|
HC RO LINAC SBRT PER SESSION
|
Facility
|
OP
|
$3,546.01
|
|
|
Service Code
|
CPT 77373
|
| Hospital Charge Code |
33300041
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$892.57 |
| Max. Negotiated Rate |
$5,407.20 |
| Rate for Payer: Aetna American Axle |
$2,304.91
|
| Rate for Payer: Aetna Commercial |
$3,014.11
|
| Rate for Payer: Aetna Medicare |
$1,789.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,304.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,150.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,150.51
|
| Rate for Payer: BCBS Complete |
$968.25
|
| Rate for Payer: BCBS MAPPO |
$1,720.41
|
| Rate for Payer: BCBS Trust/PPO |
$2,042.27
|
| Rate for Payer: BCN Commercial |
$2,042.27
|
| Rate for Payer: BCN Medicare Advantage |
$1,720.41
|
| Rate for Payer: Cash Price |
$2,836.81
|
| Rate for Payer: Cash Price |
$2,836.81
|
| Rate for Payer: Cash Price |
$2,836.81
|
| Rate for Payer: Cofinity Commercial |
$2,482.21
|
| Rate for Payer: Cofinity Commercial |
$3,049.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,482.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,836.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,720.41
|
| Rate for Payer: Healthscope Commercial |
$3,191.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,482.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,659.51
|
| Rate for Payer: Mclaren Medicaid |
$922.14
|
| Rate for Payer: Mclaren Medicare |
$1,720.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,806.43
|
| Rate for Payer: Meridian Medicaid |
$968.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,978.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,014.11
|
| Rate for Payer: Nomi Health Commercial |
$5,161.23
|
| Rate for Payer: PACE Medicare |
$1,634.39
|
| Rate for Payer: PACE SWMI |
$1,720.41
|
| Rate for Payer: PHP Commercial |
$3,014.11
|
| Rate for Payer: PHP Medicare Advantage |
$1,720.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$922.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,304.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,407.20
|
| Rate for Payer: Priority Health Medicare |
$1,720.41
|
| Rate for Payer: Priority Health Narrow Network |
$4,325.76
|
| Rate for Payer: Priority Health SBD |
$2,233.99
|
| Rate for Payer: Railroad Medicare Medicare |
$1,720.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$981.83
|
| Rate for Payer: UHC Core |
$979.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,720.41
|
| Rate for Payer: UHC Exchange |
$892.57
|
| Rate for Payer: UHC Medicare Advantage |
$1,720.41
|
| Rate for Payer: UHCCP Medicaid |
$922.14
|
| Rate for Payer: UMR Bronson Commercial |
$1,312.02
|
| Rate for Payer: VA VA |
$1,720.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,659.51
|
|
|
HC ROMOSOZUMAB-AQQG INJ 1 MG
|
Facility
|
OP
|
$11.44
|
|
|
Service Code
|
HCPCS J3111
|
| Hospital Charge Code |
63600150
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.23 |
| Max. Negotiated Rate |
$34.47 |
| Rate for Payer: Aetna American Axle |
$7.44
|
| Rate for Payer: Aetna Commercial |
$9.72
|
| Rate for Payer: Aetna Medicare |
$11.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.36
|
| Rate for Payer: BCBS Complete |
$6.47
|
| Rate for Payer: BCBS MAPPO |
$11.49
|
| Rate for Payer: BCBS Trust/PPO |
$30.96
|
| Rate for Payer: BCN Commercial |
$30.96
|
| Rate for Payer: BCN Medicare Advantage |
$11.49
|
| Rate for Payer: Cash Price |
$9.15
|
| Rate for Payer: Cash Price |
$9.15
|
| Rate for Payer: Cofinity Commercial |
$9.84
|
| Rate for Payer: Cofinity Commercial |
$8.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.49
|
| Rate for Payer: Healthscope Commercial |
$10.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.58
|
| Rate for Payer: Mclaren Medicaid |
$6.16
|
| Rate for Payer: Mclaren Medicare |
$11.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.06
|
| Rate for Payer: Meridian Medicaid |
$6.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.72
|
| Rate for Payer: Nomi Health Commercial |
$34.47
|
| Rate for Payer: PACE Medicare |
$10.92
|
| Rate for Payer: PACE SWMI |
$11.49
|
| Rate for Payer: PHP Commercial |
$9.72
|
| Rate for Payer: PHP Medicare Advantage |
$11.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$32.16
|
| Rate for Payer: Priority Health Medicare |
$11.49
|
| Rate for Payer: Priority Health Narrow Network |
$25.73
|
| Rate for Payer: Priority Health SBD |
$7.21
|
| Rate for Payer: Railroad Medicare Medicare |
$11.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.49
|
| Rate for Payer: UHC Exchange |
$21.96
|
| Rate for Payer: UHC Medicare Advantage |
$11.49
|
| Rate for Payer: UHCCP Medicaid |
$6.16
|
| Rate for Payer: UMR Bronson Commercial |
$4.23
|
| Rate for Payer: VA VA |
$11.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.58
