|
HC SILVER HAWK CATHETER
|
Facility
|
OP
|
$8,921.49
|
|
|
Service Code
|
HCPCS C1888
|
| Hospital Charge Code |
27200070
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,300.95 |
| Max. Negotiated Rate |
$8,029.34 |
| Rate for Payer: Aetna American Axle |
$5,798.97
|
| Rate for Payer: Aetna Commercial |
$7,583.27
|
| Rate for Payer: Aetna Medicare |
$4,460.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,798.97
|
| Rate for Payer: BCBS Complete |
$3,568.60
|
| Rate for Payer: Cash Price |
$7,137.19
|
| Rate for Payer: Cofinity Advantage |
$6,245.04
|
| Rate for Payer: Cofinity Commercial |
$7,672.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,137.19
|
| Rate for Payer: Healthscope Commercial |
$8,029.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,245.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,691.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,137.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,583.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,691.12
|
| Rate for Payer: PHP Commercial |
$7,583.27
|
| Rate for Payer: Priority Health SBD |
$5,620.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,798.97
|
| Rate for Payer: UHC Core |
$4,648.10
|
| Rate for Payer: UHC Exchange |
$3,506.15
|
| Rate for Payer: UMR Bronson Commercial |
$3,300.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,691.12
|
|
|
HC SILVER HAWK CATHETER
|
Facility
|
IP
|
$8,921.49
|
|
|
Service Code
|
HCPCS C1888
|
| Hospital Charge Code |
27200070
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,925.46 |
| Max. Negotiated Rate |
$8,029.34 |
| Rate for Payer: Aetna American Axle |
$5,798.97
|
| Rate for Payer: Aetna Commercial |
$7,583.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,798.97
|
| Rate for Payer: Cash Price |
$7,137.19
|
| Rate for Payer: Cofinity Advantage |
$6,245.04
|
| Rate for Payer: Cofinity Commercial |
$7,672.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,137.19
|
| Rate for Payer: Healthscope Commercial |
$8,029.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,245.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,691.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,583.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,691.12
|
| Rate for Payer: PHP Commercial |
$7,583.27
|
| Rate for Payer: Priority Health SBD |
$5,620.54
|
| Rate for Payer: UMR Bronson Commercial |
$3,925.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,691.12
|
|
|
HC SILVER ROPE
|
Facility
|
IP
|
$55.67
|
|
| Hospital Charge Code |
27000147
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.49 |
| Max. Negotiated Rate |
$50.10 |
| Rate for Payer: Aetna American Axle |
$36.19
|
| Rate for Payer: Aetna Commercial |
$47.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.19
|
| Rate for Payer: Cash Price |
$44.54
|
| Rate for Payer: Cofinity Advantage |
$38.97
|
| Rate for Payer: Cofinity Commercial |
$47.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.54
|
| Rate for Payer: Healthscope Commercial |
$50.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$38.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.75
|
| Rate for Payer: PHP Commercial |
$47.32
|
| Rate for Payer: Priority Health SBD |
$35.07
|
| Rate for Payer: UMR Bronson Commercial |
$24.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.75
|
|
|
HC SILVER ROPE
|
Facility
|
OP
|
$55.67
|
|
| Hospital Charge Code |
27000147
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$20.60 |
| Max. Negotiated Rate |
$50.10 |
| Rate for Payer: Aetna American Axle |
$36.19
|
| Rate for Payer: Aetna Commercial |
$47.32
|
| Rate for Payer: Aetna Medicare |
$27.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.19
|
| Rate for Payer: BCBS Complete |
$22.27
|
| Rate for Payer: Cash Price |
$44.54
|
| Rate for Payer: Cofinity Advantage |
$38.97
|
| Rate for Payer: Cofinity Commercial |
$47.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.54
|
| Rate for Payer: Healthscope Commercial |
$50.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$38.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.75
|
| Rate for Payer: PHP Commercial |
$47.32
|
| Rate for Payer: Priority Health SBD |
$35.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.19
|
| Rate for Payer: UHC Core |
$29.00
|
| Rate for Payer: UHC Exchange |
$21.88
|
| Rate for Payer: UMR Bronson Commercial |
$20.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.75
|
|
|
HC SIMIAN B AB
|
Facility
|
OP
|
$92.91
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
30200333
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.74 |
| Max. Negotiated Rate |
$83.62 |
| Rate for Payer: Aetna American Axle |
$60.39
|
| Rate for Payer: Aetna Commercial |
$78.97
|
| Rate for Payer: Aetna Medicare |
$13.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.10
|
| Rate for Payer: BCBS Complete |
$7.07
|
| Rate for Payer: BCBS MAPPO |
$12.88
|
| Rate for Payer: BCBS Trust/PPO |
$14.89
|
| Rate for Payer: BCN Commercial |
$14.89
|
| Rate for Payer: BCN Medicare Advantage |
$12.88
|
| Rate for Payer: Cash Price |
$74.33
|
| Rate for Payer: Cash Price |
$74.33
|
| Rate for Payer: Cofinity Advantage |
$65.04
|
| Rate for Payer: Cofinity Commercial |
$79.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.88
