|
HC SIMPLE REP WD FACE,EAR,EYELID,NOSE,LIP,MUC MEMB 2.5CM OR LESS
|
Facility
|
IP
|
$272.69
|
|
|
Service Code
|
CPT 12011
|
| Hospital Charge Code |
76100274
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$119.98 |
| Max. Negotiated Rate |
$245.42 |
| Rate for Payer: Aetna American Axle |
$177.25
|
| Rate for Payer: Aetna Commercial |
$231.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.25
|
| Rate for Payer: Cash Price |
$218.15
|
| Rate for Payer: Cofinity Commercial |
$190.88
|
| Rate for Payer: Cofinity Commercial |
$234.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$190.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.15
|
| Rate for Payer: Healthscope Commercial |
$245.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$190.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$204.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.79
|
| Rate for Payer: PHP Commercial |
$231.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.25
|
| Rate for Payer: Priority Health SBD |
$171.79
|
| Rate for Payer: UMR Bronson Commercial |
$119.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$204.52
|
|
|
HC SIMPLE REP WD FACE,EAR,EYELID,NOSE,LIP,MUC MEMB 2.5CM OR LESS
|
Facility
|
OP
|
$272.69
|
|
|
Service Code
|
CPT 12011
|
| Hospital Charge Code |
76100274
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$100.90 |
| Max. Negotiated Rate |
$545.50 |
| Rate for Payer: Aetna American Axle |
$177.25
|
| Rate for Payer: Aetna Commercial |
$231.79
|
| Rate for Payer: Aetna Medicare |
$201.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$242.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$242.24
|
| Rate for Payer: BCBS Complete |
$109.07
|
| Rate for Payer: BCBS MAPPO |
$193.79
|
| Rate for Payer: BCN Medicare Advantage |
$193.79
|
| Rate for Payer: Cash Price |
$218.15
|
| Rate for Payer: Cash Price |
$218.15
|
| Rate for Payer: Cofinity Commercial |
$234.51
|
| Rate for Payer: Cofinity Commercial |
$190.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$190.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$193.79
|
| Rate for Payer: Healthscope Commercial |
$245.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$190.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$204.52
|
| Rate for Payer: Mclaren Medicaid |
$103.87
|
| Rate for Payer: Mclaren Medicare |
$193.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$203.48
|
| Rate for Payer: Meridian Medicaid |
$109.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$222.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.79
|
| Rate for Payer: PACE Medicare |
$184.10
|
| Rate for Payer: PACE SWMI |
$193.79
|
| Rate for Payer: PHP Commercial |
$231.79
|
| Rate for Payer: PHP Medicare Advantage |
$193.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.25
|
| Rate for Payer: Priority Health Medicare |
$193.79
|
| Rate for Payer: Priority Health SBD |
$171.79
|
| Rate for Payer: Railroad Medicare Medicare |
$193.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$545.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$193.79
|
| Rate for Payer: UHC Exchange |
$370.35
|
| Rate for Payer: UHC Medicare Advantage |
$193.79
|
| Rate for Payer: UHCCP Medicaid |
$103.87
|
| Rate for Payer: UMR Bronson Commercial |
$100.90
|
| Rate for Payer: VA VA |
$193.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$204.52
|
|
|
HC SIMPLE REP WD SCALP,NECK,AXILLAE,GENITALIA,TRUNK, EXTREMS 2.6 TO 7.5 CM
|
Facility
|
IP
|
$147.11
|
|
|
Service Code
|
CPT 12002
|
| Hospital Charge Code |
76100114
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$64.73 |
| Max. Negotiated Rate |
$132.40 |
| Rate for Payer: Aetna American Axle |
$95.62
|
| Rate for Payer: Aetna Commercial |
$125.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.62
|
| Rate for Payer: Cash Price |
$117.69
|
| Rate for Payer: Cofinity Commercial |
$102.98
|
| Rate for Payer: Cofinity Commercial |
$126.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$102.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.69
|
| Rate for Payer: Healthscope Commercial |
$132.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$102.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.04
|
| Rate for Payer: PHP Commercial |
$125.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.62
|
| Rate for Payer: Priority Health SBD |
$92.68
|
| Rate for Payer: UMR Bronson Commercial |
$64.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.33
|
|
|
HC SIMPLE REP WD SCALP,NECK,AXILLAE,GENITALIA,TRUNK, EXTREMS 2.6 TO 7.5 CM
|
Facility
|
OP
|
$147.11
|
|
|
Service Code
|
CPT 12002
|
| Hospital Charge Code |
76100114
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$54.43 |
| Max. Negotiated Rate |
$545.50 |
| Rate for Payer: Aetna American Axle |
$95.62
|
| Rate for Payer: Aetna Commercial |
$125.04
|
| Rate for Payer: Aetna Medicare |
$201.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$242.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$242.24
|
| Rate for Payer: BCBS Complete |
$109.07
|