|
|
|
HC ROMOSOZUMAB-AQQG INJ 1 MG
|
Facility
|
IP
|
$11.44
|
|
|
Service Code
|
HCPCS J3111
|
| Hospital Charge Code |
63600150
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.03 |
| Max. Negotiated Rate |
$10.30 |
| Rate for Payer: Aetna American Axle |
$7.44
|
| Rate for Payer: Aetna Commercial |
$9.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.44
|
| Rate for Payer: Cash Price |
$9.15
|
| Rate for Payer: Cofinity Commercial |
$8.01
|
| Rate for Payer: Cofinity Commercial |
$9.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.15
|
| Rate for Payer: Healthscope Commercial |
$10.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.72
|
| Rate for Payer: PHP Commercial |
$9.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.44
|
| Rate for Payer: Priority Health SBD |
$7.21
|
| Rate for Payer: UMR Bronson Commercial |
$5.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.58
|
|
|
HC ROOM & BOARD PSYCH
|
Facility
|
IP
|
$1,810.72
|
|
| Hospital Charge Code |
12400001
|
|
Hospital Revenue Code
|
124
|
| Min. Negotiated Rate |
$796.72 |
| Max. Negotiated Rate |
$1,629.65 |
| Rate for Payer: Aetna American Axle |
$1,176.97
|
| Rate for Payer: Aetna Commercial |
$1,539.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,176.97
|
| Rate for Payer: Cash Price |
$1,448.58
|
| Rate for Payer: Cofinity Commercial |
$1,267.50
|
| Rate for Payer: Cofinity Commercial |
$1,557.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,267.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,448.58
|
| Rate for Payer: Healthscope Commercial |
$1,629.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,267.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,358.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,539.11
|
| Rate for Payer: PHP Commercial |
$1,539.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,176.97
|
| Rate for Payer: Priority Health SBD |
$1,140.75
|
| Rate for Payer: UMR Bronson Commercial |
$796.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,358.04
|
|
|
HC ROOM MED SURG
|
Facility
|
IP
|
$3,356.84
|
|
| Hospital Charge Code |
12100001
|
|
Hospital Revenue Code
|
121
|
| Min. Negotiated Rate |
$1,477.01 |
| Max. Negotiated Rate |
$3,021.16 |
| Rate for Payer: Aetna American Axle |
$2,181.95
|
| Rate for Payer: Aetna Commercial |
$2,853.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,181.95
|
| Rate for Payer: Cash Price |
$2,685.47
|
| Rate for Payer: Cofinity Commercial |
$2,349.79
|
| Rate for Payer: Cofinity Commercial |
$2,886.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,349.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,685.47
|
| Rate for Payer: Healthscope Commercial |
$3,021.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,349.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,517.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,853.31
|
| Rate for Payer: PHP Commercial |
$2,853.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,181.95
|
| Rate for Payer: Priority Health SBD |
$2,114.81
|
| Rate for Payer: UMR Bronson Commercial |
$1,477.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,517.63
|
|
|
HC ROOM SCU
|
Facility
|
IP
|
$2,352.06
|
|
| Hospital Charge Code |
20000002
|
|
Hospital Revenue Code
|
200
|
| Min. Negotiated Rate |
$1,034.91 |
| Max. Negotiated Rate |
$2,116.85 |
| Rate for Payer: Aetna American Axle |
$1,528.84
|
| Rate for Payer: Aetna Commercial |
$1,999.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,528.84
|
| Rate for Payer: Cash Price |
$1,881.65
|
| Rate for Payer: Cofinity Commercial |
$1,646.44
|
| Rate for Payer: Cofinity Commercial |
$2,022.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,646.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,881.65
|
| Rate for Payer: Healthscope Commercial |
$2,116.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,646.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,764.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,999.25
|
| Rate for Payer: PHP Commercial |
$1,999.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,528.84
|
| Rate for Payer: Priority Health SBD |
$1,481.80
|
| Rate for Payer: UMR Bronson Commercial |
$1,034.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,764.04
|
|
|
HC RO OR SSA SJOGRENS AB
|
Facility
|
IP
|
$35.17
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200162
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.47 |
| Max. Negotiated Rate |
$31.65 |
| Rate for Payer: Aetna American Axle |
$22.86
|
| Rate for Payer: Aetna Commercial |
$29.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.86
|
| Rate for Payer: Cash Price |
$28.14
|
| Rate for Payer: Cofinity Commercial |
$24.62
|
| Rate for Payer: Cofinity Commercial |