|
| Rate for Payer: Healthscope Commercial |
$83.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$65.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.68
|
| Rate for Payer: Mclaren Medicaid |
$12.88
|
| Rate for Payer: Mclaren Medicare |
$12.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.52
|
| Rate for Payer: Meridian Medicaid |
$13.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.97
|
| Rate for Payer: Nomi Health Commercial |
$19.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$69.68
|
| Rate for Payer: PACE Medicare |
$12.24
|
| Rate for Payer: PACE SWMI |
$12.88
|
| Rate for Payer: PHP Commercial |
$78.97
|
| Rate for Payer: PHP Medicare Advantage |
$12.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12.88
|
| Rate for Payer: Priority Health Medicare |
$12.88
|
| Rate for Payer: Priority Health SBD |
$58.53
|
| Rate for Payer: Priority Health Tiered Network |
$10.30
|
| Rate for Payer: Railroad Medicare Medicare |
$12.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.32
|
| Rate for Payer: UHC Core |
$19.32
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.88
|
| Rate for Payer: UHC Exchange |
$19.32
|
| Rate for Payer: UHC Medicaid |
$6.74
|
| Rate for Payer: UHCCP Medicaid |
$6.74
|
| Rate for Payer: UMR Bronson Commercial |
$34.38
|
| Rate for Payer: VA VA |
$12.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.68
|
|
|
HC SIMIAN B AB
|
Facility
|
IP
|
$92.91
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
30200333
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$40.88 |
| Max. Negotiated Rate |
$83.62 |
| Rate for Payer: Aetna American Axle |
$60.39
|
| Rate for Payer: Aetna Commercial |
$78.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.39
|
| Rate for Payer: Cash Price |
$74.33
|
| Rate for Payer: Cofinity Advantage |
$65.04
|
| Rate for Payer: Cofinity Commercial |
$79.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.33
|
| Rate for Payer: Healthscope Commercial |
$83.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$65.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$69.68
|
| Rate for Payer: PHP Commercial |
$78.97
|
| Rate for Payer: Priority Health SBD |
$58.53
|
| Rate for Payer: UMR Bronson Commercial |
$40.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.68
|
|
|
HC SIMPLE CYSTOMETROGRAM
|
Facility
|
OP
|
$368.37
|
|
|
Service Code
|
CPT 51725
|
| Hospital Charge Code |
76100189
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$130.20 |
| Max. Negotiated Rate |
$805.08 |
| Rate for Payer: Aetna American Axle |
$239.44
|
| Rate for Payer: Aetna Commercial |
$313.11
|
| Rate for Payer: Aetna Medicare |
$258.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$239.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$311.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$311.19
|
| Rate for Payer: BCBS Complete |
$136.72
|
| Rate for Payer: BCBS MAPPO |
$248.95
|
| Rate for Payer: BCBS Trust/PPO |
$151.62
|
| Rate for Payer: BCN Commercial |
$151.62
|
| Rate for Payer: BCN Medicare Advantage |
$248.95
|
| Rate for Payer: Cash Price |
$294.70
|
| Rate for Payer: Cash Price |
$294.70
|
| Rate for Payer: Cash Price |
$294.70
|
| Rate for Payer: Cofinity Advantage |
$257.86
|
| Rate for Payer: Cofinity Commercial |
$316.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$294.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$248.95
|
| Rate for Payer: Healthscope Commercial |
$331.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$257.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$276.28
|
| Rate for Payer: Mclaren Medicaid |
$248.95
|
| Rate for Payer: Mclaren Medicare |
$248.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$261.40
|
| Rate for Payer: Meridian Medicaid |
$261.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$286.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$273.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$313.11
|
| Rate for Payer: Nomi Health Commercial |
$746.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$276.28
|
| Rate for Payer: PACE Medicare |
$236.50
|
| Rate for Payer: PACE SWMI |
$248.95
|
| Rate for Payer: PHP Commercial |
$313.11
|
| Rate for Payer: PHP Medicare Advantage |
$248.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$130.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$805.08
|
| Rate for Payer: Priority Health Medicare |
$248.95
|
| Rate for Payer: Priority Health SBD |
$232.07
|
| Rate for Payer: Priority Health Tiered Network |
$644.06
|
| Rate for Payer: Railroad Medicare Medicare |
$248.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$239.44
|
| Rate for Payer: UHC Core |
$191.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$248.95
|
| Rate for Payer: UHC Exchange |
$144.77
|
| Rate for Payer: UHC Medicaid |
$130.20
|
| Rate for Payer: UHCCP Medicaid |
$130.20
|
| Rate for Payer: UMR Bronson Commercial |
$136.30
|
| Rate for Payer: VA VA |
$248.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$276.28
|
|
|
HC SIMPLE CYSTOMETROGRAM
|
Facility
|
IP
|
$368.37
|
|
|
Service Code
|
CPT 51725
|
| Hospital Charge Code |
76100189
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$162.08 |
| Max. Negotiated Rate |
$331.53 |
| Rate for Payer: Aetna American Axle |
$239.44
|