| Rate for Payer: BCBS MAPPO |
$193.79
|
| Rate for Payer: BCN Medicare Advantage |
$193.79
|
| Rate for Payer: Cash Price |
$117.69
|
| Rate for Payer: Cash Price |
$117.69
|
| Rate for Payer: Cofinity Commercial |
$126.51
|
| Rate for Payer: Cofinity Commercial |
$102.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$102.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$193.79
|
| Rate for Payer: Healthscope Commercial |
$132.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$102.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.33
|
| Rate for Payer: Mclaren Medicaid |
$103.87
|
| Rate for Payer: Mclaren Medicare |
$193.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$203.48
|
| Rate for Payer: Meridian Medicaid |
$109.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$222.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.04
|
| Rate for Payer: PACE Medicare |
$184.10
|
| Rate for Payer: PACE SWMI |
$193.79
|
| Rate for Payer: PHP Commercial |
$125.04
|
| Rate for Payer: PHP Medicare Advantage |
$193.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.62
|
| Rate for Payer: Priority Health Medicare |
$193.79
|
| Rate for Payer: Priority Health SBD |
$92.68
|
| Rate for Payer: Railroad Medicare Medicare |
$193.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$545.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$193.79
|
| Rate for Payer: UHC Exchange |
$370.35
|
| Rate for Payer: UHC Medicare Advantage |
$193.79
|
| Rate for Payer: UHCCP Medicaid |
$103.87
|
| Rate for Payer: UMR Bronson Commercial |
$54.43
|
| Rate for Payer: VA VA |
$193.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.33
|
|
|
HC SIMPLE REP WD SCALPNECKAXILLAEGENITALIIATRUNK EXTREMS 7.6 TO 12.5 CM
|
Facility
|
IP
|
$556.48
|
|
|
Service Code
|
CPT 12004
|
| Hospital Charge Code |
76100437
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$244.85 |
| Max. Negotiated Rate |
$500.83 |
| Rate for Payer: Aetna American Axle |
$361.71
|
| Rate for Payer: Aetna Commercial |
$473.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$361.71
|
| Rate for Payer: Cash Price |
$445.18
|
| Rate for Payer: Cofinity Commercial |
$389.54
|
| Rate for Payer: Cofinity Commercial |
$478.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$389.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$445.18
|
| Rate for Payer: Healthscope Commercial |
$500.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$389.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$417.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$473.01
|
| Rate for Payer: PHP Commercial |
$473.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$361.71
|
| Rate for Payer: Priority Health SBD |
$350.58
|
| Rate for Payer: UMR Bronson Commercial |
$244.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$417.36
|
|
|
HC SIMPLE REP WD SCALPNECKAXILLAEGENITALIIATRUNK EXTREMS 7.6 TO 12.5 CM
|
Facility
|
OP
|
$556.48
|
|
|
Service Code
|
CPT 12004
|
| Hospital Charge Code |
76100437
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$103.87 |
| Max. Negotiated Rate |
$545.50 |
| Rate for Payer: Aetna American Axle |
$361.71
|
| Rate for Payer: Aetna Commercial |
$473.01
|
| Rate for Payer: Aetna Medicare |
$201.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$361.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$242.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$242.24
|
| Rate for Payer: BCBS Complete |
$109.07
|
| Rate for Payer: BCBS MAPPO |
$193.79
|
| Rate for Payer: BCN Medicare Advantage |
$193.79
|
| Rate for Payer: Cash Price |
$445.18
|
| Rate for Payer: Cash Price |
$445.18
|
| Rate for Payer: Cofinity Commercial |
$478.57
|
| Rate for Payer: Cofinity Commercial |
$389.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$389.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$445.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$193.79
|
| Rate for Payer: Healthscope Commercial |
$500.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$389.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$417.36
|
| Rate for Payer: Mclaren Medicaid |
$103.87
|
| Rate for Payer: Mclaren Medicare |
$193.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$203.48
|
| Rate for Payer: Meridian Medicaid |
$109.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$222.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$473.01
|
| Rate for Payer: PACE Medicare |
$184.10
|
| Rate for Payer: PACE SWMI |
$193.79
|
| Rate for Payer: PHP Commercial |
$473.01
|
| Rate for Payer: PHP Medicare Advantage |
$193.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$361.71
|
| Rate for Payer: Priority Health Medicare |
$193.79
|
| Rate for Payer: Priority Health SBD |
$350.58
|
| Rate for Payer: Railroad Medicare Medicare |
$193.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$545.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$193.79
|
| Rate for Payer: UHC Exchange |
$370.35
|
| Rate for Payer: UHC Medicare Advantage |
$193.79
|
| Rate for Payer: UHCCP Medicaid |
