|
HC UNILATERAL TOMOSYNTHESIS
|
Facility
|
IP
|
$105.27
|
|
|
Service Code
|
CPT 77061
|
| Hospital Charge Code |
32000299
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$46.32 |
| Max. Negotiated Rate |
$94.74 |
| Rate for Payer: Aetna American Axle |
$68.43
|
| Rate for Payer: Aetna Commercial |
$89.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.43
|
| Rate for Payer: Cash Price |
$84.22
|
| Rate for Payer: Cofinity Advantage |
$73.69
|
| Rate for Payer: Cofinity Commercial |
$90.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.22
|
| Rate for Payer: Healthscope Commercial |
$94.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$73.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.95
|
| Rate for Payer: PHP Commercial |
$89.48
|
| Rate for Payer: Priority Health SBD |
$66.32
|
| Rate for Payer: UMR Bronson Commercial |
$46.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.95
|
|
|
HC UNILAT PERC IMPLANT NEUROSTIM ELTRD, SACRAL NERVE W/IMAG
|
Facility
|
IP
|
$9,848.75
|
|
|
Service Code
|
CPT 64561
|
| Hospital Charge Code |
76100247
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$4,333.45 |
| Max. Negotiated Rate |
$8,863.88 |
| Rate for Payer: Aetna American Axle |
$6,401.69
|
| Rate for Payer: Aetna Commercial |
$8,371.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,401.69
|
| Rate for Payer: Cash Price |
$7,879.00
|
| Rate for Payer: Cofinity Advantage |
$6,894.12
|
| Rate for Payer: Cofinity Commercial |
$8,469.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,879.00
|
| Rate for Payer: Healthscope Commercial |
$8,863.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,894.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,386.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,371.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,386.56
|
| Rate for Payer: PHP Commercial |
$8,371.44
|
| Rate for Payer: Priority Health SBD |
$6,204.71
|
| Rate for Payer: UMR Bronson Commercial |
$4,333.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,386.56
|
|
|
HC UNILAT PERC IMPLANT NEUROSTIM ELTRD, SACRAL NERVE W/IMAG
|
Facility
|
OP
|
$9,848.75
|
|
|
Service Code
|
CPT 64561
|
| Hospital Charge Code |
76100247
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,321.09 |
| Max. Negotiated Rate |
$20,535.59 |
| Rate for Payer: Aetna American Axle |
$6,401.69
|
| Rate for Payer: Aetna Commercial |
$8,371.44
|
| Rate for Payer: Aetna Medicare |
$6,604.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,401.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,937.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,937.60
|
| Rate for Payer: BCBS Complete |
$3,487.46
|
| Rate for Payer: BCBS MAPPO |
$6,350.08
|
| Rate for Payer: BCBS Trust/PPO |
$9,765.57
|
| Rate for Payer: BCN Commercial |
$9,765.57
|
| Rate for Payer: BCN Medicare Advantage |
$6,350.08
|
| Rate for Payer: Cash Price |
$7,879.00
|
| Rate for Payer: Cash Price |
$7,879.00
|
| Rate for Payer: Cash Price |
$7,879.00
|
| Rate for Payer: Cofinity Advantage |
$6,894.12
|
| Rate for Payer: Cofinity Commercial |
$8,469.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,879.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,350.08
|
| Rate for Payer: Healthscope Commercial |
$8,863.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,894.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,386.56
|
| Rate for Payer: Mclaren Medicaid |
$6,350.08
|
| Rate for Payer: Mclaren Medicare |
$6,350.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,667.58
|
| Rate for Payer: Meridian Medicaid |
$6,667.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,302.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,985.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,371.44
|
| Rate for Payer: Nomi Health Commercial |
$19,050.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,386.56
|
| Rate for Payer: PACE Medicare |
$6,032.58
|
| Rate for Payer: PACE SWMI |
$6,350.08
|
| Rate for Payer: PHP Commercial |
$8,371.44
|
| Rate for Payer: PHP Medicare Advantage |
$6,350.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,321.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$20,535.59
|
| Rate for Payer: Priority Health Medicare |
$6,350.08
|
| Rate for Payer: Priority Health SBD |
$6,204.71
|
| Rate for Payer: Priority Health Tiered Network |
$16,428.47
|
| Rate for Payer: Railroad Medicare Medicare |
$6,350.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,401.69
|
| Rate for Payer: UHC Core |
$5,131.20
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6,350.08
|
| Rate for Payer: UHC Exchange |
$3,870.56
|
| Rate for Payer: UHC Medicaid |
$3,321.09
|
| Rate for Payer: UHCCP Medicaid |
$3,321.09
|
| Rate for Payer: UMR Bronson Commercial |
$3,644.04
|
| Rate for Payer: VA VA |
$6,350.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,386.56
|
|
|
HC UNLISTED FEMALE GENITAL SYSTEM
|
Facility
|
IP
|
$1,147.85
|
|
|
Service Code
|
CPT 58999
|
| Hospital Charge Code |
36100387
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$505.05 |
| Max. Negotiated Rate |
$1,033.07 |
| Rate for Payer: Aetna American Axle |
$746.10
|
| Rate for Payer: Aetna Commercial |
$975.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$746.10
|
| Rate for Payer: Cash Price |
$918.28
|
| Rate for Payer: Cofinity Advantage |
$803.50
|
| Rate for Payer: Cofinity Commercial |
$987.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$918.28
|
| Rate for Payer: Healthscope Commercial |
$1,033.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$803.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$860.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$975.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$860.89
|
