|
HC SP UNLISTED PROC SKIN SUBCUT TISS
|
Facility
|
OP
|
$710.23
|
|
|
Service Code
|
CPT 17999
|
| Hospital Charge Code |
36100314
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$104.55 |
| Max. Negotiated Rate |
$646.50 |
| Rate for Payer: Aetna American Axle |
$461.65
|
| Rate for Payer: Aetna Commercial |
$603.70
|
| Rate for Payer: Aetna Medicare |
$207.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$461.65
|
| 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 |
$172.78
|
| Rate for Payer: BCN Commercial |
$172.78
|
| Rate for Payer: BCN Medicare Advantage |
$199.91
|
| Rate for Payer: Cash Price |
$568.18
|
| Rate for Payer: Cash Price |
$568.18
|
| Rate for Payer: Cash Price |
$568.18
|
| Rate for Payer: Cofinity Advantage |
$497.16
|
| Rate for Payer: Cofinity Commercial |
$610.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$568.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.91
|
| Rate for Payer: Healthscope Commercial |
$639.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$497.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$532.67
|
| 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 |
$603.70
|
| Rate for Payer: Nomi Health Commercial |
$599.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$532.67
|
| Rate for Payer: PACE Medicare |
$189.91
|
| Rate for Payer: PACE SWMI |
$199.91
|
| Rate for Payer: PHP Commercial |
$603.70
|
| 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 |
$447.44
|
| Rate for Payer: Priority Health Tiered Network |
$517.20
|
| Rate for Payer: Railroad Medicare Medicare |
$199.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$199.91
|
| Rate for Payer: UHC Medicaid |
$104.55
|
| Rate for Payer: UHCCP Medicaid |
$104.55
|
| Rate for Payer: UMR Bronson Commercial |
$262.79
|
| Rate for Payer: VA VA |
$199.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$532.67
|
|
|
HC SP XR INJ ARTHROGRAM ANKLE
|
Facility
|
OP
|
$1,118.31
|
|
|
Service Code
|
CPT 27648
|
| Hospital Charge Code |
36100317
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$413.77 |
| Max. Negotiated Rate |
$1,006.48 |
| Rate for Payer: Aetna American Axle |
$726.90
|
| Rate for Payer: Aetna Commercial |
$950.56
|
| Rate for Payer: Aetna Medicare |
$559.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$726.90
|
| Rate for Payer: BCBS Complete |
$447.32
|
| Rate for Payer: BCBS Trust/PPO |
$718.90
|
| Rate for Payer: BCN Commercial |
$718.90
|
| Rate for Payer: Cash Price |
$894.65
|
| Rate for Payer: Cash Price |
$894.65
|
| Rate for Payer: Cash Price |
$894.65
|
| Rate for Payer: Cofinity Advantage |
$782.82
|
| Rate for Payer: Cofinity Commercial |
$961.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$894.65
|
| Rate for Payer: Healthscope Commercial |
$1,006.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$782.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$838.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$894.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$950.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$838.73
|
| Rate for Payer: PHP Commercial |
$950.56
|
| Rate for Payer: Priority Health SBD |
$704.54
|
| Rate for Payer: UMR Bronson Commercial |
$413.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$838.73
|
|
|
HC SP XR INJ ARTHROGRAM ANKLE
|
Facility
|
IP
|
$1,118.31
|
|
|
Service Code
|
CPT 27648
|
| Hospital Charge Code |
36100317
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$492.06 |
| Max. Negotiated Rate |
$1,006.48 |
| Rate for Payer: Aetna American Axle |
$726.90
|
| Rate for Payer: Aetna Commercial |
$950.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$726.90
|
| Rate for Payer: Cash Price |
$894.65
|
| Rate for Payer: Cofinity Advantage |
$782.82
|
| Rate for Payer: Cofinity Commercial |
$961.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$894.65
|
| Rate for Payer: Healthscope Commercial |
$1,006.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$782.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$838.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$950.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$838.73
|
| Rate for Payer: PHP Commercial |
$950.56
|
| Rate for Payer: Priority Health SBD |
$704.54
|
| Rate for Payer: UMR Bronson Commercial |