| Rate for Payer: Aetna Commercial |
$313.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$239.44
|
| Rate for Payer: Cash Price |
$294.70
|
| Rate for Payer: Cofinity Advantage |
$257.86
|
| Rate for Payer: Cofinity Commercial |
$316.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$294.70
|
| Rate for Payer: Healthscope Commercial |
$331.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$257.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$276.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$313.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$276.28
|
| Rate for Payer: PHP Commercial |
$313.11
|
| Rate for Payer: Priority Health SBD |
$232.07
|
| Rate for Payer: UMR Bronson Commercial |
$162.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$276.28
|
|
|
HC SIMPLE REPAIR FACE EARS EYELIDS NOSE LIP OR MUC MEMB 2.6 CM-5.0 CM
|
Facility
|
IP
|
$573.24
|
|
|
Service Code
|
CPT 12013
|
| Hospital Charge Code |
76100434
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$252.23 |
| Max. Negotiated Rate |
$515.92 |
| Rate for Payer: Aetna American Axle |
$372.61
|
| Rate for Payer: Aetna Commercial |
$487.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$372.61
|
| Rate for Payer: Cash Price |
$458.59
|
| Rate for Payer: Cofinity Advantage |
$401.27
|
| Rate for Payer: Cofinity Commercial |
$492.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$458.59
|
| Rate for Payer: Healthscope Commercial |
$515.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$401.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$429.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$487.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$429.93
|
| Rate for Payer: PHP Commercial |
$487.25
|
| Rate for Payer: Priority Health SBD |
$361.14
|
| Rate for Payer: UMR Bronson Commercial |
$252.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$429.93
|
|
|
HC SIMPLE REPAIR FACE EARS EYELIDS NOSE LIP OR MUC MEMB 2.6 CM-5.0 CM
|
Facility
|
OP
|
$573.24
|
|
|
Service Code
|
CPT 12013
|
| Hospital Charge Code |
76100434
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.55 |
| Max. Negotiated Rate |
$646.50 |
| Rate for Payer: Aetna American Axle |
$372.61
|
| Rate for Payer: Aetna Commercial |
$487.25
|
| Rate for Payer: Aetna Medicare |
$207.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$372.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$249.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$249.89
|
| Rate for Payer: BCBS Complete |
$109.79
|
| Rate for Payer: BCBS MAPPO |
$199.91
|
| Rate for Payer: BCBS Trust/PPO |
$234.66
|
| Rate for Payer: BCN Commercial |
$234.66
|
| Rate for Payer: BCN Medicare Advantage |
$199.91
|
| Rate for Payer: Cash Price |
$458.59
|
| Rate for Payer: Cash Price |
$458.59
|
| Rate for Payer: Cash Price |
$458.59
|
| Rate for Payer: Cofinity Advantage |
$401.27
|
| Rate for Payer: Cofinity Commercial |
$492.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$458.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.91
|
| Rate for Payer: Healthscope Commercial |
$515.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$401.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$429.93
|
| Rate for Payer: Mclaren Medicaid |
$199.91
|
| Rate for Payer: Mclaren Medicare |
$199.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$209.91
|
| Rate for Payer: Meridian Medicaid |
$209.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$229.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$219.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$487.25
|
| Rate for Payer: Nomi Health Commercial |
$599.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$429.93
|
| Rate for Payer: PACE Medicare |
$189.91
|
| Rate for Payer: PACE SWMI |
$199.91
|
| Rate for Payer: PHP Commercial |
$487.25
|
| Rate for Payer: PHP Medicare Advantage |
$199.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$646.50
|
| Rate for Payer: Priority Health Medicare |
$199.91
|
| Rate for Payer: Priority Health SBD |
$361.14
|
| Rate for Payer: Priority Health Tiered Network |
$517.20
|
| Rate for Payer: Railroad Medicare Medicare |
$199.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$372.61
|
| Rate for Payer: UHC Core |
$298.66
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$199.91
|
| Rate for Payer: UHC Exchange |
$225.28
|
| Rate for Payer: UHC Medicaid |
$104.55
|
| Rate for Payer: UHCCP Medicaid |
$104.55
|
| Rate for Payer: UMR Bronson Commercial |
$212.10
|
| Rate for Payer: VA VA |
$199.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$429.93
|
|
|
HC SIMPLE REPAIR FACE EARS EYELIDS NOSE LIP OR MUC MEMB 5.1CM-7.5 CM
|
Facility
|
IP
|
$650.76
|
|
|
Service Code
|
CPT 12014
|
| Hospital Charge Code |
76100433
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$286.33 |
| Max. Negotiated Rate |
$585.68 |
| Rate for Payer: Aetna American Axle |
$422.99
|
| Rate for Payer: Aetna Commercial |
$553.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$422.99
|
| Rate for Payer: Cash Price |
$520.61
|
| Rate for Payer: Cofinity Advantage |
$455.53
|
| Rate for Payer: Cofinity Commercial |
$559.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$520.61
|
| Rate for Payer: Healthscope Commercial |