$103.87
|
| Rate for Payer: UMR Bronson Commercial |
$205.90
|
| Rate for Payer: VA VA |
$193.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$417.36
|
|
|
HC SIMULATION - 3D
|
Facility
|
OP
|
$5,248.82
|
|
|
Service Code
|
CPT 77295
|
| Hospital Charge Code |
33300004
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$715.26 |
| Max. Negotiated Rate |
$4,723.94 |
| Rate for Payer: Aetna American Axle |
$3,411.73
|
| Rate for Payer: Aetna Commercial |
$4,461.50
|
| Rate for Payer: Aetna Medicare |
$1,387.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,411.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,668.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,668.05
|
| Rate for Payer: BCBS Complete |
$751.02
|
| Rate for Payer: BCBS MAPPO |
$1,334.44
|
| Rate for Payer: BCN Medicare Advantage |
$1,334.44
|
| Rate for Payer: Cash Price |
$4,199.06
|
| Rate for Payer: Cash Price |
$4,199.06
|
| Rate for Payer: Cash Price |
$4,199.06
|
| Rate for Payer: Cofinity Commercial |
$3,674.17
|
| Rate for Payer: Cofinity Commercial |
$4,513.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,674.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,199.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,334.44
|
| Rate for Payer: Healthscope Commercial |
$4,723.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,674.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,936.61
|
| Rate for Payer: Mclaren Medicaid |
$715.26
|
| Rate for Payer: Mclaren Medicare |
$1,334.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,401.16
|
| Rate for Payer: Meridian Medicaid |
$751.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,534.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,461.50
|
| Rate for Payer: PACE Medicare |
$1,267.72
|
| Rate for Payer: PACE SWMI |
$1,334.44
|
| Rate for Payer: PHP Commercial |
$4,461.50
|
| Rate for Payer: PHP Medicare Advantage |
$1,334.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$715.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,411.73
|
| Rate for Payer: Priority Health Medicare |
$1,334.44
|
| Rate for Payer: Priority Health SBD |
$3,306.76
|
| Rate for Payer: Railroad Medicare Medicare |
$1,334.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,756.32
|
| Rate for Payer: UHC Core |
$979.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,334.44
|
| Rate for Payer: UHC Exchange |
$2,550.25
|
| Rate for Payer: UHC Medicare Advantage |
$1,334.44
|
| Rate for Payer: UHCCP Medicaid |
$715.26
|
| Rate for Payer: UMR Bronson Commercial |
$1,942.06
|
| Rate for Payer: VA VA |
$1,334.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,936.61
|
|
|
HC SIMULATION - 3D
|
Facility
|
IP
|
$5,248.82
|
|
|
Service Code
|
CPT 77295
|
| Hospital Charge Code |
33300004
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$2,309.48 |
| Max. Negotiated Rate |
$4,723.94 |
| Rate for Payer: Aetna American Axle |
$3,411.73
|
| Rate for Payer: Aetna Commercial |
$4,461.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,411.73
|
| Rate for Payer: Cash Price |
$4,199.06
|
| Rate for Payer: Cofinity Commercial |
$3,674.17
|
| Rate for Payer: Cofinity Commercial |
$4,513.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,674.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,199.06
|
| Rate for Payer: Healthscope Commercial |
$4,723.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,674.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,936.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,461.50
|
| Rate for Payer: PHP Commercial |
$4,461.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,411.73
|
| Rate for Payer: Priority Health SBD |
$3,306.76
|
| Rate for Payer: UMR Bronson Commercial |
$2,309.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,936.61
|
|
|
HC SIMULATION - C
|
Facility
|
OP
|
$1,707.30
|
|
|
Service Code
|
CPT 77290
|
| Hospital Charge Code |
33300003
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$191.36 |
| Max. Negotiated Rate |
$1,536.57 |
| Rate for Payer: Aetna American Axle |
$1,109.74
|
| Rate for Payer: Aetna Commercial |
$1,451.20
|
| Rate for Payer: Aetna Medicare |
$371.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,109.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$446.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$446.27
|
| Rate for Payer: BCBS Complete |
$200.93
|
| Rate for Payer: BCBS MAPPO |
$357.02
|
| Rate for Payer: BCN Medicare Advantage |
$357.02
|
| Rate for Payer: Cash Price |
$1,365.84
|
| Rate for Payer: Cash Price |
$1,365.84
|
| Rate for Payer: Cash Price |
$1,365.84
|
| Rate for Payer: Cofinity Commercial |
$1,195.11
|
| Rate for Payer: Cofinity Commercial |
$1,468.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,195.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,365.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$357.02
|
| Rate for Payer: Healthscope Commercial |
$1,536.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,195.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,280.47