$492.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$838.73
|
|
|
HC SPYGLASS CHOLANGIOSCOPY
|
Facility
|
IP
|
$6,388.13
|
|
| Hospital Charge Code |
36000086
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,810.78 |
| Max. Negotiated Rate |
$5,749.32 |
| Rate for Payer: Aetna American Axle |
$4,152.28
|
| Rate for Payer: Aetna Commercial |
$5,429.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,152.28
|
| Rate for Payer: Cash Price |
$5,110.50
|
| Rate for Payer: Cofinity Advantage |
$4,471.69
|
| Rate for Payer: Cofinity Commercial |
$5,493.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,110.50
|
| Rate for Payer: Healthscope Commercial |
$5,749.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,471.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,791.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,429.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,791.10
|
| Rate for Payer: PHP Commercial |
$5,429.91
|
| Rate for Payer: Priority Health SBD |
$4,024.52
|
| Rate for Payer: UMR Bronson Commercial |
$2,810.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,791.10
|
|
|
HC SPYGLASS CHOLANGIOSCOPY
|
Facility
|
OP
|
$6,388.13
|
|
| Hospital Charge Code |
36000086
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,363.61 |
| Max. Negotiated Rate |
$5,749.32 |
| Rate for Payer: Aetna American Axle |
$4,152.28
|
| Rate for Payer: Aetna Commercial |
$5,429.91
|
| Rate for Payer: Aetna Medicare |
$3,194.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,152.28
|
| Rate for Payer: BCBS Complete |
$2,555.25
|
| Rate for Payer: Cash Price |
$5,110.50
|
| Rate for Payer: Cofinity Advantage |
$4,471.69
|
| Rate for Payer: Cofinity Commercial |
$5,493.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,110.50
|
| Rate for Payer: Healthscope Commercial |
$5,749.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,471.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,791.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,110.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,429.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,791.10
|
| Rate for Payer: PHP Commercial |
$5,429.91
|
| Rate for Payer: Priority Health SBD |
$4,024.52
|
| Rate for Payer: UMR Bronson Commercial |
$2,363.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,791.10
|
|
|
HC SPYGLASS FORCEPS
|
Facility
|
IP
|
$2,493.73
|
|
| Hospital Charge Code |
27200151
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,097.24 |
| Max. Negotiated Rate |
$2,244.36 |
| Rate for Payer: Aetna American Axle |
$1,620.92
|
| Rate for Payer: Aetna Commercial |
$2,119.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,620.92
|
| Rate for Payer: Cash Price |
$1,994.98
|
| Rate for Payer: Cofinity Advantage |
$1,745.61
|
| Rate for Payer: Cofinity Commercial |
$2,144.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,994.98
|
| Rate for Payer: Healthscope Commercial |
$2,244.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,745.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,870.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,119.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,870.30
|
| Rate for Payer: PHP Commercial |
$2,119.67
|
| Rate for Payer: Priority Health SBD |
$1,571.05
|
| Rate for Payer: UMR Bronson Commercial |
$1,097.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,870.30
|
|
|
HC SPYGLASS FORCEPS
|
Facility
|
OP
|
$2,493.73
|
|
| Hospital Charge Code |
27200151
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$922.68 |
| Max. Negotiated Rate |
$2,244.36 |
| Rate for Payer: Aetna American Axle |
$1,620.92
|
| Rate for Payer: Aetna Commercial |
$2,119.67
|
| Rate for Payer: Aetna Medicare |
$1,246.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,620.92
|
| Rate for Payer: BCBS Complete |
$997.49
|
| Rate for Payer: Cash Price |
$1,994.98
|
| Rate for Payer: Cofinity Advantage |
$1,745.61
|
| Rate for Payer: Cofinity Commercial |
$2,144.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,994.98
|
| Rate for Payer: Healthscope Commercial |
$2,244.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,745.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,870.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,994.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,119.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,870.30