$30.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.14
|
| Rate for Payer: Healthscope Commercial |
$31.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.89
|
| Rate for Payer: PHP Commercial |
$29.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.86
|
| Rate for Payer: Priority Health SBD |
$22.16
|
| Rate for Payer: UMR Bronson Commercial |
$15.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.38
|
|
|
HC RO OR SSA SJOGRENS AB
|
Facility
|
OP
|
$35.17
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200162
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.61 |
| Max. Negotiated Rate |
$31.65 |
| Rate for Payer: Aetna American Axle |
$22.86
|
| Rate for Payer: Aetna Commercial |
$29.89
|
| Rate for Payer: Aetna Medicare |
$18.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.86
|
| 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 |
$10.09
|
| Rate for Payer: BCBS MAPPO |
$17.93
|
| Rate for Payer: BCBS Trust/PPO |
$17.28
|
| Rate for Payer: BCN Commercial |
$17.28
|
| Rate for Payer: BCN Medicare Advantage |
$17.93
|
| Rate for Payer: Cash Price |
$28.14
|
| Rate for Payer: Cash Price |
$28.14
|
| Rate for Payer: Cofinity Commercial |
$30.25
|
| Rate for Payer: Cofinity Commercial |
$24.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.93
|
| Rate for Payer: Healthscope Commercial |
$31.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.38
|
| Rate for Payer: Mclaren Medicaid |
$9.61
|
| 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 |
$10.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.89
|
| Rate for Payer: Nomi Health Commercial |
$26.90
|
| Rate for Payer: PACE Medicare |
$17.03
|
| Rate for Payer: PACE SWMI |
$17.93
|
| Rate for Payer: PHP Commercial |
$29.89
|
| Rate for Payer: PHP Medicare Advantage |
$17.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.93
|
| Rate for Payer: Priority Health Medicare |
$17.93
|
| Rate for Payer: Priority Health Narrow Network |
$14.34
|
| Rate for Payer: Priority Health SBD |
$22.16
|
| Rate for Payer: Railroad Medicare Medicare |
$17.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.93
|
| Rate for Payer: UHC Exchange |
$17.93
|
| Rate for Payer: UHC Medicare Advantage |
$17.93
|
| Rate for Payer: UHCCP Medicaid |
$9.61
|
| Rate for Payer: UMR Bronson Commercial |
$13.01
|
| Rate for Payer: VA VA |
$17.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.38
|
|
|
HC ROPIVACAINE HYDROCHLORIDE 1 MG
|
Facility
|
OP
|
$4.08
|
|
|
Service Code
|
CPT J2795
|
| Hospital Charge Code |
63600236
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$3.67 |
| Rate for Payer: Aetna American Axle |
$2.65
|
| Rate for Payer: Aetna Commercial |
$3.47
|
| Rate for Payer: Aetna Medicare |
$2.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.65
|
| Rate for Payer: BCBS Complete |
$1.63
|
| Rate for Payer: BCBS Trust/PPO |
$0.16
|
| Rate for Payer: BCN Commercial |
$0.16
|
| Rate for Payer: Cash Price |
$3.26
|
| Rate for Payer: Cash Price |
$3.26
|
| Rate for Payer: Cofinity Commercial |
$2.86
|
| Rate for Payer: Cofinity Commercial |
$3.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.26
|
| Rate for Payer: Healthscope Commercial |
$3.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.47
|
| Rate for Payer: PHP Commercial |
$3.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.65
|
| Rate for Payer: Priority Health SBD |
$2.57
|
| Rate for Payer: UMR Bronson Commercial |
$1.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.06
|
|
|
HC ROPIVACAINE HYDROCHLORIDE 1 MG
|
Facility
|
IP
|
$4.08
|
|
|
Service Code
|
CPT J2795
|
| Hospital Charge Code |
63600236
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$3.67 |
| Rate for Payer: Aetna American Axle |
$2.65
|
| Rate for Payer: Aetna Commercial |
$3.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.65
|
| Rate for Payer: Cash Price |
$3.26
|
| Rate for Payer: Cofinity Commercial |
$2.86
|
| Rate for Payer: Cofinity Commercial |
$3.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.26
|
| Rate for Payer: Healthscope Commercial |
$3.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.47
|
| Rate for Payer: PHP Commercial |
$3.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.65
|
| Rate for Payer: Priority Health SBD |
$2.57
|
| Rate for Payer: UMR Bronson Commercial |
$1.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.06
|
|
|
HC RO SUPERFICIAL AND/OR ORTHO
|
Facility
|
IP
|
$199.76
|
|
|
Service Code
|
CPT 77401
|
| Hospital Charge Code |
33300036
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$87.89 |
| Max. Negotiated Rate |
$179.78 |
| Rate for Payer: Aetna American Axle |
$129.84
|
| Rate for Payer: Aetna Commercial |
$169.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.84
|
| Rate for Payer: Cash Price |
$159.81
|
