|
HC SP Z ANGIO SUPERSELECT RENAL UNI
|
Facility
|
IP
|
$3,849.48
|
|
|
Service Code
|
CPT 36253
|
| Hospital Charge Code |
36100349
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,693.77 |
| Max. Negotiated Rate |
$3,464.53 |
| Rate for Payer: Aetna American Axle |
$2,502.16
|
| Rate for Payer: Aetna Commercial |
$3,272.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,502.16
|
| Rate for Payer: Cash Price |
$3,079.58
|
| Rate for Payer: Cofinity Commercial |
$2,694.64
|
| Rate for Payer: Cofinity Commercial |
$3,310.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,694.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,079.58
|
| Rate for Payer: Healthscope Commercial |
$3,464.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,694.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,887.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,272.06
|
| Rate for Payer: PHP Commercial |
$3,272.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,502.16
|
| Rate for Payer: Priority Health SBD |
$2,425.17
|
| Rate for Payer: UMR Bronson Commercial |
$1,693.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,887.11
|
|
|
HC SP Z EMBOLIZATION COIL BODY
|
Facility
|
OP
|
$414.53
|
|
| Hospital Charge Code |
27800058
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$153.38 |
| Max. Negotiated Rate |
$373.08 |
| Rate for Payer: Aetna American Axle |
$269.44
|
| Rate for Payer: Aetna Commercial |
$352.35
|
| Rate for Payer: Aetna Medicare |
$207.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$269.44
|
| Rate for Payer: BCBS Complete |
$165.81
|
| Rate for Payer: Cash Price |
$331.62
|
| Rate for Payer: Cofinity Commercial |
$290.17
|
| Rate for Payer: Cofinity Commercial |
$356.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$290.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$331.62
|
| Rate for Payer: Healthscope Commercial |
$373.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$290.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$310.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$352.35
|
| Rate for Payer: PHP Commercial |
$352.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$269.44
|
| Rate for Payer: Priority Health SBD |
$261.15
|
| Rate for Payer: UMR Bronson Commercial |
$153.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$310.90
|
|
|
HC SP Z EMBOLIZATION COIL BODY
|
Facility
|
IP
|
$414.53
|
|
| Hospital Charge Code |
27800058
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$182.39 |
| Max. Negotiated Rate |
$373.08 |
| Rate for Payer: Aetna American Axle |
$269.44
|
| Rate for Payer: Aetna Commercial |
$352.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$269.44
|
| Rate for Payer: Cash Price |
$331.62
|
| Rate for Payer: Cofinity Commercial |
$290.17
|
| Rate for Payer: Cofinity Commercial |
$356.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$290.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$331.62
|
| Rate for Payer: Healthscope Commercial |
$373.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$290.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$310.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$352.35
|
| Rate for Payer: PHP Commercial |
$352.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$269.44
|
| Rate for Payer: Priority Health SBD |
$261.15
|
| Rate for Payer: UMR Bronson Commercial |
$182.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$310.90
|
|
|
HC SP Z EMBOLIZATION SPHERES
|
Facility
|
OP
|
$1,024.11
|
|
| Hospital Charge Code |
27800057
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$378.92 |
| Max. Negotiated Rate |
$921.70 |
| Rate for Payer: Aetna American Axle |
$665.67
|
| Rate for Payer: Aetna Commercial |
$870.49
|
| Rate for Payer: Aetna Medicare |
$512.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$665.67
|
| Rate for Payer: BCBS Complete |
$409.64
|
| Rate for Payer: Cash Price |
$819.29
|
| Rate for Payer: Cofinity Commercial |
$716.88
|
| Rate for Payer: Cofinity Commercial |
$880.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$716.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$819.29
|
| Rate for Payer: Healthscope Commercial |
$921.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$716.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$768.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$870.49
|
| Rate for Payer: PHP Commercial |
$870.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$665.67
|
| Rate for Payer: Priority Health SBD |