|
| Rate for Payer: PHP Commercial |
$2,119.67
|
| Rate for Payer: Priority Health SBD |
$1,571.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,620.92
|
| Rate for Payer: UHC Core |
$1,299.23
|
| Rate for Payer: UHC Exchange |
$980.04
|
| Rate for Payer: UMR Bronson Commercial |
$922.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,870.30
|
|
|
HC SP Z ANGIO SUPERSEL ECT RENAL BIL
|
Facility
|
OP
|
$3,926.47
|
|
|
Service Code
|
CPT 36254
|
| Hospital Charge Code |
36100350
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,452.79 |
| Max. Negotiated Rate |
$10,174.29 |
| Rate for Payer: Aetna American Axle |
$2,552.21
|
| Rate for Payer: Aetna Commercial |
$3,337.50
|
| Rate for Payer: Aetna Medicare |
$3,271.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,552.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,932.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,932.66
|
| Rate for Payer: BCBS Complete |
$1,727.85
|
| Rate for Payer: BCBS MAPPO |
$3,146.13
|
| Rate for Payer: BCBS Trust/PPO |
$2,663.55
|
| Rate for Payer: BCN Commercial |
$2,663.55
|
| Rate for Payer: BCN Medicare Advantage |
$3,146.13
|
| Rate for Payer: Cash Price |
$3,141.18
|
| Rate for Payer: Cash Price |
$3,141.18
|
| Rate for Payer: Cash Price |
$3,141.18
|
| Rate for Payer: Cofinity Advantage |
$2,748.53
|
| Rate for Payer: Cofinity Commercial |
$3,376.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,141.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,146.13
|
| Rate for Payer: Healthscope Commercial |
$3,533.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,748.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,944.85
|
| Rate for Payer: Mclaren Medicaid |
$3,146.13
|
| Rate for Payer: Mclaren Medicare |
$3,146.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,303.44
|
| Rate for Payer: Meridian Medicaid |
$3,303.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,618.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,460.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,337.50
|
| Rate for Payer: Nomi Health Commercial |
$9,438.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,944.85
|
| Rate for Payer: PACE Medicare |
$2,988.82
|
| Rate for Payer: PACE SWMI |
$3,146.13
|
| Rate for Payer: PHP Commercial |
$3,337.50
|
| Rate for Payer: PHP Medicare Advantage |
$3,146.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,174.29
|
| Rate for Payer: Priority Health Medicare |
$3,146.13
|
| Rate for Payer: Priority Health SBD |
$2,473.68
|
| Rate for Payer: Priority Health Tiered Network |
$8,139.43
|
| Rate for Payer: Railroad Medicare Medicare |
$3,146.13
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,146.13
|
| Rate for Payer: UHC Medicaid |
$1,645.43
|
| Rate for Payer: UHCCP Medicaid |
$1,645.43
|
| Rate for Payer: UMR Bronson Commercial |
$1,452.79
|
| Rate for Payer: VA VA |
$3,146.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,944.85
|
|
|
HC SP Z ANGIO SUPERSEL ECT RENAL BIL
|
Facility
|
IP
|
$3,926.47
|
|
|
Service Code
|
CPT 36254
|
| Hospital Charge Code |
36100350
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,727.65 |
| Max. Negotiated Rate |
$3,533.82 |
| Rate for Payer: Aetna American Axle |
$2,552.21
|
| Rate for Payer: Aetna Commercial |
$3,337.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,552.21
|
| Rate for Payer: Cash Price |
$3,141.18
|
| Rate for Payer: Cofinity Advantage |
$2,748.53
|
| Rate for Payer: Cofinity Commercial |
$3,376.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,141.18
|
| Rate for Payer: Healthscope Commercial |
$3,533.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,748.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,944.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,337.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,944.85
|
| Rate for Payer: PHP Commercial |
$3,337.50
|
| Rate for Payer: Priority Health SBD |
$2,473.68
|
| Rate for Payer: UMR Bronson Commercial |
$1,727.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,944.85
|
|
|
HC SP Z ANGIO SUPERSELECT RENAL UNI
|
Facility
|
OP
|
$3,926.47
|
|
|
Service Code
|
CPT 36253
|
| Hospital Charge Code |
36100349
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,452.79 |
| Max. Negotiated Rate |
$17,930.33 |