|
| Rate for Payer: Mclaren Medicaid |
$191.36
|
| Rate for Payer: Mclaren Medicare |
$357.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$374.87
|
| Rate for Payer: Meridian Medicaid |
$200.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$410.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,451.20
|
| Rate for Payer: PACE Medicare |
$339.17
|
| Rate for Payer: PACE SWMI |
$357.02
|
| Rate for Payer: PHP Commercial |
$1,451.20
|
| Rate for Payer: PHP Medicare Advantage |
$357.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$191.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,109.74
|
| Rate for Payer: Priority Health Medicare |
$357.02
|
| Rate for Payer: Priority Health SBD |
$1,075.60
|
| Rate for Payer: Railroad Medicare Medicare |
$357.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,004.98
|
| Rate for Payer: UHC Core |
$979.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$357.02
|
| Rate for Payer: UHC Exchange |
$682.30
|
| Rate for Payer: UHC Medicare Advantage |
$357.02
|
| Rate for Payer: UHCCP Medicaid |
$191.36
|
| Rate for Payer: UMR Bronson Commercial |
$631.70
|
| Rate for Payer: VA VA |
$357.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,280.47
|
|
|
HC SIMULATION - C
|
Facility
|
IP
|
$1,707.30
|
|
|
Service Code
|
CPT 77290
|
| Hospital Charge Code |
33300003
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$751.21 |
| Max. Negotiated Rate |
$1,536.57 |
| Rate for Payer: Aetna American Axle |
$1,109.74
|
| Rate for Payer: Aetna Commercial |
$1,451.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,109.74
|
| Rate for Payer: Cash Price |
$1,365.84
|
| Rate for Payer: Cofinity Commercial |
$1,195.11
|
| Rate for Payer: Cofinity Commercial |
$1,468.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,195.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,365.84
|
| Rate for Payer: Healthscope Commercial |
$1,536.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,195.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,280.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,451.20
|
| Rate for Payer: PHP Commercial |
$1,451.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,109.74
|
| Rate for Payer: Priority Health SBD |
$1,075.60
|
| Rate for Payer: UMR Bronson Commercial |
$751.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,280.47
|
|
|
HC SIMULATION - I
|
Facility
|
IP
|
$1,193.40
|
|
|
Service Code
|
CPT 77285
|
| Hospital Charge Code |
33300060
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$525.10 |
| Max. Negotiated Rate |
$1,074.06 |
| Rate for Payer: Aetna American Axle |
$775.71
|
| Rate for Payer: Aetna Commercial |
$1,014.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$775.71
|
| Rate for Payer: Cash Price |
$954.72
|
| Rate for Payer: Cofinity Commercial |
$1,026.32
|
| Rate for Payer: Cofinity Commercial |
$835.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$835.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$954.72
|
| Rate for Payer: Healthscope Commercial |
$1,074.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$835.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$895.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,014.39
|
| Rate for Payer: PHP Commercial |
$1,014.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$775.71
|
| Rate for Payer: Priority Health SBD |
$751.84
|
| Rate for Payer: UMR Bronson Commercial |
$525.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$895.05
|
|
|
HC SIMULATION - I
|
Facility
|
OP
|
$1,193.40
|
|
|
Service Code
|
CPT 77285
|
| Hospital Charge Code |
33300060
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$191.36 |
| Max. Negotiated Rate |
$1,074.06 |
| Rate for Payer: Aetna American Axle |
$775.71
|
| Rate for Payer: Aetna Commercial |
$1,014.39
|
| Rate for Payer: Aetna Medicare |
$371.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$775.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$446.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$446.27
|
| Rate for Payer: BCBS Complete |
$200.93
|
| Rate for Payer: BCBS MAPPO |
$357.02
|
| Rate for Payer: BCN Medicare Advantage |
$357.02
|
| Rate for Payer: Cash Price |
$954.72
|
| Rate for Payer: Cash Price |
$954.72
|
| Rate for Payer: Cash Price |
$954.72
|
| Rate for Payer: Cofinity Commercial |
$1,026.32
|
| Rate for Payer: Cofinity Commercial |
$835.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$835.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$954.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$357.02
|
| Rate for Payer: Healthscope Commercial |
$1,074.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$835.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$895.05
|
| Rate for Payer: Mclaren Medicaid |
$191.36
|
| Rate for Payer: Mclaren Medicare |
$357.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$374.87
|
| Rate for Payer: Meridian Medicaid |
$200.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$410.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,014.39