$585.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$455.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$488.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$553.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$488.07
|
| Rate for Payer: PHP Commercial |
$553.15
|
| Rate for Payer: Priority Health SBD |
$409.98
|
| Rate for Payer: UMR Bronson Commercial |
$286.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$488.07
|
|
|
HC SIMPLE REPAIR FACE EARS EYELIDS NOSE LIP OR MUC MEMB 5.1CM-7.5 CM
|
Facility
|
OP
|
$650.76
|
|
|
Service Code
|
CPT 12014
|
| Hospital Charge Code |
76100433
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.55 |
| Max. Negotiated Rate |
$646.50 |
| Rate for Payer: Aetna American Axle |
$422.99
|
| Rate for Payer: Aetna Commercial |
$553.15
|
| Rate for Payer: Aetna Medicare |
$207.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$422.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$249.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$249.89
|
| Rate for Payer: BCBS Complete |
$109.79
|
| Rate for Payer: BCBS MAPPO |
$199.91
|
| Rate for Payer: BCBS Trust/PPO |
$416.59
|
| Rate for Payer: BCN Commercial |
$416.59
|
| Rate for Payer: BCN Medicare Advantage |
$199.91
|
| Rate for Payer: Cash Price |
$520.61
|
| Rate for Payer: Cash Price |
$520.61
|
| Rate for Payer: Cash Price |
$520.61
|
| Rate for Payer: Cofinity Advantage |
$455.53
|
| Rate for Payer: Cofinity Commercial |
$559.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$520.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.91
|
| Rate for Payer: Healthscope Commercial |
$585.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$455.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$488.07
|
| Rate for Payer: Mclaren Medicaid |
$199.91
|
| Rate for Payer: Mclaren Medicare |
$199.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$209.91
|
| Rate for Payer: Meridian Medicaid |
$209.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$229.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$219.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$553.15
|
| Rate for Payer: Nomi Health Commercial |
$599.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$488.07
|
| Rate for Payer: PACE Medicare |
$189.91
|
| Rate for Payer: PACE SWMI |
$199.91
|
| Rate for Payer: PHP Commercial |
$553.15
|
| Rate for Payer: PHP Medicare Advantage |
$199.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$646.50
|
| Rate for Payer: Priority Health Medicare |
$199.91
|
| Rate for Payer: Priority Health SBD |
$409.98
|
| Rate for Payer: Priority Health Tiered Network |
$517.20
|
| Rate for Payer: Railroad Medicare Medicare |
$199.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$422.99
|
| Rate for Payer: UHC Core |
$339.05
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$199.91
|
| Rate for Payer: UHC Exchange |
$255.75
|
| Rate for Payer: UHC Medicaid |
$104.55
|
| Rate for Payer: UHCCP Medicaid |
$104.55
|
| Rate for Payer: UMR Bronson Commercial |
$240.78
|
| Rate for Payer: VA VA |
$199.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$488.07
|
|
|
HC SIMPLE REP WD FACE,EAR,EYELID,NOSE,LIP,MUC MEMB 2.5CM OR LESS
|
Facility
|
OP
|
$278.14
|
|
|
Service Code
|
CPT 12011
|
| Hospital Charge Code |
76100274
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$102.91 |
| Max. Negotiated Rate |
$646.50 |
| Rate for Payer: Aetna American Axle |
$180.79
|
| Rate for Payer: Aetna Commercial |
$236.42
|
| Rate for Payer: Aetna Medicare |
$207.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$249.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$249.89
|
| Rate for Payer: BCBS Complete |
$109.79
|
| Rate for Payer: BCBS MAPPO |
$199.91
|
| Rate for Payer: BCBS Trust/PPO |
$173.24
|
| Rate for Payer: BCN Commercial |
$173.24
|
| Rate for Payer: BCN Medicare Advantage |
$199.91
|
| Rate for Payer: Cash Price |
$222.51
|
| Rate for Payer: Cash Price |
$222.51
|
| Rate for Payer: Cash Price |
$222.51
|
| Rate for Payer: Cofinity Advantage |
$194.70
|
| Rate for Payer: Cofinity Commercial |
$239.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.91
|
| Rate for Payer: Healthscope Commercial |
$250.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$194.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$208.60
|
| Rate for Payer: Mclaren Medicaid |
$199.91
|
| Rate for Payer: Mclaren Medicare |
$199.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$209.91
|
| Rate for Payer: Meridian Medicaid |
$209.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$229.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$219.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.42
|
| Rate for Payer: Nomi Health Commercial |
$599.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$208.60
|
| Rate for Payer: PACE Medicare |
$189.91
|
| Rate for Payer: PACE SWMI |
$199.91
|
| Rate for Payer: PHP Commercial |
$236.42
|
| Rate for Payer: PHP Medicare Advantage |
$199.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$646.50
|
| Rate for Payer: Priority Health Medicare |
$199.91
|
| Rate for Payer: Priority Health SBD |
$175.23
|
| Rate for Payer: Priority Health Tiered Network |
$517.20
|
| Rate for Payer: Railroad Medicare Medicare |
$199.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$180.79