| Rate for Payer: Aetna American Axle |
$2,552.21
|
| Rate for Payer: Aetna Commercial |
$3,337.50
|
| Rate for Payer: Aetna Medicare |
$5,766.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,552.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,930.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,930.60
|
| Rate for Payer: BCBS Complete |
$3,045.03
|
| Rate for Payer: BCBS MAPPO |
$5,544.48
|
| Rate for Payer: BCBS Trust/PPO |
$3,323.44
|
| Rate for Payer: BCN Commercial |
$3,323.44
|
| Rate for Payer: BCN Medicare Advantage |
$5,544.48
|
| Rate for Payer: Cash Price |
$3,141.18
|
| Rate for Payer: Cash Price |
$3,141.18
|
| Rate for Payer: Cash Price |
$3,141.18
|
| Rate for Payer: Cofinity Advantage |
$2,748.53
|
| Rate for Payer: Cofinity Commercial |
$3,376.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,141.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,544.48
|
| Rate for Payer: Healthscope Commercial |
$3,533.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,748.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,944.85
|
| Rate for Payer: Mclaren Medicaid |
$5,544.48
|
| Rate for Payer: Mclaren Medicare |
$5,544.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,821.70
|
| Rate for Payer: Meridian Medicaid |
$5,821.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,376.15
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,098.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,337.50
|
| Rate for Payer: Nomi Health Commercial |
$16,633.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,944.85
|
| Rate for Payer: PACE Medicare |
$5,267.26
|
| Rate for Payer: PACE SWMI |
$5,544.48
|
| Rate for Payer: PHP Commercial |
$3,337.50
|
| Rate for Payer: PHP Medicare Advantage |
$5,544.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,899.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$17,930.33
|
| Rate for Payer: Priority Health Medicare |
$5,544.48
|
| Rate for Payer: Priority Health SBD |
$2,473.68
|
| Rate for Payer: Priority Health Tiered Network |
$14,344.26
|
| Rate for Payer: Railroad Medicare Medicare |
$5,544.48
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,544.48
|
| Rate for Payer: UHC Medicaid |
$2,899.76
|
| Rate for Payer: UHCCP Medicaid |
$2,899.76
|
| Rate for Payer: UMR Bronson Commercial |
$1,452.79
|
| Rate for Payer: VA VA |
$5,544.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,944.85
|
|
|
HC SP Z ANGIO SUPERSELECT RENAL UNI
|
Facility
|
IP
|
$3,926.47
|
|
|
Service Code
|
CPT 36253
|
| Hospital Charge Code |
36100349
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,727.65 |
| Max. Negotiated Rate |
$3,533.82 |
| Rate for Payer: Aetna American Axle |
$2,552.21
|
| Rate for Payer: Aetna Commercial |
$3,337.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,552.21
|
| Rate for Payer: Cash Price |
$3,141.18
|
| Rate for Payer: Cofinity Advantage |
$2,748.53
|
| Rate for Payer: Cofinity Commercial |
$3,376.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,141.18
|
| Rate for Payer: Healthscope Commercial |
$3,533.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,748.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,944.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,337.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,944.85
|
| Rate for Payer: PHP Commercial |
$3,337.50
|
| Rate for Payer: Priority Health SBD |
$2,473.68
|
| Rate for Payer: UMR Bronson Commercial |
$1,727.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,944.85
|
|
|
HC SP Z EMBOLIZATION COIL BODY
|
Facility
|
IP
|
$422.82
|
|
| Hospital Charge Code |
27800058
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$186.04 |
| Max. Negotiated Rate |
$380.54 |
| Rate for Payer: Aetna American Axle |
$274.83
|
| Rate for Payer: Aetna Commercial |
$359.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$274.83
|
| Rate for Payer: Cash Price |
$338.26
|
| Rate for Payer: Cofinity Advantage |
$295.97
|
| Rate for Payer: Cofinity Commercial |
$363.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$338.26
|
| Rate for Payer: Healthscope Commercial |
$380.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$295.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$317.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$359.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$317.12