|
| Rate for Payer: PACE Medicare |
$339.17
|
| Rate for Payer: PACE SWMI |
$357.02
|
| Rate for Payer: PHP Commercial |
$1,014.39
|
| Rate for Payer: PHP Medicare Advantage |
$357.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$191.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$775.71
|
| Rate for Payer: Priority Health Medicare |
$357.02
|
| Rate for Payer: Priority Health SBD |
$751.84
|
| Rate for Payer: Railroad Medicare Medicare |
$357.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,004.98
|
| Rate for Payer: UHC Core |
$979.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$357.02
|
| Rate for Payer: UHC Exchange |
$682.30
|
| Rate for Payer: UHC Medicare Advantage |
$357.02
|
| Rate for Payer: UHCCP Medicaid |
$191.36
|
| Rate for Payer: UMR Bronson Commercial |
$441.56
|
| Rate for Payer: VA VA |
$357.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$895.05
|
|
|
HC SIMULATION - S
|
Facility
|
OP
|
$728.28
|
|
|
Service Code
|
CPT 77280
|
| Hospital Charge Code |
33300002
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$69.41 |
| Max. Negotiated Rate |
$979.00 |
| Rate for Payer: Aetna American Axle |
$473.38
|
| Rate for Payer: Aetna Commercial |
$619.04
|
| Rate for Payer: Aetna Medicare |
$134.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$473.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$161.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$161.86
|
| Rate for Payer: BCBS Complete |
$72.88
|
| Rate for Payer: BCBS MAPPO |
$129.49
|
| Rate for Payer: BCN Medicare Advantage |
$129.49
|
| Rate for Payer: Cash Price |
$582.62
|
| Rate for Payer: Cash Price |
$582.62
|
| Rate for Payer: Cash Price |
$582.62
|
| Rate for Payer: Cofinity Commercial |
$509.80
|
| Rate for Payer: Cofinity Commercial |
$626.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$509.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$582.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$129.49
|
| Rate for Payer: Healthscope Commercial |
$655.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$509.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$546.21
|
| Rate for Payer: Mclaren Medicaid |
$69.41
|
| Rate for Payer: Mclaren Medicare |
$129.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$135.96
|
| Rate for Payer: Meridian Medicaid |
$72.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$148.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$619.04
|
| Rate for Payer: PACE Medicare |
$123.02
|
| Rate for Payer: PACE SWMI |
$129.49
|
| Rate for Payer: PHP Commercial |
$619.04
|
| Rate for Payer: PHP Medicare Advantage |
$129.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$473.38
|
| Rate for Payer: Priority Health Medicare |
$129.49
|
| Rate for Payer: Priority Health SBD |
$458.82
|
| Rate for Payer: Railroad Medicare Medicare |
$129.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$364.50
|
| Rate for Payer: UHC Core |
$979.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$129.49
|
| Rate for Payer: UHC Exchange |
$247.47
|
| Rate for Payer: UHC Medicare Advantage |
$129.49
|
| Rate for Payer: UHCCP Medicaid |
$69.41
|
| Rate for Payer: UMR Bronson Commercial |
$269.46
|
| Rate for Payer: VA VA |
$129.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$546.21
|
|
|
HC SIMULATION - S
|
Facility
|
IP
|
$728.28
|
|
|
Service Code
|
CPT 77280
|
| Hospital Charge Code |
33300002
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$320.44 |
| Max. Negotiated Rate |
$655.45 |
| Rate for Payer: Aetna American Axle |
$473.38
|
| Rate for Payer: Aetna Commercial |
$619.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$473.38
|
| Rate for Payer: Cash Price |
$582.62
|
| Rate for Payer: Cofinity Commercial |
$509.80
|
| Rate for Payer: Cofinity Commercial |
$626.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$509.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$582.62
|
| Rate for Payer: Healthscope Commercial |
$655.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$509.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$546.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$619.04
|
| Rate for Payer: PHP Commercial |
$619.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$473.38
|
| Rate for Payer: Priority Health SBD |
$458.82
|
| Rate for Payer: UMR Bronson Commercial |
$320.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$546.21
|
|
|
HC SINGLE LEAD INSERTION
|
Facility
|
OP
|
$4,340.87
|
|
|
Service Code
|
CPT 33216
|
| Hospital Charge Code |
36100065
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,606.12 |
| Max. Negotiated Rate |
$22,720.18 |
| Rate for Payer: Aetna American Axle |
$2,821.57
|
| Rate for Payer: Aetna Commercial |
$3,689.74
|
| Rate for Payer: Aetna Medicare |
$8,394.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,821.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,089.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,089.25
|
| Rate for Payer: BCBS Complete |
$4,542.58
|
| Rate for Payer: BCBS MAPPO |