| Rate for Payer: PHP Commercial |
$975.67
|
| Rate for Payer: Priority Health SBD |
$723.15
|
| Rate for Payer: UMR Bronson Commercial |
$505.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$860.89
|
|
|
HC UNLISTED FEMALE GENITAL SYSTEM
|
Facility
|
OP
|
$1,147.85
|
|
|
Service Code
|
CPT 58999
|
| Hospital Charge Code |
36100387
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$105.35 |
| Max. Negotiated Rate |
$1,033.07 |
| Rate for Payer: Aetna American Axle |
$746.10
|
| Rate for Payer: Aetna Commercial |
$975.67
|
| Rate for Payer: Aetna Medicare |
$209.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$746.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$251.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$251.80
|
| Rate for Payer: BCBS Complete |
$110.63
|
| Rate for Payer: BCBS MAPPO |
$201.44
|
| Rate for Payer: BCBS Trust/PPO |
$171.73
|
| Rate for Payer: BCN Commercial |
$171.73
|
| Rate for Payer: BCN Medicare Advantage |
$201.44
|
| Rate for Payer: Cash Price |
$918.28
|
| Rate for Payer: Cash Price |
$918.28
|
| Rate for Payer: Cash Price |
$918.28
|
| Rate for Payer: Cofinity Advantage |
$803.50
|
| Rate for Payer: Cofinity Commercial |
$987.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$918.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$201.44
|
| Rate for Payer: Healthscope Commercial |
$1,033.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$803.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$860.89
|
| Rate for Payer: Mclaren Medicaid |
$201.44
|
| Rate for Payer: Mclaren Medicare |
$201.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$211.51
|
| Rate for Payer: Meridian Medicaid |
$211.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$231.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$221.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$975.67
|
| Rate for Payer: Nomi Health Commercial |
$604.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$860.89
|
| Rate for Payer: PACE Medicare |
$191.37
|
| Rate for Payer: PACE SWMI |
$201.44
|
| Rate for Payer: PHP Commercial |
$975.67
|
| Rate for Payer: PHP Medicare Advantage |
$201.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$105.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$651.46
|
| Rate for Payer: Priority Health Medicare |
$201.44
|
| Rate for Payer: Priority Health SBD |
$723.15
|
| Rate for Payer: Priority Health Tiered Network |
$521.17
|
| Rate for Payer: Railroad Medicare Medicare |
$201.44
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$201.44
|
| Rate for Payer: UHC Medicaid |
$105.35
|
| Rate for Payer: UHCCP Medicaid |
$105.35
|
| Rate for Payer: UMR Bronson Commercial |
$424.70
|
| Rate for Payer: VA VA |
$201.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$860.89
|
|
|
HC UNLISTED PROCEDURE, FEMUR OR KNEE
|
Facility
|
OP
|
$686.66
|
|
|
Service Code
|
CPT 27599
|
| Hospital Charge Code |
76100418
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$128.54 |
| Max. Negotiated Rate |
$794.84 |
| Rate for Payer: Aetna American Axle |
$446.33
|
| Rate for Payer: Aetna Commercial |
$583.66
|
| Rate for Payer: Aetna Medicare |
$255.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$446.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$307.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$307.23
|
| Rate for Payer: BCBS Complete |
$134.98
|
| Rate for Payer: BCBS MAPPO |
$245.78
|
| Rate for Payer: BCBS Trust/PPO |
$225.47
|
| Rate for Payer: BCN Commercial |
$225.47
|
| Rate for Payer: BCN Medicare Advantage |
$245.78
|
| Rate for Payer: Cash Price |
$549.33
|
| Rate for Payer: Cash Price |
$549.33
|
| Rate for Payer: Cash Price |
$549.33
|
| Rate for Payer: Cofinity Advantage |
$480.66
|
| Rate for Payer: Cofinity Commercial |
$590.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$549.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$245.78
|
| Rate for Payer: Healthscope Commercial |
$617.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$480.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$515.00
|
| Rate for Payer: Mclaren Medicaid |
$245.78
|
| Rate for Payer: Mclaren Medicare |
$245.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$258.07
|
| Rate for Payer: Meridian Medicaid |
$258.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$282.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$270.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$583.66
|
| Rate for Payer: Nomi Health Commercial |
$737.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$515.00
|
| Rate for Payer: PACE Medicare |
$233.49
|
| Rate for Payer: PACE SWMI |
$245.78
|
| Rate for Payer: PHP Commercial |
$583.66
|
| Rate for Payer: PHP Medicare Advantage |
$245.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$128.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$794.84
|
| Rate for Payer: Priority Health Medicare |
$245.78
|
| Rate for Payer: Priority Health SBD |
$432.60
|
| Rate for Payer: Priority Health Tiered Network |
$635.87
|
| Rate for Payer: Railroad Medicare Medicare |
$245.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$446.33
|
| Rate for Payer: UHC Core |
$357.75
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$245.78
|
| Rate for Payer: UHC Exchange |
$269.86
|
| Rate for Payer: UHC Medicaid |
$128.54
|
| Rate for Payer: UHCCP Medicaid |
$128.54
|
| Rate for Payer: UMR Bronson Commercial |
$254.06
|
| Rate for Payer: VA VA |
$245.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$515.00
|
|
|
HC UNLISTED PROCEDURE, FEMUR OR KNEE
|
Facility
|
IP
|
$686.66
|
|
|
Service Code
|
CPT 27599
|
| Hospital Charge Code |
76100418
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$302.13 |
| Max. Negotiated Rate |
$617.99 |