|
| Rate for Payer: PHP Commercial |
$359.40
|
| Rate for Payer: Priority Health SBD |
$266.38
|
| Rate for Payer: UMR Bronson Commercial |
$186.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$317.12
|
|
|
HC SP Z EMBOLIZATION COIL BODY
|
Facility
|
OP
|
$422.82
|
|
| Hospital Charge Code |
27800058
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$156.44 |
| Max. Negotiated Rate |
$380.54 |
| Rate for Payer: Aetna American Axle |
$274.83
|
| Rate for Payer: Aetna Commercial |
$359.40
|
| Rate for Payer: Aetna Medicare |
$211.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$274.83
|
| Rate for Payer: BCBS Complete |
$169.13
|
| Rate for Payer: Cash Price |
$338.26
|
| Rate for Payer: Cofinity Advantage |
$295.97
|
| Rate for Payer: Cofinity Commercial |
$363.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$338.26
|
| Rate for Payer: Healthscope Commercial |
$380.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$295.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$317.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$338.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$359.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$317.12
|
| Rate for Payer: PHP Commercial |
$359.40
|
| Rate for Payer: Priority Health SBD |
$266.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$274.83
|
| Rate for Payer: UHC Core |
$220.29
|
| Rate for Payer: UHC Exchange |
$166.17
|
| Rate for Payer: UMR Bronson Commercial |
$156.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$317.12
|
|
|
HC SP Z EMBOLIZATION SPHERES
|
Facility
|
OP
|
$1,044.59
|
|
| Hospital Charge Code |
27800057
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$386.50 |
| Max. Negotiated Rate |
$940.13 |
| Rate for Payer: Aetna American Axle |
$678.98
|
| Rate for Payer: Aetna Commercial |
$887.90
|
| Rate for Payer: Aetna Medicare |
$522.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$678.98
|
| Rate for Payer: BCBS Complete |
$417.84
|
| Rate for Payer: Cash Price |
$835.67
|
| Rate for Payer: Cofinity Advantage |
$731.21
|
| Rate for Payer: Cofinity Commercial |
$898.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$835.67
|
| Rate for Payer: Healthscope Commercial |
$940.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$731.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$783.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$835.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$887.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$783.44
|
| Rate for Payer: PHP Commercial |
$887.90
|
| Rate for Payer: Priority Health SBD |
$658.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$678.98
|
| Rate for Payer: UHC Core |
$544.23
|
| Rate for Payer: UHC Exchange |
$410.52
|
| Rate for Payer: UMR Bronson Commercial |
$386.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$783.44
|
|
|
HC SP Z EMBOLIZATION SPHERES
|
Facility
|
IP
|
$1,044.59
|
|
| Hospital Charge Code |
27800057
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$459.62 |
| Max. Negotiated Rate |
$940.13 |
| Rate for Payer: Aetna American Axle |
$678.98
|
| Rate for Payer: Aetna Commercial |
$887.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$678.98
|
| Rate for Payer: Cash Price |
$835.67
|
| Rate for Payer: Cofinity Advantage |
$731.21
|
| Rate for Payer: Cofinity Commercial |
$898.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$835.67
|
| Rate for Payer: Healthscope Commercial |
$940.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$731.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$783.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$887.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$783.44
|
| Rate for Payer: PHP Commercial |
$887.90
|
| Rate for Payer: Priority Health SBD |
$658.09
|
| Rate for Payer: UMR Bronson Commercial |
$459.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$783.44
|
|
|
HC SP Z SEL CATH SEG SUBSEG PULM ART
|
Facility
|
IP
|
$1,303.18
|
|
|
Service Code
|
CPT 36015
|
| Hospital Charge Code |
36100318
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$573.40 |
| Max. Negotiated Rate |
$1,172.86 |
| Rate for Payer: Aetna American Axle |
$847.07
|
| Rate for Payer: Aetna Commercial |
$1,107.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$847.07