|
| Rate for Payer: UHC Core |
$144.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$199.91
|
| Rate for Payer: UHC Exchange |
$109.31
|
| Rate for Payer: UHC Medicaid |
$104.55
|
| Rate for Payer: UHCCP Medicaid |
$104.55
|
| Rate for Payer: UMR Bronson Commercial |
$102.91
|
| Rate for Payer: VA VA |
$199.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$208.60
|
|
|
HC SIMPLE REP WD FACE,EAR,EYELID,NOSE,LIP,MUC MEMB 2.5CM OR LESS
|
Facility
|
IP
|
$278.14
|
|
|
Service Code
|
CPT 12011
|
| Hospital Charge Code |
76100274
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$122.38 |
| Max. Negotiated Rate |
$250.33 |
| Rate for Payer: Aetna American Axle |
$180.79
|
| Rate for Payer: Aetna Commercial |
$236.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.79
|
| Rate for Payer: Cash Price |
$222.51
|
| Rate for Payer: Cofinity Advantage |
$194.70
|
| Rate for Payer: Cofinity Commercial |
$239.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.51
|
| Rate for Payer: Healthscope Commercial |
$250.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$194.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$208.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$208.60
|
| Rate for Payer: PHP Commercial |
$236.42
|
| Rate for Payer: Priority Health SBD |
$175.23
|
| Rate for Payer: UMR Bronson Commercial |
$122.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$208.60
|
|
|
HC SIMPLE REP WD SCALP,NECK,AXILLAE,GENITALIA,TRUNK, EXTREMS 2.6 TO 7.5 CM
|
Facility
|
IP
|
$150.05
|
|
|
Service Code
|
CPT 12002
|
| Hospital Charge Code |
76100114
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$66.02 |
| Max. Negotiated Rate |
$135.04 |
| Rate for Payer: Aetna American Axle |
$97.53
|
| Rate for Payer: Aetna Commercial |
$127.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.53
|
| Rate for Payer: Cash Price |
$120.04
|
| Rate for Payer: Cofinity Advantage |
$105.03
|
| Rate for Payer: Cofinity Commercial |
$129.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.04
|
| Rate for Payer: Healthscope Commercial |
$135.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$105.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$112.54
|
| Rate for Payer: PHP Commercial |
$127.54
|
| Rate for Payer: Priority Health SBD |
$94.53
|
| Rate for Payer: UMR Bronson Commercial |
$66.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.54
|
|
|
HC SIMPLE REP WD SCALP,NECK,AXILLAE,GENITALIA,TRUNK, EXTREMS 2.6 TO 7.5 CM
|
Facility
|
OP
|
$150.05
|
|
|
Service Code
|
CPT 12002
|
| Hospital Charge Code |
76100114
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$55.52 |
| Max. Negotiated Rate |
$646.50 |
| Rate for Payer: Aetna American Axle |
$97.53
|
| Rate for Payer: Aetna Commercial |
$127.54
|
| Rate for Payer: Aetna Medicare |
$207.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$249.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$249.89
|
| Rate for Payer: BCBS Complete |
$109.79
|
| Rate for Payer: BCBS MAPPO |
$199.91
|
| Rate for Payer: BCBS Trust/PPO |
$203.62
|
| Rate for Payer: BCN Commercial |
$203.62
|
| Rate for Payer: BCN Medicare Advantage |
$199.91
|
| Rate for Payer: Cash Price |
$120.04
|
| Rate for Payer: Cash Price |
$120.04
|
| Rate for Payer: Cash Price |
$120.04
|
| Rate for Payer: Cofinity Advantage |
$105.03
|
| Rate for Payer: Cofinity Commercial |
$129.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.91
|
| Rate for Payer: Healthscope Commercial |
$135.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$105.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.54
|
| Rate for Payer: Mclaren Medicaid |
$199.91
|
| Rate for Payer: Mclaren Medicare |
$199.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$209.91
|
| Rate for Payer: Meridian Medicaid |
$209.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$229.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$219.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.54
|
| Rate for Payer: Nomi Health Commercial |
$599.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$112.54
|
| Rate for Payer: PACE Medicare |
$189.91
|
| Rate for Payer: PACE SWMI |
$199.91
|
| Rate for Payer: PHP Commercial |
$127.54
|
| Rate for Payer: PHP Medicare Advantage |
$199.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$646.50
|
| Rate for Payer: Priority Health Medicare |
$199.91
|
| Rate for Payer: Priority Health SBD |
$94.53
|
| Rate for Payer: Priority Health Tiered Network |
$517.20
|
| Rate for Payer: Railroad Medicare Medicare |
$199.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$97.53
|
| Rate for Payer: UHC Core |
$78.18
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$199.91
|
| Rate for Payer: UHC Exchange |
$58.97
|
| Rate for Payer: UHC Medicaid |
$104.55
|
| Rate for Payer: UHCCP Medicaid |
$104.55
|
| Rate for Payer: UMR Bronson Commercial |
$55.52
|
| Rate for Payer: VA VA |
$199.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.54
|
|
|
HC SIMPLE REP WD SCALPNECKAXILLAEGENITALIIATRUNK EXTREMS 7.6 TO 12.5 CM
|
Facility
|
IP
|
$567.61
|
|
|
Service Code
|
CPT 12004
|
| Hospital Charge Code |
76100437
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$249.75 |
| Max. Negotiated Rate |
$510.85 |
| Rate for Payer: Aetna American Axle |
$368.95
|