$8,071.40
|
| Rate for Payer: BCN Medicare Advantage |
$8,071.40
|
| Rate for Payer: Cash Price |
$3,472.70
|
| Rate for Payer: Cash Price |
$3,472.70
|
| Rate for Payer: Cofinity Commercial |
$3,733.15
|
| Rate for Payer: Cofinity Commercial |
$3,038.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,038.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,472.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,071.40
|
| Rate for Payer: Healthscope Commercial |
$3,906.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,038.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,255.65
|
| Rate for Payer: Mclaren Medicaid |
$4,326.27
|
| Rate for Payer: Mclaren Medicare |
$8,071.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,474.97
|
| Rate for Payer: Meridian Medicaid |
$4,542.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,282.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,689.74
|
| Rate for Payer: PACE Medicare |
$7,667.83
|
| Rate for Payer: PACE SWMI |
$8,071.40
|
| Rate for Payer: PHP Commercial |
$3,689.74
|
| Rate for Payer: PHP Medicare Advantage |
$8,071.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,326.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,821.57
|
| Rate for Payer: Priority Health Medicare |
$8,071.40
|
| Rate for Payer: Priority Health SBD |
$2,734.75
|
| Rate for Payer: Railroad Medicare Medicare |
$8,071.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22,720.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$8,071.40
|
| Rate for Payer: UHC Exchange |
$15,425.25
|
| Rate for Payer: UHC Medicare Advantage |
$8,071.40
|
| Rate for Payer: UHCCP Medicaid |
$4,326.27
|
| Rate for Payer: UMR Bronson Commercial |
$1,606.12
|
| Rate for Payer: VA VA |
$8,071.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,255.65
|
|
|
HC SINGLE LEAD INSERTION
|
Facility
|
IP
|
$4,340.87
|
|
|
Service Code
|
CPT 33216
|
| Hospital Charge Code |
36100065
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,909.98 |
| Max. Negotiated Rate |
$3,906.78 |
| Rate for Payer: Aetna American Axle |
$2,821.57
|
| Rate for Payer: Aetna Commercial |
$3,689.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,821.57
|
| Rate for Payer: Cash Price |
$3,472.70
|
| Rate for Payer: Cofinity Commercial |
$3,038.61
|
| Rate for Payer: Cofinity Commercial |
$3,733.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,038.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,472.70
|
| Rate for Payer: Healthscope Commercial |
$3,906.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,038.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,255.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,689.74
|
| Rate for Payer: PHP Commercial |
$3,689.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,821.57
|
| Rate for Payer: Priority Health SBD |
$2,734.75
|
| Rate for Payer: UMR Bronson Commercial |
$1,909.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,255.65
|
|
|
HC SINOGRAM INJECTION
|
Facility
|
IP
|
$452.01
|
|
|
Service Code
|
CPT 20501
|
| Hospital Charge Code |
36100021
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$198.88 |
| Max. Negotiated Rate |
$406.81 |
| Rate for Payer: Aetna American Axle |
$293.81
|
| Rate for Payer: Aetna Commercial |
$384.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$293.81
|
| Rate for Payer: Cash Price |
$361.61
|
| Rate for Payer: Cofinity Commercial |
$316.41
|
| Rate for Payer: Cofinity Commercial |
$388.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$316.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$361.61
|
| Rate for Payer: Healthscope Commercial |
$406.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$316.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$339.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$384.21
|
| Rate for Payer: PHP Commercial |
$384.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$293.81
|
| Rate for Payer: Priority Health SBD |
$284.77
|
| Rate for Payer: UMR Bronson Commercial |
$198.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$339.01
|
|
|
HC SINOGRAM INJECTION
|
Facility
|
OP
|
$452.01
|
|
|
Service Code
|
CPT 20501
|
| Hospital Charge Code |
36100021
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$167.24 |
| Max. Negotiated Rate |
$406.81 |
| Rate for Payer: Aetna American Axle |
$293.81
|
| Rate for Payer: Aetna Commercial |
$384.21
|
| Rate for Payer: Aetna Medicare |
$226.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$293.81
|
| Rate for Payer: BCBS Complete |
$180.80
|
| Rate for Payer: Cash Price |
$361.61
|
| Rate for Payer: Cofinity Commercial |
$316.41
|
| Rate for Payer: Cofinity Commercial |
$388.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$316.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$361.61
|
| Rate for Payer: Healthscope Commercial |
$406.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$316.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$339.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$384.21
|