$645.19
|
| Rate for Payer: UMR Bronson Commercial |
$378.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$768.08
|
|
|
HC SP Z EMBOLIZATION SPHERES
|
Facility
|
IP
|
$1,024.11
|
|
| Hospital Charge Code |
27800057
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$450.61 |
| Max. Negotiated Rate |
$921.70 |
| Rate for Payer: Aetna American Axle |
$665.67
|
| Rate for Payer: Aetna Commercial |
$870.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$665.67
|
| Rate for Payer: Cash Price |
$819.29
|
| Rate for Payer: Cofinity Commercial |
$716.88
|
| Rate for Payer: Cofinity Commercial |
$880.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$716.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$819.29
|
| Rate for Payer: Healthscope Commercial |
$921.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$716.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$768.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$870.49
|
| Rate for Payer: PHP Commercial |
$870.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$665.67
|
| Rate for Payer: Priority Health SBD |
$645.19
|
| Rate for Payer: UMR Bronson Commercial |
$450.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$768.08
|
|
|
HC SP Z SEL CATH SEG SUBSEG PULM ART
|
Facility
|
IP
|
$1,277.63
|
|
|
Service Code
|
CPT 36015
|
| Hospital Charge Code |
36100318
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$562.16 |
| Max. Negotiated Rate |
$1,149.87 |
| Rate for Payer: Aetna American Axle |
$830.46
|
| Rate for Payer: Aetna Commercial |
$1,085.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$830.46
|
| Rate for Payer: Cash Price |
$1,022.10
|
| Rate for Payer: Cofinity Commercial |
$1,098.76
|
| Rate for Payer: Cofinity Commercial |
$894.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$894.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,022.10
|
| Rate for Payer: Healthscope Commercial |
$1,149.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$894.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$958.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,085.99
|
| Rate for Payer: PHP Commercial |
$1,085.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$830.46
|
| Rate for Payer: Priority Health SBD |
$804.91
|
| Rate for Payer: UMR Bronson Commercial |
$562.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$958.22
|
|
|
HC SP Z SEL CATH SEG SUBSEG PULM ART
|
Facility
|
OP
|
$1,277.63
|
|
|
Service Code
|
CPT 36015
|
| Hospital Charge Code |
36100318
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$162.86 |
| Max. Negotiated Rate |
$3,085.40 |
| Rate for Payer: Aetna American Axle |
$830.46
|
| Rate for Payer: Aetna Commercial |
$1,085.99
|
| Rate for Payer: Aetna Medicare |
$638.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$830.46
|
| Rate for Payer: BCBS Complete |
$511.05
|
| Rate for Payer: BCBS Trust/PPO |
$3,085.40
|
| Rate for Payer: BCN Commercial |
$3,085.40
|
| Rate for Payer: Cash Price |
$1,022.10
|
| Rate for Payer: Cash Price |
$1,022.10
|
| Rate for Payer: Cash Price |
$1,022.10
|
| Rate for Payer: Cofinity Commercial |
$894.34
|
| Rate for Payer: Cofinity Commercial |
$1,098.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$894.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,022.10
|
| Rate for Payer: Healthscope Commercial |
$1,149.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$894.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$958.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,085.99
|
| Rate for Payer: PHP Commercial |
$1,085.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$830.46
|
| Rate for Payer: Priority Health SBD |
$804.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$179.15
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$162.86
|
| Rate for Payer: UMR Bronson Commercial |
$472.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$958.22
|
|
|
HC SP Z TRUE FILL
|
Facility
|
OP
|
$6,757.01
|
|
| Hospital Charge Code |
27800059
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,500.09 |
| Max. Negotiated Rate |
$6,081.31 |
| Rate for Payer: Aetna American Axle |
$4,392.06
|
| Rate for Payer: Aetna Commercial |
$5,743.46
|
| Rate for Payer: Aetna Medicare |
$3,378.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,392.06
|
| Rate for Payer: BCBS Complete |
$2,702.80
|
| Rate for Payer: Cash Price |
$5,405.61
|
| Rate for Payer: Cofinity Commercial |
$4,729.91
|
| Rate for Payer: Cofinity Commercial |
