VA |
$384.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$322.48
|
|
|
HC RO TRTMNT > 1 MEV INTERMEDIATE
|
Facility
|
IP
|
$429.97
|
|
|
Service Code
|
CPT 77407
|
| Hospital Charge Code |
33300052
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$189.19 |
| Max. Negotiated Rate |
$386.97 |
| Rate for Payer: Aetna American Axle |
$279.48
|
| Rate for Payer: Aetna Commercial |
$365.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$279.48
|
| Rate for Payer: Cash Price |
$343.98
|
| Rate for Payer: Cofinity Advantage |
$300.98
|
| Rate for Payer: Cofinity Commercial |
$369.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$343.98
|
| Rate for Payer: Healthscope Commercial |
$386.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$300.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$322.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$365.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$322.48
|
| Rate for Payer: PHP Commercial |
$365.47
|
| Rate for Payer: Priority Health SBD |
$270.88
|
| Rate for Payer: UMR Bronson Commercial |
$189.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$322.48
|
|
|
HC RO TRTMNT >1 MEV SIMPLE
|
Facility
|
IP
|
$235.86
|
|
|
Service Code
|
CPT 77402
|
| Hospital Charge Code |
33300048
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$103.78 |
| Max. Negotiated Rate |
$212.27 |
| Rate for Payer: Aetna American Axle |
$153.31
|
| Rate for Payer: Aetna Commercial |
$200.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.31
|
| Rate for Payer: Cash Price |
$188.69
|
| Rate for Payer: Cofinity Advantage |
$165.10
|
| Rate for Payer: Cofinity Commercial |
$202.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.69
|
| Rate for Payer: Healthscope Commercial |
$212.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$165.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$176.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$176.90
|
| Rate for Payer: PHP Commercial |
$200.48
|
| Rate for Payer: Priority Health SBD |
$148.59
|
| Rate for Payer: UMR Bronson Commercial |
$103.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$176.90
|
|
|
HC RO TRTMNT >1 MEV SIMPLE
|
Facility
|
OP
|
$235.86
|
|
|
Service Code
|
CPT 77402
|
| Hospital Charge Code |
33300048
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$53.17 |
| Max. Negotiated Rate |
$328.77 |
| Rate for Payer: Aetna American Axle |
$153.31
|
| Rate for Payer: Aetna Commercial |
$200.48
|
| Rate for Payer: Aetna Medicare |
$105.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$127.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$127.08
|
| Rate for Payer: BCBS Complete |
$55.83
|
| Rate for Payer: BCBS MAPPO |
$101.66
|
| Rate for Payer: BCBS Trust/PPO |
$177.80
|
| Rate for Payer: BCN Commercial |
$177.80
|
| Rate for Payer: BCN Medicare Advantage |
$101.66
|
| Rate for Payer: Cash Price |
$188.69
|
| Rate for Payer: Cash Price |
$188.69
|
| Rate for Payer: Cofinity Advantage |
$165.10
|
| Rate for Payer: Cofinity Commercial |
$202.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.66
|
| Rate for Payer: Healthscope Commercial |
$212.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$165.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$176.90
|
| Rate for Payer: Mclaren Medicaid |
$101.66
|
| Rate for Payer: Mclaren Medicare |
$101.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$106.74
|
| Rate for Payer: Meridian Medicaid |
$106.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$116.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$111.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.48
|
| Rate for Payer: Nomi Health Commercial |
$304.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$176.90
|
| Rate for Payer: PACE Medicare |
$96.58
|
| Rate for Payer: PACE SWMI |
$101.66
|
| Rate for Payer: PHP Commercial |
$200.48
|
| Rate for Payer: PHP Medicare Advantage |
$101.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$328.77
|
| Rate for Payer: Priority Health Medicare |
$101.66
|
| Rate for Payer: Priority Health SBD |
$148.59
|
| Rate for Payer: Priority Health Tiered Network |
$263.02
|
| Rate for Payer: Railroad Medicare Medicare |
$101.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$153.31
|
| Rate for Payer: UHC Core |
$122.88
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$101.66
|
| Rate for Payer: UHC Exchange |
$92.69
|
| Rate for Payer: UHC Medicaid |
$53.17
|
| Rate for Payer: UHCCP Medicaid |
$53.17
|
| Rate for Payer: UMR Bronson Commercial |
$87.27
|
| Rate for Payer: VA VA |
$101.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$176.90
|
|
|
HC RO TRTMNT LEVEL 1
|
Facility
|
IP
|
$254.15
|
|
|
Service Code
|
CPT 77402
|
| Hospital Charge Code |
33300078
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$111.83 |
| Max. Negotiated Rate |
$228.74 |
| Rate for Payer: Aetna American Axle |
$165.20
|
| Rate for Payer: Aetna Commercial |
$216.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.20
|
| Rate for Payer: Cash Price |
$203.32
|
| Rate for Payer: Cofinity Advantage |
$177.91
|
| Rate for Payer: Cofinity Commercial |
$218.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.32
|
| Rate for Payer: Healthscope Commercial |
$228.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$177.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$190.61
|
| Rate for Payer: PHP Commercial |
$216.03
|
| Rate for Payer: Priority Health SBD |
$160.11
|
| Rate for Payer: UMR Bronson Commercial |
$111.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.61
|
|