| Rate for Payer: PHP Commercial |
$384.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$293.81
|
| Rate for Payer: Priority Health SBD |
$284.77
|
| Rate for Payer: UMR Bronson Commercial |
$167.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$339.01
|
|
|
HC SIROLIMUS
|
Facility
|
OP
|
$75.95
|
|
|
Service Code
|
CPT 80195
|
| Hospital Charge Code |
30100045
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.36 |
| Max. Negotiated Rate |
$68.36 |
| Rate for Payer: Aetna American Axle |
$49.37
|
| Rate for Payer: Aetna Commercial |
$64.56
|
| Rate for Payer: Aetna Medicare |
$14.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.16
|
| Rate for Payer: BCBS Complete |
$7.73
|
| Rate for Payer: BCBS MAPPO |
$13.73
|
| Rate for Payer: BCN Medicare Advantage |
$13.73
|
| Rate for Payer: Cash Price |
$60.76
|
| Rate for Payer: Cash Price |
$60.76
|
| Rate for Payer: Cofinity Commercial |
$65.32
|
| Rate for Payer: Cofinity Commercial |
$53.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$53.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.73
|
| Rate for Payer: Healthscope Commercial |
$68.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$53.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.96
|
| Rate for Payer: Mclaren Medicaid |
$7.36
|
| Rate for Payer: Mclaren Medicare |
$13.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.42
|
| Rate for Payer: Meridian Medicaid |
$7.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.56
|
| Rate for Payer: PACE Medicare |
$13.04
|
| Rate for Payer: PACE SWMI |
$13.73
|
| Rate for Payer: PHP Commercial |
$64.56
|
| Rate for Payer: PHP Medicare Advantage |
$13.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.37
|
| Rate for Payer: Priority Health Medicare |
$13.73
|
| Rate for Payer: Priority Health SBD |
$47.85
|
| Rate for Payer: Railroad Medicare Medicare |
$13.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.73
|
| Rate for Payer: UHC Exchange |
$26.24
|
| Rate for Payer: UHC Medicare Advantage |
$13.73
|
| Rate for Payer: UHCCP Medicaid |
$7.36
|
| Rate for Payer: UMR Bronson Commercial |
$28.10
|
| Rate for Payer: VA VA |
$13.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.96
|
|
|
HC SIROLIMUS
|
Facility
|
IP
|
$75.95
|
|
|
Service Code
|
CPT 80195
|
| Hospital Charge Code |
30100045
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.42 |
| Max. Negotiated Rate |
$68.36 |
| Rate for Payer: Aetna American Axle |
$49.37
|
| Rate for Payer: Aetna Commercial |
$64.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.37
|
| Rate for Payer: Cash Price |
$60.76
|
| Rate for Payer: Cofinity Commercial |
$53.16
|
| Rate for Payer: Cofinity Commercial |
$65.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$53.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.76
|
| Rate for Payer: Healthscope Commercial |
$68.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$53.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.56
|
| Rate for Payer: PHP Commercial |
$64.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.37
|
| Rate for Payer: Priority Health SBD |
$47.85
|
| Rate for Payer: UMR Bronson Commercial |
$33.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.96
|
|
|
HC SITZ MARKER
|
Facility
|
IP
|
$85.68
|
|
|
Service Code
|
CPT A9698
|
| Hospital Charge Code |
25500004
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$37.70 |
| Max. Negotiated Rate |
$77.11 |
| Rate for Payer: Aetna American Axle |
$55.69
|
| Rate for Payer: Aetna Commercial |
$72.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.69
|
| Rate for Payer: Cash Price |
$68.54
|
| Rate for Payer: Cofinity Commercial |
$59.98
|
| Rate for Payer: Cofinity Commercial |
$73.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$59.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.54
|
| Rate for Payer: Healthscope Commercial |
$77.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$59.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.83
|
| Rate for Payer: PHP Commercial |
$72.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.69
|
| Rate for Payer: Priority Health SBD |
$53.98
|
| Rate for Payer: UMR Bronson Commercial |
$37.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.26
|
|
|
HC SITZ MARKER
|
Facility
|
OP
|
$85.68
|
|
|
Service Code
|
CPT A9698
|
| Hospital Charge Code |
25500004
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$31.70 |
| Max. Negotiated Rate |
$77.11 |
| Rate for Payer: Aetna American Axle |
$55.69
|
| Rate for Payer: Aetna Commercial |
$72.83
|
| Rate for Payer: Aetna Medicare |
$42.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.69
|
| Rate for Payer: BCBS Complete |
$34.27
|
| Rate for Payer: Cash Price |
$68.54
|
| Rate for Payer: Cofinity Commercial |
$59.98
|
| Rate for Payer: Cofinity Commercial |
$73.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$59.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.54
|
| Rate for Payer: Healthscope Commercial |
$77.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$59.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.83