| Rate for Payer: Cofinity Commercial |
$139.83
|
| Rate for Payer: Cofinity Commercial |
$171.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$139.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.81
|
| Rate for Payer: Healthscope Commercial |
$179.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$139.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$149.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.80
|
| Rate for Payer: PHP Commercial |
$169.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.84
|
| Rate for Payer: Priority Health SBD |
$125.85
|
| Rate for Payer: UMR Bronson Commercial |
$87.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$149.82
|
|
|
HC RO SUPERFICIAL AND/OR ORTHO
|
Facility
|
OP
|
$199.76
|
|
|
Service Code
|
CPT 77401
|
| Hospital Charge Code |
33300036
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$37.37 |
| Max. Negotiated Rate |
$979.00 |
| Rate for Payer: Aetna American Axle |
$129.84
|
| Rate for Payer: Aetna Commercial |
$169.80
|
| Rate for Payer: Aetna Medicare |
$111.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$134.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$134.11
|
| Rate for Payer: BCBS Complete |
$60.38
|
| Rate for Payer: BCBS MAPPO |
$107.29
|
| Rate for Payer: BCBS Trust/PPO |
$85.53
|
| Rate for Payer: BCN Commercial |
$85.53
|
| Rate for Payer: BCN Medicare Advantage |
$107.29
|
| Rate for Payer: Cash Price |
$159.81
|
| Rate for Payer: Cash Price |
$159.81
|
| Rate for Payer: Cash Price |
$159.81
|
| Rate for Payer: Cofinity Commercial |
$139.83
|
| Rate for Payer: Cofinity Commercial |
$171.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$139.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$107.29
|
| Rate for Payer: Healthscope Commercial |
$179.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$139.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$149.82
|
| Rate for Payer: Mclaren Medicaid |
$57.51
|
| Rate for Payer: Mclaren Medicare |
$107.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$112.65
|
| Rate for Payer: Meridian Medicaid |
$60.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$123.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.80
|
| Rate for Payer: Nomi Health Commercial |
$321.87
|
| Rate for Payer: PACE Medicare |
$101.93
|
| Rate for Payer: PACE SWMI |
$107.29
|
| Rate for Payer: PHP Commercial |
$169.80
|
| Rate for Payer: PHP Medicare Advantage |
$107.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$57.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$337.20
|
| Rate for Payer: Priority Health Medicare |
$107.29
|
| Rate for Payer: Priority Health Narrow Network |
$269.76
|
| Rate for Payer: Priority Health SBD |
$125.85
|
| Rate for Payer: Railroad Medicare Medicare |
$107.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.11
|
| Rate for Payer: UHC Core |
$979.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$107.29
|
| Rate for Payer: UHC Exchange |
$37.37
|
| Rate for Payer: UHC Medicare Advantage |
$107.29
|
| Rate for Payer: UHCCP Medicaid |
$57.51
|
| Rate for Payer: UMR Bronson Commercial |
$73.91
|
| Rate for Payer: VA VA |
$107.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$149.82
|
|
|
HC ROTABLATOR BURR
|
Facility
|
IP
|
$4,184.71
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
27200069
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,841.27 |
| Max. Negotiated Rate |
$3,766.24 |
| Rate for Payer: Aetna American Axle |
$2,720.06
|
| Rate for Payer: Aetna Commercial |
$3,557.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,720.06
|
| Rate for Payer: Cash Price |
$3,347.77
|
| Rate for Payer: Cofinity Commercial |
$2,929.30
|
| Rate for Payer: Cofinity Commercial |
$3,598.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,929.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,347.77
|
| Rate for Payer: Healthscope Commercial |
$3,766.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,929.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,138.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,557.00
|
| Rate for Payer: PHP Commercial |
$3,557.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,720.06
|
| Rate for Payer: Priority Health SBD |
$2,636.37
|
| Rate for Payer: UMR Bronson Commercial |
$1,841.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,138.53
|
|
|
HC ROTABLATOR BURR
|
Facility
|
OP
|
$4,184.71
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
27200069
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$3,766.24 |
| Rate for Payer: Aetna American Axle |
$2,720.06
|
| Rate for Payer: Aetna Commercial |
$3,557.00
|
| Rate for Payer: Aetna Medicare |
$2,092.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,720.06
|
| Rate for Payer: BCBS Complete |
$1,673.88