| Rate for Payer: Aetna American Axle |
$446.33
|
| Rate for Payer: Aetna Commercial |
$583.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$446.33
|
| Rate for Payer: Cash Price |
$549.33
|
| Rate for Payer: Cofinity Advantage |
$480.66
|
| Rate for Payer: Cofinity Commercial |
$590.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$549.33
|
| Rate for Payer: Healthscope Commercial |
$617.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$480.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$515.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$583.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$515.00
|
| Rate for Payer: PHP Commercial |
$583.66
|
| Rate for Payer: Priority Health SBD |
$432.60
|
| Rate for Payer: UMR Bronson Commercial |
$302.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$515.00
|
|
|
HC UNLISTED PROCEDURE HUMERUS ELBOW
|
Facility
|
OP
|
$686.66
|
|
|
Service Code
|
CPT 24999
|
| Hospital Charge Code |
76100409
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$128.54 |
| Max. Negotiated Rate |
$794.84 |
| Rate for Payer: Aetna American Axle |
$446.33
|
| Rate for Payer: Aetna Commercial |
$583.66
|
| Rate for Payer: Aetna Medicare |
$255.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$446.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$307.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$307.23
|
| Rate for Payer: BCBS Complete |
$134.98
|
| Rate for Payer: BCBS MAPPO |
$245.78
|
| Rate for Payer: BCBS Trust/PPO |
$225.47
|
| Rate for Payer: BCN Commercial |
$225.47
|
| Rate for Payer: BCN Medicare Advantage |
$245.78
|
| Rate for Payer: Cash Price |
$549.33
|
| Rate for Payer: Cash Price |
$549.33
|
| Rate for Payer: Cash Price |
$549.33
|
| Rate for Payer: Cofinity Advantage |
$480.66
|
| Rate for Payer: Cofinity Commercial |
$590.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$549.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$245.78
|
| Rate for Payer: Healthscope Commercial |
$617.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$480.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$515.00
|
| Rate for Payer: Mclaren Medicaid |
$245.78
|
| Rate for Payer: Mclaren Medicare |
$245.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$258.07
|
| Rate for Payer: Meridian Medicaid |
$258.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$282.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$270.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$583.66
|
| Rate for Payer: Nomi Health Commercial |
$737.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$515.00
|
| Rate for Payer: PACE Medicare |
$233.49
|
| Rate for Payer: PACE SWMI |
$245.78
|
| Rate for Payer: PHP Commercial |
$583.66
|
| Rate for Payer: PHP Medicare Advantage |
$245.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$128.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$794.84
|
| Rate for Payer: Priority Health Medicare |
$245.78
|
| Rate for Payer: Priority Health SBD |
$432.60
|
| Rate for Payer: Priority Health Tiered Network |
$635.87
|
| Rate for Payer: Railroad Medicare Medicare |
$245.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$446.33
|
| Rate for Payer: UHC Core |
$357.75
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$245.78
|
| Rate for Payer: UHC Exchange |
$269.86
|
| Rate for Payer: UHC Medicaid |
$128.54
|
| Rate for Payer: UHCCP Medicaid |
$128.54
|
| Rate for Payer: UMR Bronson Commercial |
$254.06
|
| Rate for Payer: VA VA |
$245.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$515.00
|
|
|
HC UNLISTED PROCEDURE HUMERUS ELBOW
|
Facility
|
IP
|
$686.66
|
|
|
Service Code
|
CPT 24999
|
| Hospital Charge Code |
76100409
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$302.13 |
| Max. Negotiated Rate |
$617.99 |
| Rate for Payer: Aetna American Axle |
$446.33
|
| Rate for Payer: Aetna Commercial |
$583.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$446.33
|
| Rate for Payer: Cash Price |
$549.33
|
| Rate for Payer: Cofinity Advantage |
$480.66
|
| Rate for Payer: Cofinity Commercial |
$590.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$549.33
|
| Rate for Payer: Healthscope Commercial |
$617.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$480.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$515.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$583.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$515.00
|
| Rate for Payer: PHP Commercial |
$583.66
|
| Rate for Payer: Priority Health SBD |
$432.60
|
| Rate for Payer: UMR Bronson Commercial |
$302.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$515.00
|
|
|
HC UNLISTED PROCEDURE MUSCULOSKELETAL SYSTEM GENERAL
|
Facility
|
IP
|
$686.66
|
|
|
Service Code
|
CPT 20999
|
| Hospital Charge Code |
76100421
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$302.13 |
| Max. Negotiated Rate |
$617.99 |
| Rate for Payer: Aetna American Axle |
$446.33
|
| Rate for Payer: Aetna Commercial |
$583.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$446.33
|
| Rate for Payer: Cash Price |
$549.33
|
| Rate for Payer: Cofinity Advantage |
$480.66
|
| Rate for Payer: Cofinity Commercial |
$590.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$549.33
|
| Rate for Payer: Healthscope Commercial |
$617.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$480.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$515.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$583.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$515.00
|
| Rate for Payer: PHP Commercial |
$583.66
|
| Rate for Payer: Priority Health SBD |
$432.60
|
| Rate for Payer: UMR Bronson Commercial |
$302.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$515.00
|
|
|