|
| Rate for Payer: PHP Commercial |
$72.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.69
|
| Rate for Payer: Priority Health SBD |
$53.98
|
| Rate for Payer: UMR Bronson Commercial |
$31.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.26
|
|
|
HC SKIN FULL GRFT FACE/GENIT/HF 20 SQ CM OR <
|
Facility
|
IP
|
$5,495.01
|
|
|
Service Code
|
CPT 15240
|
| Hospital Charge Code |
76100445
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,417.80 |
| Max. Negotiated Rate |
$4,945.51 |
| Rate for Payer: Aetna American Axle |
$3,571.76
|
| Rate for Payer: Aetna Commercial |
$4,670.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,571.76
|
| Rate for Payer: Cash Price |
$4,396.01
|
| Rate for Payer: Cofinity Commercial |
$3,846.51
|
| Rate for Payer: Cofinity Commercial |
$4,725.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,846.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,396.01
|
| Rate for Payer: Healthscope Commercial |
$4,945.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,846.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,121.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,670.76
|
| Rate for Payer: PHP Commercial |
$4,670.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,571.76
|
| Rate for Payer: Priority Health SBD |
$3,461.86
|
| Rate for Payer: UMR Bronson Commercial |
$2,417.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,121.26
|
|
|
HC SKIN FULL GRFT FACE/GENIT/HF 20 SQ CM OR <
|
Facility
|
OP
|
$5,495.01
|
|
|
Service Code
|
CPT 15240
|
| Hospital Charge Code |
76100445
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$956.23 |
| Max. Negotiated Rate |
$5,021.81 |
| Rate for Payer: Aetna American Axle |
$3,571.76
|
| Rate for Payer: Aetna Commercial |
$4,670.76
|
| Rate for Payer: Aetna Medicare |
$1,855.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,571.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,230.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,230.01
|
| Rate for Payer: BCBS Complete |
$1,004.04
|
| Rate for Payer: BCBS MAPPO |
$1,784.01
|
| Rate for Payer: BCN Medicare Advantage |
$1,784.01
|
| Rate for Payer: Cash Price |
$4,396.01
|
| Rate for Payer: Cash Price |
$4,396.01
|
| Rate for Payer: Cofinity Commercial |
$4,725.71
|
| Rate for Payer: Cofinity Commercial |
$3,846.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,846.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,396.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,784.01
|
| Rate for Payer: Healthscope Commercial |
$4,945.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,846.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,121.26
|
| Rate for Payer: Mclaren Medicaid |
$956.23
|
| Rate for Payer: Mclaren Medicare |
$1,784.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,873.21
|
| Rate for Payer: Meridian Medicaid |
$1,004.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,051.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,670.76
|
| Rate for Payer: PACE Medicare |
$1,694.81
|
| Rate for Payer: PACE SWMI |
$1,784.01
|
| Rate for Payer: PHP Commercial |
$4,670.76
|
| Rate for Payer: PHP Medicare Advantage |
$1,784.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$956.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,571.76
|
| Rate for Payer: Priority Health Medicare |
$1,784.01
|
| Rate for Payer: Priority Health SBD |
$3,461.86
|
| Rate for Payer: Railroad Medicare Medicare |
$1,784.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,021.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,784.01
|
| Rate for Payer: UHC Exchange |
$3,409.42
|
| Rate for Payer: UHC Medicare Advantage |
$1,784.01
|
| Rate for Payer: UHCCP Medicaid |
$956.23
|
| Rate for Payer: UMR Bronson Commercial |
$2,033.15
|
| Rate for Payer: VA VA |
$1,784.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,121.26
|
|
|
HC SKIN TAG REMOVAL UP TO 15
|
Facility
|
IP
|
$272.69
|
|
|
Service Code
|
CPT 11200
|
| Hospital Charge Code |
45000078
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$119.98 |
| Max. Negotiated Rate |
$245.42 |
| Rate for Payer: Aetna American Axle |
$177.25
|
| Rate for Payer: Aetna Commercial |
$231.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.25
|
| Rate for Payer: Cash Price |
$218.15
|
| Rate for Payer: Cofinity Commercial |
$190.88
|
| Rate for Payer: Cofinity Commercial |
$234.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$190.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.15
|
| Rate for Payer: Healthscope Commercial |
$245.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$190.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$204.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.79
|
| Rate for Payer: PHP Commercial |
$231.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.25
|
| Rate for Payer: Priority Health SBD |
$171.79
|
| Rate for Payer: UMR Bronson Commercial |
$119.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$204.52
|
|