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$3,347.77
|
| Rate for Payer: Cash Price |
$3,347.77
|
| Rate for Payer: Cofinity Commercial |
$2,929.30
|
| Rate for Payer: Cofinity Commercial |
$3,598.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,929.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,347.77
|
| Rate for Payer: Healthscope Commercial |
$3,766.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,929.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,138.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,557.00
|
| Rate for Payer: PHP Commercial |
$3,557.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,720.06
|
| Rate for Payer: Priority Health SBD |
$2,636.37
|
| Rate for Payer: UMR Bronson Commercial |
$1,548.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,138.53
|
|
|
HC ROTAVIRUS ANTIGEN
|
Facility
|
OP
|
$109.75
|
|
|
Service Code
|
CPT 87425
|
| Hospital Charge Code |
30600145
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.42 |
| Max. Negotiated Rate |
$98.78 |
| Rate for Payer: Aetna American Axle |
$71.34
|
| Rate for Payer: Aetna Commercial |
$93.29
|
| Rate for Payer: Aetna Medicare |
$12.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.98
|
| Rate for Payer: BCBS Complete |
$6.74
|
| Rate for Payer: BCBS MAPPO |
$11.98
|
| Rate for Payer: BCBS Trust/PPO |
$11.55
|
| Rate for Payer: BCN Commercial |
$11.55
|
| Rate for Payer: BCN Medicare Advantage |
$11.98
|
| Rate for Payer: Cash Price |
$87.80
|
| Rate for Payer: Cash Price |
$87.80
|
| Rate for Payer: Cofinity Commercial |
$94.38
|
| Rate for Payer: Cofinity Commercial |
$76.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$76.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.98
|
| Rate for Payer: Healthscope Commercial |
$98.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$76.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.31
|
| Rate for Payer: Mclaren Medicaid |
$6.42
|
| 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 |
$6.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.29
|
| Rate for Payer: Nomi Health Commercial |
$17.97
|
| Rate for Payer: PACE Medicare |
$11.38
|
| Rate for Payer: PACE SWMI |
$11.98
|
| Rate for Payer: PHP Commercial |
$93.29
|
| Rate for Payer: PHP Medicare Advantage |
$11.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.33
|
| Rate for Payer: Priority Health Medicare |
$11.98
|
| Rate for Payer: Priority Health Narrow Network |
$9.86
|
| Rate for Payer: Priority Health SBD |
$69.14
|
| Rate for Payer: Railroad Medicare Medicare |
$11.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.98
|
| Rate for Payer: UHC Exchange |
$11.98
|
| Rate for Payer: UHC Medicare Advantage |
$11.98
|
| Rate for Payer: UHCCP Medicaid |
$6.42
|
| Rate for Payer: UMR Bronson Commercial |
$40.61
|
| Rate for Payer: VA VA |
$11.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.31
|
|
|
HC ROTAVIRUS ANTIGEN
|
Facility
|
IP
|
$109.75
|
|
|
Service Code
|
CPT 87425
|
| Hospital Charge Code |
30600145
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$48.29 |
| Max. Negotiated Rate |
$98.78 |
| Rate for Payer: Aetna American Axle |
$71.34
|
| Rate for Payer: Aetna Commercial |
$93.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.34
|
| Rate for Payer: Cash Price |
$87.80
|
| Rate for Payer: Cofinity Commercial |
$76.82
|
| Rate for Payer: Cofinity Commercial |
$94.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$76.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.80
|
| Rate for Payer: Healthscope Commercial |
$98.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$76.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.29
|
| Rate for Payer: PHP Commercial |
$93.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.34
|
| Rate for Payer: Priority Health SBD |
$69.14
|
| Rate for Payer: UMR Bronson Commercial |
$48.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.31
|
|
|
HC ROTAVIRUS ATTEN 2 DOSE SCHED LIVE ORAL
|
Facility
|
IP
|
$178.53
|
|
|
Service Code
|
CPT 90681
|
| Hospital Charge Code |
63600121
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$78.55 |
| Max. Negotiated Rate |
$160.68 |
| Rate for Payer: Aetna American Axle |
$116.04
|
| Rate for Payer: Aetna Commercial |
$151.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.04
|
| Rate for Payer: Cash Price |
$142.82
|
| Rate for Payer: Cofinity Commercial |
$124.97
|
| Rate for Payer: Cofinity Commercial |
$153.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$124.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.82
|
| Rate for Payer: Healthscope Commercial |
$160.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$124.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$133.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$151.75
|