$5,811.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,729.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,405.61
|
| Rate for Payer: Healthscope Commercial |
$6,081.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,729.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,067.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,743.46
|
| Rate for Payer: PHP Commercial |
$5,743.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,392.06
|
| Rate for Payer: Priority Health SBD |
$4,256.92
|
| Rate for Payer: UMR Bronson Commercial |
$2,500.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,067.76
|
|
|
HC SP Z TRUE FILL
|
Facility
|
IP
|
$6,757.01
|
|
| Hospital Charge Code |
27800059
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,973.08 |
| Max. Negotiated Rate |
$6,081.31 |
| Rate for Payer: Aetna American Axle |
$4,392.06
|
| Rate for Payer: Aetna Commercial |
$5,743.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,392.06
|
| Rate for Payer: Cash Price |
$5,405.61
|
| Rate for Payer: Cofinity Commercial |
$4,729.91
|
| Rate for Payer: Cofinity Commercial |
$5,811.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,729.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,405.61
|
| Rate for Payer: Healthscope Commercial |
$6,081.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,729.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,067.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,743.46
|
| Rate for Payer: PHP Commercial |
$5,743.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,392.06
|
| Rate for Payer: Priority Health SBD |
$4,256.92
|
| Rate for Payer: UMR Bronson Commercial |
$2,973.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,067.76
|
|
|
HC SQ ICD
|
Facility
|
OP
|
$56,418.24
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27800122
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20,874.75 |
| Max. Negotiated Rate |
$50,776.42 |
| Rate for Payer: Aetna American Axle |
$36,671.86
|
| Rate for Payer: Aetna Commercial |
$47,955.50
|
| Rate for Payer: Aetna Medicare |
$28,209.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36,671.86
|
| Rate for Payer: BCBS Complete |
$22,567.30
|
| Rate for Payer: Cash Price |
$45,134.59
|
| Rate for Payer: Cofinity Commercial |
$39,492.77
|
| Rate for Payer: Cofinity Commercial |
$48,519.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$39,492.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45,134.59
|
| Rate for Payer: Healthscope Commercial |
$50,776.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39,492.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42,313.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47,955.50
|
| Rate for Payer: PHP Commercial |
$47,955.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36,671.86
|
| Rate for Payer: Priority Health SBD |
$35,543.49
|
| Rate for Payer: UMR Bronson Commercial |
$20,874.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42,313.68
|
|
|
HC SQ ICD
|
Facility
|
IP
|
$56,418.24
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27800122
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24,824.03 |
| Max. Negotiated Rate |
$50,776.42 |
| Rate for Payer: Aetna American Axle |
$36,671.86
|
| Rate for Payer: Aetna Commercial |
$47,955.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36,671.86
|
| Rate for Payer: Cash Price |
$45,134.59
|
| Rate for Payer: Cofinity Commercial |
$39,492.77
|
| Rate for Payer: Cofinity Commercial |
$48,519.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$39,492.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45,134.59
|
| Rate for Payer: Healthscope Commercial |
$50,776.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39,492.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42,313.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47,955.50
|
| Rate for Payer: PHP Commercial |
$47,955.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36,671.86
|
| Rate for Payer: Priority Health SBD |
$35,543.49
|
| Rate for Payer: UMR Bronson Commercial |
$24,824.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42,313.68
|
|
|
HC SQ ICD LEAD
|
Facility
|
IP
|
$14,662.50
|
|
|
Service Code
|
HCPCS C1896
|
| Hospital Charge Code |
27800123
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,451.50 |
| Max. Negotiated Rate |
$13,196.25 |
| Rate for Payer: Aetna American Axle |
$9,530.62
|
| Rate for Payer: Aetna Commercial |