HC UNLISTED PROCEDURE MUSCULOSKELETAL SYSTEM GENERAL
|
Facility
|
OP
|
$686.66
|
|
|
Service Code
|
CPT 20999
|
| Hospital Charge Code |
76100421
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$128.54 |
| Max. Negotiated Rate |
$794.84 |
| Rate for Payer: Aetna American Axle |
$446.33
|
| Rate for Payer: Aetna Commercial |
$583.66
|
| Rate for Payer: Aetna Medicare |
$255.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$446.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$307.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$307.23
|
| Rate for Payer: BCBS Complete |
$134.98
|
| Rate for Payer: BCBS MAPPO |
$245.78
|
| Rate for Payer: BCBS Trust/PPO |
$225.47
|
| Rate for Payer: BCN Commercial |
$225.47
|
| Rate for Payer: BCN Medicare Advantage |
$245.78
|
| Rate for Payer: Cash Price |
$549.33
|
| Rate for Payer: Cash Price |
$549.33
|
| Rate for Payer: Cash Price |
$549.33
|
| Rate for Payer: Cofinity Advantage |
$480.66
|
| Rate for Payer: Cofinity Commercial |
$590.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$549.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$245.78
|
| Rate for Payer: Healthscope Commercial |
$617.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$480.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$515.00
|
| Rate for Payer: Mclaren Medicaid |
$245.78
|
| Rate for Payer: Mclaren Medicare |
$245.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$258.07
|
| Rate for Payer: Meridian Medicaid |
$258.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$282.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$270.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$583.66
|
| Rate for Payer: Nomi Health Commercial |
$737.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$515.00
|
| Rate for Payer: PACE Medicare |
$233.49
|
| Rate for Payer: PACE SWMI |
$245.78
|
| Rate for Payer: PHP Commercial |
$583.66
|
| Rate for Payer: PHP Medicare Advantage |
$245.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$128.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$794.84
|
| Rate for Payer: Priority Health Medicare |
$245.78
|
| Rate for Payer: Priority Health SBD |
$432.60
|
| Rate for Payer: Priority Health Tiered Network |
$635.87
|
| Rate for Payer: Railroad Medicare Medicare |
$245.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$446.33
|
| Rate for Payer: UHC Core |
$357.75
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$245.78
|
| Rate for Payer: UHC Exchange |
$269.86
|
| Rate for Payer: UHC Medicaid |
$128.54
|
| Rate for Payer: UHCCP Medicaid |
$128.54
|
| Rate for Payer: UMR Bronson Commercial |
$254.06
|
| Rate for Payer: VA VA |
$245.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$515.00
|
|
|
HC UNLISTED PROCEDURE NERVOUS SYSTEM 64999
|
Facility
|
OP
|
$741.19
|
|
|
Service Code
|
CPT 64999
|
| Hospital Charge Code |
36100437
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$159.96 |
| Max. Negotiated Rate |
$989.08 |
| Rate for Payer: Aetna American Axle |
$481.77
|
| Rate for Payer: Aetna Commercial |
$630.01
|
| Rate for Payer: Aetna Medicare |
$318.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$481.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$382.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$382.31
|
| Rate for Payer: BCBS Complete |
$167.97
|
| Rate for Payer: BCBS MAPPO |
$305.85
|
| Rate for Payer: BCBS Trust/PPO |
$260.63
|
| Rate for Payer: BCN Commercial |
$260.63
|
| Rate for Payer: BCN Medicare Advantage |
$305.85
|
| Rate for Payer: Cash Price |
$592.95
|
| Rate for Payer: Cash Price |
$592.95
|
| Rate for Payer: Cash Price |
$592.95
|
| Rate for Payer: Cofinity Advantage |
$518.83
|
| Rate for Payer: Cofinity Commercial |
$637.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$592.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.85
|
| Rate for Payer: Healthscope Commercial |
$667.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$518.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$555.89
|
| Rate for Payer: Mclaren Medicaid |
$305.85
|
| Rate for Payer: Mclaren Medicare |
$305.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$321.14
|
| Rate for Payer: Meridian Medicaid |
$321.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$351.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$336.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$630.01
|
| Rate for Payer: Nomi Health Commercial |
$917.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$555.89
|
| Rate for Payer: PACE Medicare |
$290.56
|
| Rate for Payer: PACE SWMI |
$305.85
|
| Rate for Payer: PHP Commercial |
$630.01
|
| Rate for Payer: PHP Medicare Advantage |
$305.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$159.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$989.08
|
| Rate for Payer: Priority Health Medicare |
$305.85
|
| Rate for Payer: Priority Health SBD |
$466.95
|
| Rate for Payer: Priority Health Tiered Network |
$791.26
|
| Rate for Payer: Railroad Medicare Medicare |
$305.85
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$305.85
|
| Rate for Payer: UHC Medicaid |
$159.96
|
| Rate for Payer: UHCCP Medicaid |
$159.96
|
| Rate for Payer: UMR Bronson Commercial |
$274.24
|
| Rate for Payer: VA VA |
$305.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$555.89
|
|
|
HC UNLISTED PROCEDURE NERVOUS SYSTEM 64999
|
Facility
|
IP
|
$741.19
|
|
|
Service Code
|
CPT 64999
|
| Hospital Charge Code |
36100437
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$326.12 |
| Max. Negotiated Rate |
$667.07 |
| Rate for Payer: Aetna American Axle |
$481.77
|
| Rate for Payer: Aetna Commercial |
$630.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$481.77
|
| Rate for Payer: Cash Price |
$592.95
|