| Rate for Payer: PHP Commercial |
$151.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.04
|
| Rate for Payer: Priority Health SBD |
$112.47
|
| Rate for Payer: UMR Bronson Commercial |
$78.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$133.90
|
|
|
HC ROTAVIRUS ATTEN 2 DOSE SCHED LIVE ORAL
|
Facility
|
OP
|
$178.53
|
|
|
Service Code
|
CPT 90681
|
| Hospital Charge Code |
63600121
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$66.06 |
| Max. Negotiated Rate |
$360.94 |
| Rate for Payer: Aetna American Axle |
$116.04
|
| Rate for Payer: Aetna Commercial |
$151.75
|
| Rate for Payer: Aetna Medicare |
$89.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.04
|
| Rate for Payer: BCBS Complete |
$71.41
|
| Rate for Payer: BCBS Trust/PPO |
$360.94
|
| Rate for Payer: BCN Commercial |
$360.94
|
| Rate for Payer: Cash Price |
$142.82
|
| Rate for Payer: Cash Price |
$142.82
|
| Rate for Payer: Cofinity Commercial |
$124.97
|
| Rate for Payer: Cofinity Commercial |
$153.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$124.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.82
|
| Rate for Payer: Healthscope Commercial |
$160.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$124.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$133.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$151.75
|
| Rate for Payer: PHP Commercial |
$151.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$158.02
|
| Rate for Payer: Priority Health Narrow Network |
$126.42
|
| Rate for Payer: Priority Health SBD |
$112.47
|
| Rate for Payer: UMR Bronson Commercial |
$66.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$133.90
|
|
|
HC ROTAVIRUS VACCINE, PENTAVALENT (RV5), 3 DOSE SCHEDULE, LIVE ORAL
|
Facility
|
OP
|
$77.41
|
|
|
Service Code
|
CPT 90680
|
| Hospital Charge Code |
63600076
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.64 |
| Max. Negotiated Rate |
$256.99 |
| Rate for Payer: Aetna American Axle |
$50.32
|
| Rate for Payer: Aetna Commercial |
$65.80
|
| Rate for Payer: Aetna Medicare |
$38.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.32
|
| Rate for Payer: BCBS Complete |
$30.96
|
| Rate for Payer: BCBS Trust/PPO |
$256.99
|
| Rate for Payer: BCN Commercial |
$256.99
|
| Rate for Payer: Cash Price |
$61.93
|
| Rate for Payer: Cash Price |
$61.93
|
| Rate for Payer: Cofinity Commercial |
$54.19
|
| Rate for Payer: Cofinity Commercial |
$66.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$54.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.93
|
| Rate for Payer: Healthscope Commercial |
$69.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$54.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.80
|
| Rate for Payer: PHP Commercial |
$65.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$112.51
|
| Rate for Payer: Priority Health Narrow Network |
$90.01
|
| Rate for Payer: Priority Health SBD |
$48.77
|
| Rate for Payer: UMR Bronson Commercial |
$28.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.06
|
|
|
HC ROTAVIRUS VACCINE, PENTAVALENT (RV5), 3 DOSE SCHEDULE, LIVE ORAL
|
Facility
|
IP
|
$77.41
|
|
|
Service Code
|
CPT 90680
|
| Hospital Charge Code |
63600076
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.06 |
| Max. Negotiated Rate |
$69.67 |
| Rate for Payer: Aetna American Axle |
$50.32
|
| Rate for Payer: Aetna Commercial |
$65.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.32
|
| Rate for Payer: Cash Price |
$61.93
|
| Rate for Payer: Cofinity Commercial |
$54.19
|
| Rate for Payer: Cofinity Commercial |
$66.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$54.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.93
|
| Rate for Payer: Healthscope Commercial |
$69.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$54.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.80
|
| Rate for Payer: PHP Commercial |
$65.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.32
|
| Rate for Payer: Priority Health SBD |
$48.77
|
| Rate for Payer: UMR Bronson Commercial |
$34.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.06
|
|
|
HC RO TREATMENT DEVICE INTERMED
|
Facility
|
OP
|
$521.24
|
|
|
Service Code
|
CPT 77333
|
| Hospital Charge Code |
33300037
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$18.95 |
| Max. Negotiated Rate |
$979.00 |
| Rate for Payer: Aetna American Axle |
$338.81
|
| Rate for Payer: Aetna Commercial |
$443.05
|
| Rate for Payer: Aetna Medicare |
$135.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$338.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$162.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$162.61
|
| Rate for Payer: BCBS Complete |
$73.21
|
| Rate for Payer: BCBS MAPPO |
$130.09
|
| Rate for Payer: BCBS Trust/PPO |
$18.95
|
| Rate for Payer: BCN Commercial |
$18.95
|