$12,463.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,530.62
|
| Rate for Payer: Cash Price |
$11,730.00
|
| Rate for Payer: Cofinity Commercial |
$10,263.75
|
| Rate for Payer: Cofinity Commercial |
$12,609.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$10,263.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,730.00
|
| Rate for Payer: Healthscope Commercial |
$13,196.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10,263.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10,996.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,463.12
|
| Rate for Payer: PHP Commercial |
$12,463.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,530.62
|
| Rate for Payer: Priority Health SBD |
$9,237.38
|
| Rate for Payer: UMR Bronson Commercial |
$6,451.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10,996.88
|
|
|
HC SQ ICD LEAD
|
Facility
|
OP
|
$14,662.50
|
|
|
Service Code
|
HCPCS C1896
|
| Hospital Charge Code |
27800123
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,425.12 |
| Max. Negotiated Rate |
$13,196.25 |
| Rate for Payer: Aetna American Axle |
$9,530.62
|
| Rate for Payer: Aetna Commercial |
$12,463.12
|
| Rate for Payer: Aetna Medicare |
$7,331.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,530.62
|
| Rate for Payer: BCBS Complete |
$5,865.00
|
| Rate for Payer: Cash Price |
$11,730.00
|
| Rate for Payer: Cofinity Commercial |
$10,263.75
|
| Rate for Payer: Cofinity Commercial |
$12,609.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$10,263.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,730.00
|
| Rate for Payer: Healthscope Commercial |
$13,196.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10,263.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10,996.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,463.12
|
| Rate for Payer: PHP Commercial |
$12,463.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,530.62
|
| Rate for Payer: Priority Health SBD |
$9,237.38
|
| Rate for Payer: UMR Bronson Commercial |
$5,425.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10,996.88
|
|
|
HC SQ IM CHEMO HORMONAL
|
Facility
|
IP
|
$246.51
|
|
|
Service Code
|
CPT 96402
|
| Hospital Charge Code |
33100002
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$108.46 |
| Max. Negotiated Rate |
$221.86 |
| Rate for Payer: Aetna American Axle |
$160.23
|
| Rate for Payer: Aetna Commercial |
$209.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.23
|
| Rate for Payer: Cash Price |
$197.21
|
| Rate for Payer: Cofinity Commercial |
$172.56
|
| Rate for Payer: Cofinity Commercial |
$212.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$172.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.21
|
| Rate for Payer: Healthscope Commercial |
$221.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$172.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$184.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$209.53
|
| Rate for Payer: PHP Commercial |
$209.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.23
|
| Rate for Payer: Priority Health SBD |
$155.30
|
| Rate for Payer: UMR Bronson Commercial |
$108.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$184.88
|
|
|
HC SQ IM CHEMO HORMONAL
|
Facility
|
OP
|
$246.51
|
|
|
Service Code
|
CPT 96402
|
| Hospital Charge Code |
33100002
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$32.35 |
| Max. Negotiated Rate |
$284.00 |
| Rate for Payer: Aetna American Axle |
$160.23
|
| Rate for Payer: Aetna Commercial |
$209.53
|
| Rate for Payer: Aetna Medicare |
$72.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$87.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$87.16
|
| Rate for Payer: BCBS Complete |
$39.24
|
| Rate for Payer: BCBS MAPPO |
$69.73
|
| Rate for Payer: BCBS Trust/PPO |
$185.35
|
| Rate for Payer: BCN Commercial |
$185.35
|
| Rate for Payer: BCN Medicare Advantage |
$69.73
|
| Rate for Payer: Cash Price |
$197.21
|
| Rate for Payer: Cash Price |
$197.21
|
| Rate for Payer: Cofinity Commercial |
$212.00
|
| Rate for Payer: Cofinity Commercial |
$172.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$172.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$69.73
|
| Rate for Payer: Healthscope Commercial |
$221.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$172.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$184.88
|
| Rate for Payer: Mclaren Medicaid |
$37.38
|
| Rate for Payer: Mclaren Medicare |
$69.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$73.22
|