| Rate for Payer: Cofinity Advantage |
$518.83
|
| Rate for Payer: Cofinity Commercial |
$637.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$592.95
|
| Rate for Payer: Healthscope Commercial |
$667.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$518.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$555.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$630.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$555.89
|
| Rate for Payer: PHP Commercial |
$630.01
|
| Rate for Payer: Priority Health SBD |
$466.95
|
| Rate for Payer: UMR Bronson Commercial |
$326.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$555.89
|
|
|
HC UNLISTED PROCEDURE NOSE
|
Facility
|
OP
|
$676.26
|
|
|
Service Code
|
CPT 30999
|
| Hospital Charge Code |
76100453
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$123.43 |
| Max. Negotiated Rate |
$763.21 |
| Rate for Payer: Aetna American Axle |
$439.57
|
| Rate for Payer: Aetna Commercial |
$574.82
|
| Rate for Payer: Aetna Medicare |
$245.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$439.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$295.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$295.00
|
| Rate for Payer: BCBS Complete |
$129.61
|
| Rate for Payer: BCBS MAPPO |
$236.00
|
| Rate for Payer: BCBS Trust/PPO |
$199.82
|
| Rate for Payer: BCN Commercial |
$199.82
|
| Rate for Payer: BCN Medicare Advantage |
$236.00
|
| Rate for Payer: Cash Price |
$541.01
|
| Rate for Payer: Cash Price |
$541.01
|
| Rate for Payer: Cash Price |
$541.01
|
| Rate for Payer: Cofinity Advantage |
$473.38
|
| Rate for Payer: Cofinity Commercial |
$581.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$541.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$236.00
|
| Rate for Payer: Healthscope Commercial |
$608.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$473.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$507.19
|
| Rate for Payer: Mclaren Medicaid |
$236.00
|
| Rate for Payer: Mclaren Medicare |
$236.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$247.80
|
| Rate for Payer: Meridian Medicaid |
$247.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$271.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$259.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$574.82
|
| Rate for Payer: Nomi Health Commercial |
$708.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$507.19
|
| Rate for Payer: PACE Medicare |
$224.20
|
| Rate for Payer: PACE SWMI |
$236.00
|
| Rate for Payer: PHP Commercial |
$574.82
|
| Rate for Payer: PHP Medicare Advantage |
$236.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$123.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$763.21
|
| Rate for Payer: Priority Health Medicare |
$236.00
|
| Rate for Payer: Priority Health SBD |
$426.04
|
| Rate for Payer: Priority Health Tiered Network |
$610.57
|
| Rate for Payer: Railroad Medicare Medicare |
$236.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$439.57
|
| Rate for Payer: UHC Core |
$352.33
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$236.00
|
| Rate for Payer: UHC Exchange |
$265.77
|
| Rate for Payer: UHC Medicaid |
$123.43
|
| Rate for Payer: UHCCP Medicaid |
$123.43
|
| Rate for Payer: UMR Bronson Commercial |
$250.22
|
| Rate for Payer: VA VA |
$236.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$507.19
|
|
|
HC UNLISTED PROCEDURE NOSE
|
Facility
|
IP
|
$676.26
|
|
|
Service Code
|
CPT 30999
|
| Hospital Charge Code |
76100453
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$297.55 |
| Max. Negotiated Rate |
$608.63 |
| Rate for Payer: Aetna American Axle |
$439.57
|
| Rate for Payer: Aetna Commercial |
$574.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$439.57
|
| Rate for Payer: Cash Price |
$541.01
|
| Rate for Payer: Cofinity Advantage |
$473.38
|
| Rate for Payer: Cofinity Commercial |
$581.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$541.01
|
| Rate for Payer: Healthscope Commercial |
$608.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$473.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$507.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$574.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$507.19
|
| Rate for Payer: PHP Commercial |
$574.82
|
| Rate for Payer: Priority Health SBD |
$426.04
|
| Rate for Payer: UMR Bronson Commercial |
$297.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$507.19
|
|
|
HC UNLISTED PROCEDURE SPINE
|
Facility
|
OP
|
$2,962.46
|
|
|
Service Code
|
CPT 22899
|
| Hospital Charge Code |
36100036
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$128.54 |
| Max. Negotiated Rate |
$2,666.21 |
| Rate for Payer: Aetna American Axle |
$1,925.60
|
| Rate for Payer: Aetna Commercial |
$2,518.09
|
| Rate for Payer: Aetna Medicare |
$255.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,925.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$307.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$307.23
|
| Rate for Payer: BCBS Complete |
$134.98
|
| Rate for Payer: BCBS MAPPO |
$245.78
|
| Rate for Payer: BCBS Trust/PPO |
$225.47
|
| Rate for Payer: BCN Commercial |
$225.47
|
| Rate for Payer: BCN Medicare Advantage |
$245.78
|
| Rate for Payer: Cash Price |
$2,369.97
|
| Rate for Payer: Cash Price |
$2,369.97
|
| Rate for Payer: Cash Price |
$2,369.97
|
| Rate for Payer: Cofinity Advantage |
$2,073.72
|
| Rate for Payer: Cofinity Commercial |
$2,547.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,369.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$245.78
|
| Rate for Payer: Healthscope Commercial |
$2,666.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,073.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,221.84
|
| Rate for Payer: Mclaren Medicaid |