| Rate for Payer: BCN Medicare Advantage |
$130.09
|
| Rate for Payer: Cash Price |
$416.99
|
| Rate for Payer: Cash Price |
$416.99
|
| Rate for Payer: Cash Price |
$416.99
|
| Rate for Payer: Cofinity Commercial |
$364.87
|
| Rate for Payer: Cofinity Commercial |
$448.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$364.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$416.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$130.09
|
| Rate for Payer: Healthscope Commercial |
$469.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$364.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$390.93
|
| Rate for Payer: Mclaren Medicaid |
$69.73
|
| Rate for Payer: Mclaren Medicare |
$130.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$136.59
|
| Rate for Payer: Meridian Medicaid |
$73.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$149.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$443.05
|
| Rate for Payer: Nomi Health Commercial |
$390.27
|
| Rate for Payer: PACE Medicare |
$123.59
|
| Rate for Payer: PACE SWMI |
$130.09
|
| Rate for Payer: PHP Commercial |
$443.05
|
| Rate for Payer: PHP Medicare Advantage |
$130.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$338.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$408.86
|
| Rate for Payer: Priority Health Medicare |
$130.09
|
| Rate for Payer: Priority Health Narrow Network |
$327.09
|
| Rate for Payer: Priority Health SBD |
$328.38
|
| Rate for Payer: Railroad Medicare Medicare |
$130.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$137.64
|
| Rate for Payer: UHC Core |
$979.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$130.09
|
| Rate for Payer: UHC Exchange |
$125.13
|
| Rate for Payer: UHC Medicare Advantage |
$130.09
|
| Rate for Payer: UHCCP Medicaid |
$69.73
|
| Rate for Payer: UMR Bronson Commercial |
$192.86
|
| Rate for Payer: VA VA |
$130.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$390.93
|
|
|
HC RO TREATMENT DEVICE INTERMED
|
Facility
|
IP
|
$521.24
|
|
|
Service Code
|
CPT 77333
|
| Hospital Charge Code |
33300037
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$229.35 |
| Max. Negotiated Rate |
$469.12 |
| Rate for Payer: Aetna American Axle |
$338.81
|
| Rate for Payer: Aetna Commercial |
$443.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$338.81
|
| Rate for Payer: Cash Price |
$416.99
|
| Rate for Payer: Cofinity Commercial |
$364.87
|
| Rate for Payer: Cofinity Commercial |
$448.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$364.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$416.99
|
| Rate for Payer: Healthscope Commercial |
$469.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$364.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$390.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$443.05
|
| Rate for Payer: PHP Commercial |
$443.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$338.81
|
| Rate for Payer: Priority Health SBD |
$328.38
|
| Rate for Payer: UMR Bronson Commercial |
$229.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$390.93
|
|
|
HC RO TREATMENT DEVICE SIMPLE
|
Facility
|
OP
|
$414.08
|
|
|
Service Code
|
CPT 77332
|
| Hospital Charge Code |
33300038
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$36.77 |
| Max. Negotiated Rate |
$979.00 |
| Rate for Payer: Aetna American Axle |
$269.15
|
| Rate for Payer: Aetna Commercial |
$351.97
|
| Rate for Payer: Aetna Medicare |
$135.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$269.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$162.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$162.61
|
| Rate for Payer: BCBS Complete |
$73.21
|
| Rate for Payer: BCBS MAPPO |
$130.09
|
| Rate for Payer: BCBS Trust/PPO |
$108.09
|
| Rate for Payer: BCN Commercial |
$108.09
|
| Rate for Payer: BCN Medicare Advantage |
$130.09
|
| Rate for Payer: Cash Price |
$331.26
|
| Rate for Payer: Cash Price |
$331.26
|
| Rate for Payer: Cash Price |
$331.26
|
| Rate for Payer: Cofinity Commercial |
$289.86
|
| Rate for Payer: Cofinity Commercial |
$356.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$289.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$331.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$130.09
|
| Rate for Payer: Healthscope Commercial |
$372.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$289.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$310.56
|
| Rate for Payer: Mclaren Medicaid |
$69.73
|
| Rate for Payer: Mclaren Medicare |
$130.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$136.59
|
| Rate for Payer: Meridian Medicaid |
$73.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$149.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$351.97
|
| Rate for Payer: Nomi Health Commercial |
$390.27
|
| Rate for Payer: PACE Medicare |