|
| Rate for Payer: Cash Price |
$1,042.54
|
| Rate for Payer: Cofinity Advantage |
$912.23
|
| Rate for Payer: Cofinity Commercial |
$1,120.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,042.54
|
| Rate for Payer: Healthscope Commercial |
$1,172.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$912.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$977.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,107.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$977.38
|
| Rate for Payer: PHP Commercial |
$1,107.70
|
| Rate for Payer: Priority Health SBD |
$821.00
|
| Rate for Payer: UMR Bronson Commercial |
$573.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$977.38
|
|
|
HC SP Z SEL CATH SEG SUBSEG PULM ART
|
Facility
|
OP
|
$1,303.18
|
|
|
Service Code
|
CPT 36015
|
| Hospital Charge Code |
36100318
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$482.18 |
| Max. Negotiated Rate |
$3,727.46 |
| Rate for Payer: Aetna American Axle |
$847.07
|
| Rate for Payer: Aetna Commercial |
$1,107.70
|
| Rate for Payer: Aetna Medicare |
$651.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$847.07
|
| Rate for Payer: BCBS Complete |
$521.27
|
| Rate for Payer: BCBS Trust/PPO |
$3,727.46
|
| Rate for Payer: BCN Commercial |
$3,727.46
|
| Rate for Payer: Cash Price |
$1,042.54
|
| Rate for Payer: Cash Price |
$1,042.54
|
| Rate for Payer: Cash Price |
$1,042.54
|
| Rate for Payer: Cofinity Advantage |
$912.23
|
| Rate for Payer: Cofinity Commercial |
$1,120.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,042.54
|
| Rate for Payer: Healthscope Commercial |
$1,172.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$912.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$977.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,042.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,107.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$977.38
|
| Rate for Payer: PHP Commercial |
$1,107.70
|
| Rate for Payer: Priority Health SBD |
$821.00
|
| Rate for Payer: UMR Bronson Commercial |
$482.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$977.38
|
|
|
HC SP Z TRUE FILL
|
Facility
|
OP
|
$6,892.15
|
|
| Hospital Charge Code |
27800059
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,550.10 |
| Max. Negotiated Rate |
$6,202.94 |
| Rate for Payer: Aetna American Axle |
$4,479.90
|
| Rate for Payer: Aetna Commercial |
$5,858.33
|
| Rate for Payer: Aetna Medicare |
$3,446.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,479.90
|
| Rate for Payer: BCBS Complete |
$2,756.86
|
| Rate for Payer: Cash Price |
$5,513.72
|
| Rate for Payer: Cofinity Advantage |
$4,824.51
|
| Rate for Payer: Cofinity Commercial |
$5,927.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,513.72
|
| Rate for Payer: Healthscope Commercial |
$6,202.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,824.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,169.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,513.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,858.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,169.11
|
| Rate for Payer: PHP Commercial |
$5,858.33
|
| Rate for Payer: Priority Health SBD |
$4,342.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,479.90
|
| Rate for Payer: UHC Core |
$3,590.81
|
| Rate for Payer: UHC Exchange |
$2,708.61
|
| Rate for Payer: UMR Bronson Commercial |
$2,550.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,169.11
|
|
|
HC SP Z TRUE FILL
|
Facility
|
IP
|
$6,892.15
|
|
| Hospital Charge Code |
27800059
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,032.55 |
| Max. Negotiated Rate |
$6,202.94 |
| Rate for Payer: Aetna American Axle |
$4,479.90
|
| Rate for Payer: Aetna Commercial |
$5,858.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,479.90
|
| Rate for Payer: Cash Price |
$5,513.72
|
| Rate for Payer: Cofinity Advantage |
$4,824.51
|
| Rate for Payer: Cofinity Commercial |
$5,927.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,513.72
|
| Rate for Payer: Healthscope Commercial |
$6,202.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,824.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,169.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,858.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,169.11
|