$245.78
|
| Rate for Payer: Mclaren Medicare |
$245.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$258.07
|
| Rate for Payer: Meridian Medicaid |
$258.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$282.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$270.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,518.09
|
| Rate for Payer: Nomi Health Commercial |
$737.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,221.84
|
| Rate for Payer: PACE Medicare |
$233.49
|
| Rate for Payer: PACE SWMI |
$245.78
|
| Rate for Payer: PHP Commercial |
$2,518.09
|
| Rate for Payer: PHP Medicare Advantage |
$245.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$128.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$794.84
|
| Rate for Payer: Priority Health Medicare |
$245.78
|
| Rate for Payer: Priority Health SBD |
$1,866.35
|
| Rate for Payer: Priority Health Tiered Network |
$635.87
|
| Rate for Payer: Railroad Medicare Medicare |
$245.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$245.78
|
| Rate for Payer: UHC Medicaid |
$128.54
|
| Rate for Payer: UHCCP Medicaid |
$128.54
|
| Rate for Payer: UMR Bronson Commercial |
$1,096.11
|
| Rate for Payer: VA VA |
$245.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,221.84
|
|
|
HC UNLISTED PROCEDURE SPINE
|
Facility
|
IP
|
$2,962.46
|
|
|
Service Code
|
CPT 22899
|
| Hospital Charge Code |
36100036
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,303.48 |
| Max. Negotiated Rate |
$2,666.21 |
| Rate for Payer: Aetna American Axle |
$1,925.60
|
| Rate for Payer: Aetna Commercial |
$2,518.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,925.60
|
| Rate for Payer: Cash Price |
$2,369.97
|
| Rate for Payer: Cofinity Advantage |
$2,073.72
|
| Rate for Payer: Cofinity Commercial |
$2,547.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,369.97
|
| Rate for Payer: Healthscope Commercial |
$2,666.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,073.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,221.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,518.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,221.84
|
| Rate for Payer: PHP Commercial |
$2,518.09
|
| Rate for Payer: Priority Health SBD |
$1,866.35
|
| Rate for Payer: UMR Bronson Commercial |
$1,303.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,221.84
|
|
|
HC UNLISTED PROC HAND OR FINGER
|
Facility
|
IP
|
$466.11
|
|
|
Service Code
|
CPT 26989
|
| Hospital Charge Code |
36100518
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$205.09 |
| Max. Negotiated Rate |
$419.50 |
| Rate for Payer: Aetna American Axle |
$302.97
|
| Rate for Payer: Aetna Commercial |
$396.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$302.97
|
| Rate for Payer: Cash Price |
$372.89
|
| Rate for Payer: Cofinity Advantage |
$326.28
|
| Rate for Payer: Cofinity Commercial |
$400.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$372.89
|
| Rate for Payer: Healthscope Commercial |
$419.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$326.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$349.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$396.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$349.58
|
| Rate for Payer: PHP Commercial |
$396.19
|
| Rate for Payer: Priority Health SBD |
$293.65
|
| Rate for Payer: UMR Bronson Commercial |
$205.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$349.58
|
|
|
HC UNLISTED PROC HAND OR FINGER
|
Facility
|
OP
|
$466.11
|
|
|
Service Code
|
CPT 26989
|
| Hospital Charge Code |
36100518
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$128.54 |
| Max. Negotiated Rate |
$794.84 |
| Rate for Payer: Aetna American Axle |
$302.97
|
| Rate for Payer: Aetna Commercial |
$396.19
|
| Rate for Payer: Aetna Medicare |
$255.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$302.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$307.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$307.23
|
| Rate for Payer: BCBS Complete |
$134.98
|
| Rate for Payer: BCBS MAPPO |
$245.78
|
| Rate for Payer: BCBS Trust/PPO |
$225.47
|
| Rate for Payer: BCN Commercial |
$225.47
|
| Rate for Payer: BCN Medicare Advantage |
$245.78
|
| Rate for Payer: Cash Price |
$372.89
|
| Rate for Payer: Cash Price |
$372.89
|
| Rate for Payer: Cash Price |
$372.89
|
| Rate for Payer: Cofinity Advantage |
$326.28
|
| Rate for Payer: Cofinity Commercial |
$400.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$372.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$245.78
|
| Rate for Payer: Healthscope Commercial |
$419.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$326.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$349.58
|
| Rate for Payer: Mclaren Medicaid |
$245.78
|
| Rate for Payer: Mclaren Medicare |
$245.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$258.07
|
| Rate for Payer: Meridian Medicaid |
$258.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$282.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$270.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$396.19
|
| Rate for Payer: Nomi Health Commercial |
$737.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$349.58
|
| Rate for Payer: PACE Medicare |
$233.49
|
| Rate for Payer: PACE SWMI |
$245.78
|
| Rate for Payer: PHP Commercial |
$396.19
|
| Rate for Payer: PHP Medicare Advantage |
$245.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$128.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$794.84
|
| Rate for Payer: Priority Health Medicare |
$245.78
|
| Rate for Payer: Priority Health SBD |
$293.65
|
| Rate for Payer: Priority Health Tiered Network |
$635.87
|
| Rate for Payer: Railroad Medicare Medicare |
$245.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$245.78