| Rate for Payer: Aetna Commercial |
$482.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$368.95
|
| Rate for Payer: Cash Price |
$454.09
|
| Rate for Payer: Cofinity Advantage |
$397.33
|
| Rate for Payer: Cofinity Commercial |
$488.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$454.09
|
| Rate for Payer: Healthscope Commercial |
$510.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$397.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$425.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$482.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$425.71
|
| Rate for Payer: PHP Commercial |
$482.47
|
| Rate for Payer: Priority Health SBD |
$357.59
|
| Rate for Payer: UMR Bronson Commercial |
$249.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$425.71
|
|
|
HC SIMPLE REP WD SCALPNECKAXILLAEGENITALIIATRUNK EXTREMS 7.6 TO 12.5 CM
|
Facility
|
OP
|
$567.61
|
|
|
Service Code
|
CPT 12004
|
| Hospital Charge Code |
76100437
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.55 |
| Max. Negotiated Rate |
$646.50 |
| Rate for Payer: Aetna American Axle |
$368.95
|
| Rate for Payer: Aetna Commercial |
$482.47
|
| Rate for Payer: Aetna Medicare |
$207.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$368.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$249.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$249.89
|
| Rate for Payer: BCBS Complete |
$109.79
|
| Rate for Payer: BCBS MAPPO |
$199.91
|
| Rate for Payer: BCBS Trust/PPO |
$265.39
|
| Rate for Payer: BCN Commercial |
$265.39
|
| Rate for Payer: BCN Medicare Advantage |
$199.91
|
| Rate for Payer: Cash Price |
$454.09
|
| Rate for Payer: Cash Price |
$454.09
|
| Rate for Payer: Cash Price |
$454.09
|
| Rate for Payer: Cofinity Advantage |
$397.33
|
| Rate for Payer: Cofinity Commercial |
$488.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$454.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.91
|
| Rate for Payer: Healthscope Commercial |
$510.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$397.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$425.71
|
| Rate for Payer: Mclaren Medicaid |
$199.91
|
| Rate for Payer: Mclaren Medicare |
$199.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$209.91
|
| Rate for Payer: Meridian Medicaid |
$209.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$229.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$219.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$482.47
|
| Rate for Payer: Nomi Health Commercial |
$599.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$425.71
|
| Rate for Payer: PACE Medicare |
$189.91
|
| Rate for Payer: PACE SWMI |
$199.91
|
| Rate for Payer: PHP Commercial |
$482.47
|
| Rate for Payer: PHP Medicare Advantage |
$199.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$646.50
|
| Rate for Payer: Priority Health Medicare |
$199.91
|
| Rate for Payer: Priority Health SBD |
$357.59
|
| Rate for Payer: Priority Health Tiered Network |
$517.20
|
| Rate for Payer: Railroad Medicare Medicare |
$199.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$368.95
|
| Rate for Payer: UHC Core |
$295.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$199.91
|
| Rate for Payer: UHC Exchange |
$223.07
|
| Rate for Payer: UHC Medicaid |
$104.55
|
| Rate for Payer: UHCCP Medicaid |
$104.55
|
| Rate for Payer: UMR Bronson Commercial |
$210.02
|
| Rate for Payer: VA VA |
$199.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$425.71
|
|
|
HC SIMULATION - 3D
|
Facility
|
OP
|
$5,353.80
|
|
|
Service Code
|
CPT 77295
|
| Hospital Charge Code |
33300004
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$639.16 |
| Max. Negotiated Rate |
$4,818.42 |
| Rate for Payer: Aetna American Axle |
$3,479.97
|
| Rate for Payer: Aetna Commercial |
$4,550.73
|
| Rate for Payer: Aetna Medicare |
$1,434.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,479.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,723.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,723.94
|
| Rate for Payer: BCBS Complete |
$757.43
|
| Rate for Payer: BCBS MAPPO |
$1,379.15
|
| Rate for Payer: BCBS Trust/PPO |
$639.16
|
| Rate for Payer: BCN Commercial |
$639.16
|
| Rate for Payer: BCN Medicare Advantage |
$1,379.15
|
| Rate for Payer: Cash Price |
$4,283.04
|
| Rate for Payer: Cash Price |
$4,283.04
|
| Rate for Payer: Cofinity Advantage |
$3,747.66
|
| Rate for Payer: Cofinity Commercial |
$4,604.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,283.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,379.15
|
| Rate for Payer: Healthscope Commercial |
$4,818.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,747.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,015.35
|
| Rate for Payer: Mclaren Medicaid |
$1,379.15
|
| Rate for Payer: Mclaren Medicare |
$1,379.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,448.11
|
| Rate for Payer: Meridian Medicaid |
$1,448.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,586.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,517.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,550.73
|
| Rate for Payer: Nomi Health Commercial |
$4,137.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,015.35
|
| Rate for Payer: PACE Medicare |
$1,310.19
|
| Rate for Payer: PACE SWMI |