$123.59
|
| Rate for Payer: PACE SWMI |
$130.09
|
| Rate for Payer: PHP Commercial |
$351.97
|
| Rate for Payer: PHP Medicare Advantage |
$130.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$269.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$408.86
|
| Rate for Payer: Priority Health Medicare |
$130.09
|
| Rate for Payer: Priority Health Narrow Network |
$327.09
|
| Rate for Payer: Priority Health SBD |
$260.87
|
| Rate for Payer: Railroad Medicare Medicare |
$130.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.45
|
| Rate for Payer: UHC Core |
$979.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$130.09
|
| Rate for Payer: UHC Exchange |
$36.77
|
| Rate for Payer: UHC Medicare Advantage |
$130.09
|
| Rate for Payer: UHCCP Medicaid |
$69.73
|
| Rate for Payer: UMR Bronson Commercial |
$153.21
|
| Rate for Payer: VA VA |
$130.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$310.56
|
|
|
HC RO TREATMENT DEVICE SIMPLE
|
Facility
|
IP
|
$414.08
|
|
|
Service Code
|
CPT 77332
|
| Hospital Charge Code |
33300038
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$182.20 |
| Max. Negotiated Rate |
$372.67 |
| Rate for Payer: Aetna American Axle |
$269.15
|
| Rate for Payer: Aetna Commercial |
$351.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$269.15
|
| Rate for Payer: Cash Price |
$331.26
|
| Rate for Payer: Cofinity Commercial |
$289.86
|
| Rate for Payer: Cofinity Commercial |
$356.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$289.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$331.26
|
| Rate for Payer: Healthscope Commercial |
$372.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$289.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$310.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$351.97
|
| Rate for Payer: PHP Commercial |
$351.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$269.15
|
| Rate for Payer: Priority Health SBD |
$260.87
|
| Rate for Payer: UMR Bronson Commercial |
$182.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$310.56
|
|
|
HC RO TRTMNT >1 MEV COMPLEX
|
Facility
|
OP
|
$701.23
|
|
|
Service Code
|
CPT 77412
|
| Hospital Charge Code |
33300049
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$138.11 |
| Max. Negotiated Rate |
$979.00 |
| Rate for Payer: Aetna American Axle |
$455.80
|
| Rate for Payer: Aetna Commercial |
$596.05
|
| Rate for Payer: Aetna Medicare |
$267.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$455.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$322.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$322.08
|
| Rate for Payer: BCBS Complete |
$145.01
|
| Rate for Payer: BCBS MAPPO |
$257.66
|
| Rate for Payer: BCBS Trust/PPO |
$261.03
|
| Rate for Payer: BCN Commercial |
$261.03
|
| Rate for Payer: BCN Medicare Advantage |
$257.66
|
| Rate for Payer: Cash Price |
$560.98
|
| Rate for Payer: Cash Price |
$560.98
|
| Rate for Payer: Cash Price |
$560.98
|
| Rate for Payer: Cofinity Commercial |
$490.86
|
| Rate for Payer: Cofinity Commercial |
$603.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$490.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$560.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$257.66
|
| Rate for Payer: Healthscope Commercial |
$631.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$490.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$525.92
|
| Rate for Payer: Mclaren Medicaid |
$138.11
|
| Rate for Payer: Mclaren Medicare |
$257.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$270.54
|
| Rate for Payer: Meridian Medicaid |
$145.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$296.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$596.05
|
| Rate for Payer: Nomi Health Commercial |
$772.98
|
| Rate for Payer: PACE Medicare |
$244.78
|
| Rate for Payer: PACE SWMI |
$257.66
|
| Rate for Payer: PHP Commercial |
$596.05
|
| Rate for Payer: PHP Medicare Advantage |
$257.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$138.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$455.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$809.82
|
| Rate for Payer: Priority Health Medicare |
$257.66
|
| Rate for Payer: Priority Health Narrow Network |
$647.86
|
| Rate for Payer: Priority Health SBD |
$441.77
|
| Rate for Payer: Railroad Medicare Medicare |
$257.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$725.29
|
| Rate for Payer: UHC Core |
$979.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$257.66
|
| Rate for Payer: UHC Exchange |
$492.41
|
| Rate for Payer: UHC Medicare Advantage |
$257.66
|
| Rate for Payer: UHCCP Medicaid |
$138.11
|
| Rate for Payer: UMR Bronson Commercial |
$259.46
|
| Rate for Payer: VA VA |
$257.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$525.92
|
|