|
| Rate for Payer: UHC Medicaid |
$128.54
|
| Rate for Payer: UHCCP Medicaid |
$128.54
|
| Rate for Payer: UMR Bronson Commercial |
$172.46
|
| Rate for Payer: VA VA |
$245.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$349.58
|
|
|
HC UNNA BOOT
|
Facility
|
IP
|
$374.61
|
|
|
Service Code
|
CPT 29580
|
| Hospital Charge Code |
42000006
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$164.83 |
| Max. Negotiated Rate |
$337.15 |
| Rate for Payer: Aetna American Axle |
$243.50
|
| Rate for Payer: Aetna Commercial |
$318.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$243.50
|
| Rate for Payer: Cash Price |
$299.69
|
| Rate for Payer: Cofinity Advantage |
$262.23
|
| Rate for Payer: Cofinity Commercial |
$322.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$299.69
|
| Rate for Payer: Healthscope Commercial |
$337.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$262.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$280.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$318.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$280.96
|
| Rate for Payer: PHP Commercial |
$318.42
|
| Rate for Payer: Priority Health SBD |
$236.00
|
| Rate for Payer: UMR Bronson Commercial |
$164.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$280.96
|
|
|
HC UNNA BOOT
|
Facility
|
OP
|
$374.61
|
|
|
Service Code
|
CPT 29580
|
| Hospital Charge Code |
42000006
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$84.68 |
| Max. Negotiated Rate |
$523.62 |
| Rate for Payer: Aetna American Axle |
$243.50
|
| Rate for Payer: Aetna Commercial |
$318.42
|
| Rate for Payer: Aetna Medicare |
$168.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$243.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$202.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$202.40
|
| Rate for Payer: BCBS Complete |
$88.93
|
| Rate for Payer: BCBS MAPPO |
$161.92
|
| Rate for Payer: BCBS Trust/PPO |
$197.50
|
| Rate for Payer: BCN Commercial |
$197.50
|
| Rate for Payer: BCN Medicare Advantage |
$161.92
|
| Rate for Payer: Cash Price |
$299.69
|
| Rate for Payer: Cash Price |
$299.69
|
| Rate for Payer: Cash Price |
$299.69
|
| Rate for Payer: Cofinity Advantage |
$262.23
|
| Rate for Payer: Cofinity Commercial |
$322.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$299.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$161.92
|
| Rate for Payer: Healthscope Commercial |
$337.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$262.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$280.96
|
| Rate for Payer: Mclaren Medicaid |
$161.92
|
| Rate for Payer: Mclaren Medicare |
$161.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$170.02
|
| Rate for Payer: Meridian Medicaid |
$170.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$186.21
|
| Rate for Payer: Molina Medicare/Medicaid |
$178.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$318.42
|
| Rate for Payer: Nomi Health Commercial |
$485.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$280.96
|
| Rate for Payer: PACE Medicare |
$153.82
|
| Rate for Payer: PACE SWMI |
$161.92
|
| Rate for Payer: PHP Commercial |
$318.42
|
| Rate for Payer: PHP Medicare Advantage |
$161.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$84.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$523.62
|
| Rate for Payer: Priority Health Medicare |
$161.92
|
| Rate for Payer: Priority Health SBD |
$236.00
|
| Rate for Payer: Priority Health Tiered Network |
$418.90
|
| Rate for Payer: Railroad Medicare Medicare |
$161.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$243.50
|
| Rate for Payer: UHC Core |
$195.17
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$161.92
|
| Rate for Payer: UHC Exchange |
$147.22
|
| Rate for Payer: UHC Medicaid |
$84.68
|
| Rate for Payer: UHCCP Medicaid |
$84.68
|
| Rate for Payer: UMR Bronson Commercial |
$138.61
|
| Rate for Payer: VA VA |
$161.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$280.96
|
|
|
HC UPGRADE PACEMAKER
|
Facility
|
OP
|
$9,202.56
|
|
|
Service Code
|
CPT 33214
|
| Hospital Charge Code |
36100063
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,404.95 |
| Max. Negotiated Rate |
$33,679.26 |
| Rate for Payer: Aetna American Axle |
$5,981.66
|
| Rate for Payer: Aetna Commercial |
$7,822.18
|
| Rate for Payer: Aetna Medicare |
$10,830.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,981.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,018.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,018.01
|
| Rate for Payer: BCBS Complete |
$5,719.59
|
| Rate for Payer: BCBS MAPPO |
$10,414.41
|
| Rate for Payer: BCBS Trust/PPO |
$16,637.83
|
| Rate for Payer: BCN Commercial |
$16,637.83
|
| Rate for Payer: BCN Medicare Advantage |
$10,414.41
|
| Rate for Payer: Cash Price |
$7,362.05
|
| Rate for Payer: Cash Price |
$7,362.05
|
| Rate for Payer: Cash Price |
$7,362.05
|
| Rate for Payer: Cofinity Advantage |
$6,441.79
|
| Rate for Payer: Cofinity Commercial |
$7,914.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,362.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,414.41
|
| Rate for Payer: Healthscope Commercial |
$8,282.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,441.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,901.92
|
| Rate for Payer: Mclaren Medicaid |
$10,414.41
|
| Rate for Payer: Mclaren Medicare |
$10,414.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,935.13
|
| Rate for Payer: Meridian Medicaid |
$10,935.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,976.57
|
| Rate for Payer: Molina Medicare/Medicaid |
$11,455.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,822.18
|
| Rate for Payer: Nomi Health Commercial |