$1,379.15
|
| Rate for Payer: PHP Commercial |
$4,550.73
|
| Rate for Payer: PHP Medicare Advantage |
$1,379.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$721.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4,460.05
|
| Rate for Payer: Priority Health Medicare |
$1,379.15
|
| Rate for Payer: Priority Health SBD |
$3,372.89
|
| Rate for Payer: Priority Health Tiered Network |
$3,568.04
|
| Rate for Payer: Railroad Medicare Medicare |
$1,379.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,479.97
|
| Rate for Payer: UHC Core |
$2,789.33
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,379.15
|
| Rate for Payer: UHC Exchange |
$2,104.04
|
| Rate for Payer: UHC Medicaid |
$721.30
|
| Rate for Payer: UHCCP Medicaid |
$721.30
|
| Rate for Payer: UMR Bronson Commercial |
$1,980.91
|
| Rate for Payer: VA VA |
$1,379.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,015.35
|
|
|
HC SIMULATION - 3D
|
Facility
|
IP
|
$5,353.80
|
|
|
Service Code
|
CPT 77295
|
| Hospital Charge Code |
33300004
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$2,355.67 |
| Max. Negotiated Rate |
$4,818.42 |
| Rate for Payer: Aetna American Axle |
$3,479.97
|
| Rate for Payer: Aetna Commercial |
$4,550.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,479.97
|
| Rate for Payer: Cash Price |
$4,283.04
|
| Rate for Payer: Cofinity Advantage |
$3,747.66
|
| Rate for Payer: Cofinity Commercial |
$4,604.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,283.04
|
| Rate for Payer: Healthscope Commercial |
$4,818.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,747.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,015.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,550.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,015.35
|
| Rate for Payer: PHP Commercial |
$4,550.73
|
| Rate for Payer: Priority Health SBD |
$3,372.89
|
| Rate for Payer: UMR Bronson Commercial |
$2,355.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,015.35
|
|
|
HC SIMULATION - C
|
Facility
|
OP
|
$1,741.45
|
|
|
Service Code
|
CPT 77290
|
| Hospital Charge Code |
33300003
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$195.12 |
| Max. Negotiated Rate |
$1,567.31 |
| Rate for Payer: Aetna American Axle |
$1,131.94
|
| Rate for Payer: Aetna Commercial |
$1,480.23
|
| Rate for Payer: Aetna Medicare |
$388.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,131.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$466.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$466.35
|
| Rate for Payer: BCBS Complete |
$204.90
|
| Rate for Payer: BCBS MAPPO |
$373.08
|
| Rate for Payer: BCBS Trust/PPO |
$881.64
|
| Rate for Payer: BCN Commercial |
$881.64
|
| Rate for Payer: BCN Medicare Advantage |
$373.08
|
| Rate for Payer: Cash Price |
$1,393.16
|
| Rate for Payer: Cash Price |
$1,393.16
|
| Rate for Payer: Cofinity Advantage |
$1,219.02
|
| Rate for Payer: Cofinity Commercial |
$1,497.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,393.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$373.08
|
| Rate for Payer: Healthscope Commercial |
$1,567.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,219.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,306.09
|
| Rate for Payer: Mclaren Medicaid |
$373.08
|
| Rate for Payer: Mclaren Medicare |
$373.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$391.73
|
| Rate for Payer: Meridian Medicaid |
$391.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$429.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$410.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,480.23
|
| Rate for Payer: Nomi Health Commercial |
$1,119.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,306.09
|
| Rate for Payer: PACE Medicare |
$354.43
|
| Rate for Payer: PACE SWMI |
$373.08
|
| Rate for Payer: PHP Commercial |
$1,480.23
|
| Rate for Payer: PHP Medicare Advantage |
$373.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$195.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,206.50
|
| Rate for Payer: Priority Health Medicare |
$373.08
|
| Rate for Payer: Priority Health SBD |
$1,097.11
|
| Rate for Payer: Priority Health Tiered Network |
$965.20
|
| Rate for Payer: Railroad Medicare Medicare |
$373.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,131.94
|
| Rate for Payer: UHC Core |
$907.30
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$373.08
|
| Rate for Payer: UHC Exchange |
$684.39
|
| Rate for Payer: UHC Medicaid |
$195.12
|
| Rate for Payer: UHCCP Medicaid |
$195.12
|
| Rate for Payer: UMR Bronson Commercial |
$644.34
|
| Rate for Payer: VA VA |
$373.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,306.09
|
|
|
HC SIMULATION - C
|
Facility
|
IP
|
$1,741.45
|
|
|
Service Code
|
CPT 77290
|
| Hospital Charge Code |
33300003
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$766.24 |
| Max. Negotiated Rate |
$1,567.31 |
| Rate for Payer: Aetna American Axle |
$1,131.94
|
| Rate for Payer: Aetna Commercial |
$1,480.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,131.94
|
| Rate for Payer: Cash Price |
$1,393.16
|
| Rate for Payer: Cofinity Advantage |
$1,219.02
|
| Rate for Payer: Cofinity Commercial |
$1,497.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,393.16
|