| Rate for Payer: Meridian Medicaid |
$39.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$209.53
|
| Rate for Payer: Nomi Health Commercial |
$209.19
|
| Rate for Payer: PACE Medicare |
$66.24
|
| Rate for Payer: PACE SWMI |
$69.73
|
| Rate for Payer: PHP Commercial |
$209.53
|
| Rate for Payer: PHP Medicare Advantage |
$69.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$219.18
|
| Rate for Payer: Priority Health Medicare |
$69.73
|
| Rate for Payer: Priority Health Narrow Network |
$175.34
|
| Rate for Payer: Priority Health SBD |
$155.30
|
| Rate for Payer: Railroad Medicare Medicare |
$69.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.58
|
| Rate for Payer: UHC Core |
$284.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$69.73
|
| Rate for Payer: UHC Exchange |
$32.35
|
| Rate for Payer: UHC Medicare Advantage |
$69.73
|
| Rate for Payer: UHCCP Medicaid |
$37.38
|
| Rate for Payer: UMR Bronson Commercial |
$91.21
|
| Rate for Payer: VA VA |
$69.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$184.88
|
|
|
HC SQ IM CHEMO NON-HORMONAL
|
Facility
|
OP
|
$498.94
|
|
|
Service Code
|
CPT 96401
|
| Hospital Charge Code |
33100001
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$37.38 |
| Max. Negotiated Rate |
$449.05 |
| Rate for Payer: Aetna American Axle |
$324.31
|
| Rate for Payer: Aetna Commercial |
$424.10
|
| Rate for Payer: Aetna Medicare |
$72.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$324.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$87.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$87.16
|
| Rate for Payer: BCBS Complete |
$39.24
|
| Rate for Payer: BCBS MAPPO |
$69.73
|
| Rate for Payer: BCBS Trust/PPO |
$375.91
|
| Rate for Payer: BCN Commercial |
$375.91
|
| Rate for Payer: BCN Medicare Advantage |
$69.73
|
| Rate for Payer: Cash Price |
$399.15
|
| Rate for Payer: Cash Price |
$399.15
|
| Rate for Payer: Cofinity Commercial |
$429.09
|
| Rate for Payer: Cofinity Commercial |
$349.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$349.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$399.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$69.73
|
| Rate for Payer: Healthscope Commercial |
$449.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$349.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$374.20
|
| Rate for Payer: Mclaren Medicaid |
$37.38
|
| Rate for Payer: Mclaren Medicare |
$69.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$73.22
|
| Rate for Payer: Meridian Medicaid |
$39.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$424.10
|
| Rate for Payer: Nomi Health Commercial |
$209.19
|
| Rate for Payer: PACE Medicare |
$66.24
|
| Rate for Payer: PACE SWMI |
$69.73
|
| Rate for Payer: PHP Commercial |
$424.10
|
| Rate for Payer: PHP Medicare Advantage |
$69.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$324.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$219.18
|
| Rate for Payer: Priority Health Medicare |
$69.73
|
| Rate for Payer: Priority Health Narrow Network |
$175.34
|
| Rate for Payer: Priority Health SBD |
$314.33
|
| Rate for Payer: Railroad Medicare Medicare |
$69.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.60
|
| Rate for Payer: UHC Core |
$284.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$69.73
|
| Rate for Payer: UHC Exchange |
$65.09
|
| Rate for Payer: UHC Medicare Advantage |
$69.73
|
| Rate for Payer: UHCCP Medicaid |
$37.38
|
| Rate for Payer: UMR Bronson Commercial |
$184.61
|
| Rate for Payer: VA VA |
$69.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$374.20
|
|
|
HC SQ IM CHEMO NON-HORMONAL
|
Facility
|
IP
|
$498.94
|
|
|
Service Code
|
CPT 96401
|
| Hospital Charge Code |
33100001
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$219.53 |
| Max. Negotiated Rate |
$449.05 |
| Rate for Payer: Aetna American Axle |
$324.31
|
| Rate for Payer: Aetna Commercial |
$424.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$324.31
|
| Rate for Payer: Cash Price |
$399.15
|
| Rate for Payer: Cofinity Commercial |
$349.26
|
| Rate for Payer: Cofinity Commercial |
$429.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$349.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$399.15
|
| Rate for Payer: Healthscope Commercial |
$449.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$349.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$374.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$424.10
|
| Rate for Payer: PHP Commercial |