$31,243.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,901.92
|
| Rate for Payer: PACE Medicare |
$9,893.69
|
| Rate for Payer: PACE SWMI |
$10,414.41
|
| Rate for Payer: PHP Commercial |
$7,822.18
|
| Rate for Payer: PHP Medicare Advantage |
$10,414.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,446.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$33,679.26
|
| Rate for Payer: Priority Health Medicare |
$10,414.41
|
| Rate for Payer: Priority Health SBD |
$5,797.61
|
| Rate for Payer: Priority Health Tiered Network |
$26,943.41
|
| Rate for Payer: Railroad Medicare Medicare |
$10,414.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10,414.41
|
| Rate for Payer: UHC Medicaid |
$5,446.74
|
| Rate for Payer: UHCCP Medicaid |
$5,446.74
|
| Rate for Payer: UMR Bronson Commercial |
$3,404.95
|
| Rate for Payer: VA VA |
$10,414.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,901.92
|
|
|
HC UPGRADE PACEMAKER
|
Facility
|
IP
|
$9,202.56
|
|
|
Service Code
|
CPT 33214
|
| Hospital Charge Code |
36100063
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,049.13 |
| Max. Negotiated Rate |
$8,282.30 |
| Rate for Payer: Aetna American Axle |
$5,981.66
|
| Rate for Payer: Aetna Commercial |
$7,822.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,981.66
|
| Rate for Payer: Cash Price |
$7,362.05
|
| Rate for Payer: Cofinity Advantage |
$6,441.79
|
| Rate for Payer: Cofinity Commercial |
$7,914.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,362.05
|
| Rate for Payer: Healthscope Commercial |
$8,282.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,441.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,901.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,822.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,901.92
|
| Rate for Payer: PHP Commercial |
$7,822.18
|
| Rate for Payer: Priority Health SBD |
$5,797.61
|
| Rate for Payer: UMR Bronson Commercial |
$4,049.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,901.92
|
|
|
HC UPGRADE TO BI-V PACEMAKER/ICD
|
Facility
|
OP
|
$4,880.19
|
|
|
Service Code
|
CPT 33224
|
| Hospital Charge Code |
36100069
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,805.67 |
| Max. Negotiated Rate |
$33,679.26 |
| Rate for Payer: Aetna American Axle |
$3,172.12
|
| Rate for Payer: Aetna Commercial |
$4,148.16
|
| Rate for Payer: Aetna Medicare |
$10,830.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,172.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,018.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,018.01
|
| Rate for Payer: BCBS Complete |
$5,719.59
|
| Rate for Payer: BCBS MAPPO |
$10,414.41
|
| Rate for Payer: BCBS Trust/PPO |
$22,162.24
|
| Rate for Payer: BCN Commercial |
$22,162.24
|
| Rate for Payer: BCN Medicare Advantage |
$10,414.41
|
| Rate for Payer: Cash Price |
$3,904.15
|
| Rate for Payer: Cash Price |
$3,904.15
|
| Rate for Payer: Cash Price |
$3,904.15
|
| Rate for Payer: Cofinity Advantage |
$3,416.13
|
| Rate for Payer: Cofinity Commercial |
$4,196.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,904.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,414.41
|
| Rate for Payer: Healthscope Commercial |
$4,392.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,416.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,660.14
|
| Rate for Payer: Mclaren Medicaid |
$10,414.41
|
| Rate for Payer: Mclaren Medicare |
$10,414.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,935.13
|
| Rate for Payer: Meridian Medicaid |
$10,935.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,976.57
|
| Rate for Payer: Molina Medicare/Medicaid |
$11,455.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,148.16
|
| Rate for Payer: Nomi Health Commercial |
$31,243.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,660.14
|
| Rate for Payer: PACE Medicare |
$9,893.69
|
| Rate for Payer: PACE SWMI |
$10,414.41
|
| Rate for Payer: PHP Commercial |
$4,148.16
|
| Rate for Payer: PHP Medicare Advantage |
$10,414.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,446.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$33,679.26
|
| Rate for Payer: Priority Health Medicare |
$10,414.41
|
| Rate for Payer: Priority Health SBD |
$3,074.52
|
| Rate for Payer: Priority Health Tiered Network |
$26,943.41
|
| Rate for Payer: Railroad Medicare Medicare |
$10,414.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10,414.41
|
| Rate for Payer: UHC Medicaid |
$5,446.74
|
| Rate for Payer: UHCCP Medicaid |
$5,446.74
|
| Rate for Payer: UMR Bronson Commercial |
$1,805.67
|
| Rate for Payer: VA VA |
$10,414.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,660.14
|
|
|
HC UPGRADE TO BI-V PACEMAKER/ICD
|
Facility
|
IP
|
$4,880.19
|
|
|
Service Code
|
CPT 33224
|
| Hospital Charge Code |
36100069
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,147.28 |
| Max. Negotiated Rate |
$4,392.17 |
| Rate for Payer: Aetna American Axle |
$3,172.12
|
| Rate for Payer: Aetna Commercial |
$4,148.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,172.12
|
| Rate for Payer: Cash Price |
$3,904.15
|
| Rate for Payer: Cofinity Advantage |
$3,416.13
|
| Rate for Payer: Cofinity Commercial |
$4,196.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,904.15
|
| Rate for Payer: Healthscope Commercial |
$4,392.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,416.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,660.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,148.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,660.14
|
| Rate for Payer: PHP Commercial |
$4,148.16
|
| Rate for Payer: Priority Health SBD |
$3,074.52
|
| Rate for Payer: UMR Bronson Commercial |
$2,147.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,660.14
|
|