| Rate for Payer: PHP Commercial |
$5,858.33
|
| Rate for Payer: Priority Health SBD |
$4,342.05
|
| Rate for Payer: UMR Bronson Commercial |
$3,032.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,169.11
|
|
|
HC SQ ICD
|
Facility
|
OP
|
$57,546.60
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27800122
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,292.24 |
| Max. Negotiated Rate |
$51,791.94 |
| Rate for Payer: Aetna American Axle |
$37,405.29
|
| Rate for Payer: Aetna Commercial |
$48,914.61
|
| Rate for Payer: Aetna Medicare |
$28,773.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37,405.29
|
| Rate for Payer: BCBS Complete |
$23,018.64
|
| Rate for Payer: Cash Price |
$46,037.28
|
| Rate for Payer: Cofinity Advantage |
$40,282.62
|
| Rate for Payer: Cofinity Commercial |
$49,490.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46,037.28
|
| Rate for Payer: Healthscope Commercial |
$51,791.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$40,282.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43,159.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46,037.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48,914.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43,159.95
|
| Rate for Payer: PHP Commercial |
$48,914.61
|
| Rate for Payer: Priority Health SBD |
$36,254.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37,405.29
|
| Rate for Payer: UHC Core |
$29,981.78
|
| Rate for Payer: UHC Exchange |
$22,615.81
|
| Rate for Payer: UMR Bronson Commercial |
$21,292.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43,159.95
|
|
|
HC SQ ICD
|
Facility
|
IP
|
$57,546.60
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27800122
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25,320.50 |
| Max. Negotiated Rate |
$51,791.94 |
| Rate for Payer: Aetna American Axle |
$37,405.29
|
| Rate for Payer: Aetna Commercial |
$48,914.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37,405.29
|
| Rate for Payer: Cash Price |
$46,037.28
|
| Rate for Payer: Cofinity Advantage |
$40,282.62
|
| Rate for Payer: Cofinity Commercial |
$49,490.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46,037.28
|
| Rate for Payer: Healthscope Commercial |
$51,791.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$40,282.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43,159.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48,914.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43,159.95
|
| Rate for Payer: PHP Commercial |
$48,914.61
|
| Rate for Payer: Priority Health SBD |
$36,254.36
|
| Rate for Payer: UMR Bronson Commercial |
$25,320.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43,159.95
|
|
|
HC SQ ICD LEAD
|
Facility
|
IP
|
$14,955.75
|
|
|
Service Code
|
HCPCS C1896
|
| Hospital Charge Code |
27800123
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,580.53 |
| Max. Negotiated Rate |
$13,460.17 |
| Rate for Payer: Aetna American Axle |
$9,721.24
|
| Rate for Payer: Aetna Commercial |
$12,712.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,721.24
|
| Rate for Payer: Cash Price |
$11,964.60
|
| Rate for Payer: Cofinity Advantage |
$10,469.02
|
| Rate for Payer: Cofinity Commercial |
$12,861.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,964.60
|
| Rate for Payer: Healthscope Commercial |
$13,460.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10,469.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11,216.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,712.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11,216.81
|
| Rate for Payer: PHP Commercial |
$12,712.39
|
| Rate for Payer: Priority Health SBD |
$9,422.12
|
| Rate for Payer: UMR Bronson Commercial |
$6,580.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11,216.81
|
|
|
HC SQ ICD LEAD
|
Facility
|
OP
|
$14,955.75
|
|
|
Service Code
|
HCPCS C1896
|
| Hospital Charge Code |
27800123
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,533.63 |
| Max. Negotiated Rate |
$13,460.17 |
| Rate for Payer: Aetna American Axle |
$9,721.24
|
| Rate for Payer: Aetna Commercial |
$12,712.39
|
| Rate for Payer: Aetna Medicare |
$7,477.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,721.24
|
| Rate for Payer: BCBS Complete |
$5,982.30
|
| Rate for Payer: Cash Price |
$11,964.60
|
| Rate for Payer: Cofinity Advantage |