$424.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$324.31
|
| Rate for Payer: Priority Health SBD |
$314.33
|
| Rate for Payer: UMR Bronson Commercial |
$219.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$374.20
|
|
|
HC SQ OR IM INJECTION
|
Facility
|
IP
|
$149.79
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
51000003
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$65.91 |
| Max. Negotiated Rate |
$134.81 |
| Rate for Payer: Aetna American Axle |
$97.36
|
| Rate for Payer: Aetna Commercial |
$127.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.36
|
| Rate for Payer: Cash Price |
$119.83
|
| Rate for Payer: Cofinity Commercial |
$104.85
|
| Rate for Payer: Cofinity Commercial |
$128.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$104.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.83
|
| Rate for Payer: Healthscope Commercial |
$134.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$104.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.32
|
| Rate for Payer: PHP Commercial |
$127.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.36
|
| Rate for Payer: Priority Health SBD |
$94.37
|
| Rate for Payer: UMR Bronson Commercial |
$65.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.34
|
|
|
HC SQ OR IM INJECTION
|
Facility
|
OP
|
$149.79
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
51000003
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$13.41 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: Aetna American Axle |
$97.36
|
| Rate for Payer: Aetna Commercial |
$127.32
|
| Rate for Payer: Aetna Medicare |
$72.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$87.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$87.16
|
| Rate for Payer: BCBS Complete |
$39.24
|
| Rate for Payer: BCBS MAPPO |
$69.73
|
| Rate for Payer: BCBS Trust/PPO |
$50.39
|
| Rate for Payer: BCN Commercial |
$50.39
|
| Rate for Payer: BCN Medicare Advantage |
$69.73
|
| Rate for Payer: Cash Price |
$119.83
|
| Rate for Payer: Cash Price |
$119.83
|
| Rate for Payer: Cofinity Commercial |
$128.82
|
| Rate for Payer: Cofinity Commercial |
$104.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$104.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$69.73
|
| Rate for Payer: Healthscope Commercial |
$134.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$104.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.34
|
| Rate for Payer: Mclaren Medicaid |
$37.38
|
| Rate for Payer: Mclaren Medicare |
$69.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$73.22
|
| Rate for Payer: Meridian Medicaid |
$39.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.32
|
| Rate for Payer: Nomi Health Commercial |
$209.19
|
| Rate for Payer: PACE Medicare |
$66.24
|
| Rate for Payer: PACE SWMI |
$69.73
|
| Rate for Payer: PHP Commercial |
$127.32
|
| Rate for Payer: PHP Medicare Advantage |
$69.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$219.18
|
| Rate for Payer: Priority Health Medicare |
$69.73
|
| Rate for Payer: Priority Health Narrow Network |
$175.34
|
| Rate for Payer: Priority Health SBD |
$94.37
|
| Rate for Payer: Railroad Medicare Medicare |
$69.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.75
|
| Rate for Payer: UHC Core |
$250.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$69.73
|
| Rate for Payer: UHC Exchange |
$13.41
|
| Rate for Payer: UHC Medicare Advantage |
$69.73
|
| Rate for Payer: UHCCP Medicaid |
$37.38
|
| Rate for Payer: UMR Bronson Commercial |
$55.42
|
| Rate for Payer: VA VA |
$69.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.34
|
|
|
HC SRA, LMWH
|
Facility
|
IP
|
$332.93
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
30200424
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$146.49 |
| Max. Negotiated Rate |
$299.64 |
| Rate for Payer: Aetna American Axle |
$216.40
|
| Rate for Payer: Aetna Commercial |
$282.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.40
|
| Rate for Payer: Cash Price |
$266.34
|
| Rate for Payer: Cofinity Commercial |
$233.05
|
| Rate for Payer: Cofinity Commercial |
$286.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$233.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.34
|
| Rate for Payer: Healthscope Commercial |
$299.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$233.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$249.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$282.99
|
| Rate for Payer: PHP Commercial |
$282.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.40