| Rate for Payer: Healthscope Commercial |
$1,567.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,219.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,306.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,480.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,306.09
|
| Rate for Payer: PHP Commercial |
$1,480.23
|
| Rate for Payer: Priority Health SBD |
$1,097.11
|
| Rate for Payer: UMR Bronson Commercial |
$766.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,306.09
|
|
|
HC SIMULATION - I
|
Facility
|
OP
|
$1,217.27
|
|
|
Service Code
|
CPT 77285
|
| Hospital Charge Code |
33300060
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$195.12 |
| Max. Negotiated Rate |
$1,206.50 |
| Rate for Payer: Aetna American Axle |
$791.23
|
| Rate for Payer: Aetna Commercial |
$1,034.68
|
| Rate for Payer: Aetna Medicare |
$388.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$791.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$466.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$466.35
|
| Rate for Payer: BCBS Complete |
$204.90
|
| Rate for Payer: BCBS MAPPO |
$373.08
|
| Rate for Payer: BCBS Trust/PPO |
$955.53
|
| Rate for Payer: BCN Commercial |
$955.53
|
| Rate for Payer: BCN Medicare Advantage |
$373.08
|
| Rate for Payer: Cash Price |
$973.82
|
| Rate for Payer: Cash Price |
$973.82
|
| Rate for Payer: Cofinity Advantage |
$852.09
|
| Rate for Payer: Cofinity Commercial |
$1,046.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$973.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$373.08
|
| Rate for Payer: Healthscope Commercial |
$1,095.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$852.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$912.95
|
| Rate for Payer: Mclaren Medicaid |
$373.08
|
| Rate for Payer: Mclaren Medicare |
$373.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$391.73
|
| Rate for Payer: Meridian Medicaid |
$391.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$429.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$410.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,034.68
|
| Rate for Payer: Nomi Health Commercial |
$1,119.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$912.95
|
| Rate for Payer: PACE Medicare |
$354.43
|
| Rate for Payer: PACE SWMI |
$373.08
|
| Rate for Payer: PHP Commercial |
$1,034.68
|
| Rate for Payer: PHP Medicare Advantage |
$373.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$195.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,206.50
|
| Rate for Payer: Priority Health Medicare |
$373.08
|
| Rate for Payer: Priority Health SBD |
$766.88
|
| Rate for Payer: Priority Health Tiered Network |
$965.20
|
| Rate for Payer: Railroad Medicare Medicare |
$373.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$791.23
|
| Rate for Payer: UHC Core |
$634.20
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$373.08
|
| Rate for Payer: UHC Exchange |
$478.39
|
| Rate for Payer: UHC Medicaid |
$195.12
|
| Rate for Payer: UHCCP Medicaid |
$195.12
|
| Rate for Payer: UMR Bronson Commercial |
$450.39
|
| Rate for Payer: VA VA |
$373.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$912.95
|
|
|
HC SIMULATION - I
|
Facility
|
IP
|
$1,217.27
|
|
|
Service Code
|
CPT 77285
|
| Hospital Charge Code |
33300060
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$535.60 |
| Max. Negotiated Rate |
$1,095.54 |
| Rate for Payer: Aetna American Axle |
$791.23
|
| Rate for Payer: Aetna Commercial |
$1,034.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$791.23
|
| Rate for Payer: Cash Price |
$973.82
|
| Rate for Payer: Cofinity Advantage |
$852.09
|
| Rate for Payer: Cofinity Commercial |
$1,046.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$973.82
|
| Rate for Payer: Healthscope Commercial |
$1,095.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$852.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$912.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,034.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$912.95
|
| Rate for Payer: PHP Commercial |
$1,034.68
|
| Rate for Payer: Priority Health SBD |
$766.88
|
| Rate for Payer: UMR Bronson Commercial |
$535.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$912.95
|
|
|
HC SIMULATION - S
|
Facility
|
IP
|
$742.85
|
|
|
Service Code
|
CPT 77280
|
| Hospital Charge Code |
33300002
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$326.85 |
| Max. Negotiated Rate |
$668.57 |
| Rate for Payer: Aetna American Axle |
$482.85
|
| Rate for Payer: Aetna Commercial |
$631.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$482.85
|
| Rate for Payer: Cash Price |
$594.28
|
| Rate for Payer: Cofinity Advantage |
$520.00
|
| Rate for Payer: Cofinity Commercial |
$638.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$594.28
|
| Rate for Payer: Healthscope Commercial |
$668.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$520.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$557.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$631.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$557.14
|
| Rate for Payer: PHP Commercial |
$631.42
|
| Rate for Payer: Priority Health SBD |
$468.00
|
| Rate for Payer: UMR Bronson Commercial |
$326.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$557.14
|
|