$10,469.02
|
| Rate for Payer: Cofinity Commercial |
$12,861.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,964.60
|
| Rate for Payer: Healthscope Commercial |
$13,460.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10,469.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11,216.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,964.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,712.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11,216.81
|
| Rate for Payer: PHP Commercial |
$12,712.39
|
| Rate for Payer: Priority Health SBD |
$9,422.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,721.24
|
| Rate for Payer: UHC Core |
$7,791.95
|
| Rate for Payer: UHC Exchange |
$5,877.61
|
| Rate for Payer: UMR Bronson Commercial |
$5,533.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11,216.81
|
|
|
HC SQ IM CHEMO HORMONAL
|
Facility
|
OP
|
$251.44
|
|
|
Service Code
|
CPT 96402
|
| Hospital Charge Code |
33100002
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$37.52 |
| Max. Negotiated Rate |
$232.01 |
| Rate for Payer: Aetna American Axle |
$163.44
|
| Rate for Payer: Aetna Commercial |
$213.72
|
| Rate for Payer: Aetna Medicare |
$74.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$163.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$89.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$89.67
|
| Rate for Payer: BCBS Complete |
$39.40
|
| Rate for Payer: BCBS MAPPO |
$71.74
|
| Rate for Payer: BCBS Trust/PPO |
$183.06
|
| Rate for Payer: BCN Commercial |
$183.06
|
| Rate for Payer: BCN Medicare Advantage |
$71.74
|
| Rate for Payer: Cash Price |
$201.15
|
| Rate for Payer: Cash Price |
$201.15
|
| Rate for Payer: Cofinity Advantage |
$176.01
|
| Rate for Payer: Cofinity Commercial |
$216.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.74
|
| Rate for Payer: Healthscope Commercial |
$226.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$176.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$188.58
|
| Rate for Payer: Mclaren Medicaid |
$71.74
|
| Rate for Payer: Mclaren Medicare |
$71.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$75.33
|
| Rate for Payer: Meridian Medicaid |
$75.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$78.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.72
|
| Rate for Payer: Nomi Health Commercial |
$215.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$188.58
|
| Rate for Payer: PACE Medicare |
$68.15
|
| Rate for Payer: PACE SWMI |
$71.74
|
| Rate for Payer: PHP Commercial |
$213.72
|
| Rate for Payer: PHP Medicare Advantage |
$71.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$232.01
|
| Rate for Payer: Priority Health Medicare |
$71.74
|
| Rate for Payer: Priority Health SBD |
$158.41
|
| Rate for Payer: Priority Health Tiered Network |
$185.61
|
| Rate for Payer: Railroad Medicare Medicare |
$71.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$163.44
|
| Rate for Payer: UHC Core |
$131.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$71.74
|
| Rate for Payer: UHC Exchange |
$98.82
|
| Rate for Payer: UHC Medicaid |
$37.52
|
| Rate for Payer: UHCCP Medicaid |
$37.52
|
| Rate for Payer: UMR Bronson Commercial |
$93.03
|
| Rate for Payer: VA VA |
$71.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$188.58
|
|
|
HC SQ IM CHEMO HORMONAL
|
Facility
|
IP
|
$251.44
|
|
|
Service Code
|
CPT 96402
|
| Hospital Charge Code |
33100002
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$110.63 |
| Max. Negotiated Rate |
$226.30 |
| Rate for Payer: Aetna American Axle |
$163.44
|
| Rate for Payer: Aetna Commercial |
$213.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$163.44
|
| Rate for Payer: Cash Price |
$201.15
|
| Rate for Payer: Cofinity Advantage |
$176.01
|
| Rate for Payer: Cofinity Commercial |
$216.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.15
|
| Rate for Payer: Healthscope Commercial |
$226.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$176.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$188.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$188.58
|
| Rate for Payer: PHP Commercial |
$213.72
|
| Rate for Payer: Priority Health SBD |
$158.41
|
| Rate for Payer: UMR Bronson Commercial |
$110.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$188.58
|
|