|
| Rate for Payer: Priority Health SBD |
$209.75
|
| Rate for Payer: UMR Bronson Commercial |
$146.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$249.70
|
|
|
HC SRA, LMWH
|
Facility
|
OP
|
$332.93
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
30200424
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.85 |
| Max. Negotiated Rate |
$299.64 |
| Rate for Payer: Aetna American Axle |
$216.40
|
| Rate for Payer: Aetna Commercial |
$282.99
|
| Rate for Payer: Aetna Medicare |
$19.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.96
|
| Rate for Payer: BCBS Complete |
$10.34
|
| Rate for Payer: BCBS MAPPO |
$18.37
|
| Rate for Payer: BCBS Trust/PPO |
$17.70
|
| Rate for Payer: BCN Commercial |
$17.70
|
| Rate for Payer: BCN Medicare Advantage |
$18.37
|
| Rate for Payer: Cash Price |
$266.34
|
| Rate for Payer: Cash Price |
$266.34
|
| Rate for Payer: Cofinity Commercial |
$286.32
|
| Rate for Payer: Cofinity Commercial |
$233.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$233.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.37
|
| Rate for Payer: Healthscope Commercial |
$299.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$233.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$249.70
|
| Rate for Payer: Mclaren Medicaid |
$9.85
|
| Rate for Payer: Mclaren Medicare |
$18.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.29
|
| Rate for Payer: Meridian Medicaid |
$10.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$282.99
|
| Rate for Payer: Nomi Health Commercial |
$27.56
|
| Rate for Payer: PACE Medicare |
$17.45
|
| Rate for Payer: PACE SWMI |
$18.37
|
| Rate for Payer: PHP Commercial |
$282.99
|
| Rate for Payer: PHP Medicare Advantage |
$18.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.37
|
| Rate for Payer: Priority Health Medicare |
$18.37
|
| Rate for Payer: Priority Health Narrow Network |
$14.70
|
| Rate for Payer: Priority Health SBD |
$209.75
|
| Rate for Payer: Railroad Medicare Medicare |
$18.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.37
|
| Rate for Payer: UHC Exchange |
$18.37
|
| Rate for Payer: UHC Medicare Advantage |
$18.37
|
| Rate for Payer: UHCCP Medicaid |
$9.85
|
| Rate for Payer: UMR Bronson Commercial |
$123.18
|
| Rate for Payer: VA VA |
$18.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$249.70
|
|
|
HC SRS CRANIAL LESION LIN ACC
|
Facility
|
IP
|
$3,101.43
|
|
|
Service Code
|
CPT 77372
|
| Hospital Charge Code |
33300032
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,364.63 |
| Max. Negotiated Rate |
$2,791.29 |
| Rate for Payer: Aetna American Axle |
$2,015.93
|
| Rate for Payer: Aetna Commercial |
$2,636.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,015.93
|
| Rate for Payer: Cash Price |
$2,481.14
|
| Rate for Payer: Cofinity Commercial |
$2,171.00
|
| Rate for Payer: Cofinity Commercial |
$2,667.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,171.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,481.14
|
| Rate for Payer: Healthscope Commercial |
$2,791.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,171.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,326.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,636.22
|
| Rate for Payer: PHP Commercial |
$2,636.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,015.93
|
| Rate for Payer: Priority Health SBD |
$1,953.90
|
| Rate for Payer: UMR Bronson Commercial |
$1,364.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,326.07
|
|
|
HC SRS CRANIAL LESION LIN ACC
|
Facility
|
OP
|
$3,101.43
|
|
|
Service Code
|
CPT 77372
|
| Hospital Charge Code |
33300032
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$854.55 |
| Max. Negotiated Rate |
$23,540.71 |
| Rate for Payer: Aetna American Axle |
$2,015.93
|
| Rate for Payer: Aetna Commercial |
$2,636.22
|
| Rate for Payer: Aetna Medicare |
$7,789.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,015.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,362.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,362.40
|
| Rate for Payer: BCBS Complete |
$4,215.33
|
| Rate for Payer: BCBS MAPPO |
$7,489.92
|
| Rate for Payer: BCBS Trust/PPO |
$1,956.06
|
| Rate for Payer: BCN Commercial |
$1,956.06
|
| Rate for Payer: BCN Medicare Advantage |
$7,489.92
|
| Rate for Payer: Cash Price |
$2,481.14
|
| Rate for Payer: Cash Price |
$2,481.14
|
| Rate for Payer: Cash Price |
$2,481.14
|
| Rate for Payer: Cash Price |
$2,481.14
|
| Rate for Payer: Cofinity Commercial |
$2,171.00
|
| Rate for Payer: Cofinity Commercial |
$2,667.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,171.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,481.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,489.92
|
| Rate for Payer: Healthscope Commercial |
$2,791.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,171.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,326.07
|
| Rate for Payer: Mclaren Medicaid |
$4,014.60
|
| Rate for Payer: Mclaren Medicare |
$7,489.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,864.42
|
| Rate for Payer: Meridian Medicaid |
$4,215.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,613.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,636.22
|
| Rate for Payer: Nomi Health Commercial |
$15,728.83
|
| Rate for Payer: PACE Medicare |
$7,115.42
|
| Rate for Payer: PACE SWMI |
$7,489.92
|
| Rate for Payer: PHP Commercial |
$2,636.22
|
| Rate for Payer: PHP Medicare Advantage |
$7,489.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,014.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,015.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23,540.71
|
| Rate for Payer: Priority Health Medicare |
$7,489.92
|
| Rate for Payer: Priority Health Narrow Network |
$18,832.57
|
| Rate for Payer: Priority Health SBD |
$1,953.90
|
| Rate for Payer: Railroad Medicare Medicare |
$7,489.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$940.00
|
| Rate for Payer: UHC Core |
$979.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,489.92
|
| Rate for Payer: UHC Exchange |
$854.55
|
| Rate for Payer: UHC Medicare Advantage |
$7,489.92
|
| Rate for Payer: UHCCP Medicaid |
$4,014.60
|
| Rate for Payer: UMR Bronson Commercial |
$1,147.53
|
| Rate for Payer: VA VA |
$7,489.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,326.07
|
|
|
HC SRT UP TO 5 FRACTIONS
|
Facility
|
IP
|
$5,306.04
|
|
|
Service Code
|
CPT 77373
|
| Hospital Charge Code |
33300018
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$2,334.66 |
| Max. Negotiated Rate |
$4,775.44 |
| Rate for Payer: Aetna American Axle |
$3,448.93
|
| Rate for Payer: Aetna Commercial |
$4,510.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,448.93
|
| Rate for Payer: Cash Price |
$4,244.83
|
| Rate for Payer: Cofinity Commercial |
$3,714.23
|
| Rate for Payer: Cofinity Commercial |
$4,563.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,714.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,244.83
|
| Rate for Payer: Healthscope Commercial |
$4,775.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,714.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,979.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,510.13
|
| Rate for Payer: PHP Commercial |
$4,510.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,448.93
|
| Rate for Payer: Priority Health SBD |
$3,342.81
|
| Rate for Payer: UMR Bronson Commercial |
$2,334.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,979.53
|
|
|
HC SRT UP TO 5 FRACTIONS
|
Facility
|
OP
|
$5,306.04
|
|
|
Service Code
|
CPT 77373
|
| Hospital Charge Code |
33300018
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$892.57 |
| Max. Negotiated Rate |
$5,407.20 |
| Rate for Payer: Aetna American Axle |
$3,448.93
|
| Rate for Payer: Aetna Commercial |
$4,510.13
|
| Rate for Payer: Aetna Medicare |
$1,789.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,448.93
|
| 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 |
$4,244.83
|
| Rate for Payer: Cash Price |
$4,244.83
|
| Rate for Payer: Cash Price |
$4,244.83
|
| Rate for Payer: Cofinity Commercial |
$3,714.23
|
| Rate for Payer: Cofinity Commercial |
$4,563.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,714.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,244.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,720.41
|
| Rate for Payer: Healthscope Commercial |
$4,775.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,714.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,979.53
|
| 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 |
$4,510.13
|
| 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 |
$4,510.13
|
| 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 |
$3,448.93
|
| 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 |
$3,342.81
|
| 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 |
$1,963.23
|
| Rate for Payer: VA VA |
$1,720.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,979.53
|
|
