|
HC US RETROPERITONEAL COMPLETE
|
Facility
|
IP
|
$765.71
|
|
|
Service Code
|
CPT 76770
|
| Hospital Charge Code |
40200011
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$336.91 |
| Max. Negotiated Rate |
$689.14 |
| Rate for Payer: Aetna American Axle |
$497.71
|
| Rate for Payer: Aetna Commercial |
$650.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$497.71
|
| Rate for Payer: Cash Price |
$612.57
|
| Rate for Payer: Cofinity Commercial |
$536.00
|
| Rate for Payer: Cofinity Commercial |
$658.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$536.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$612.57
|
| Rate for Payer: Healthscope Commercial |
$689.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$536.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$574.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$650.85
|
| Rate for Payer: PHP Commercial |
$650.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$497.71
|
| Rate for Payer: Priority Health SBD |
$482.40
|
| Rate for Payer: UMR Bronson Commercial |
$336.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$574.28
|
|
|
HC US RETROPERITONEAL COMPLETE
|
Facility
|
OP
|
$765.71
|
|
|
Service Code
|
CPT 76770
|
| Hospital Charge Code |
40200011
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$55.85 |
| Max. Negotiated Rate |
$689.14 |
| Rate for Payer: Aetna American Axle |
$497.71
|
| Rate for Payer: Aetna Commercial |
$650.85
|
| Rate for Payer: Aetna Medicare |
$108.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$497.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.24
|
| Rate for Payer: BCBS Complete |
$58.64
|
| Rate for Payer: BCBS MAPPO |
$104.19
|
| Rate for Payer: BCBS Trust/PPO |
$151.20
|
| Rate for Payer: BCN Commercial |
$151.20
|
| Rate for Payer: BCN Medicare Advantage |
$104.19
|
| Rate for Payer: Cash Price |
$612.57
|
| Rate for Payer: Cash Price |
$612.57
|
| Rate for Payer: Cofinity Commercial |
$658.51
|
| Rate for Payer: Cofinity Commercial |
$536.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$536.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$612.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.19
|
| Rate for Payer: Healthscope Commercial |
$689.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$536.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$574.28
|
| Rate for Payer: Mclaren Medicaid |
$55.85
|
| Rate for Payer: Mclaren Medicare |
$104.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.40
|
| Rate for Payer: Meridian Medicaid |
$58.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$650.85
|
| Rate for Payer: Nomi Health Commercial |
$312.57
|
| Rate for Payer: PACE Medicare |
$98.98
|
| Rate for Payer: PACE SWMI |
$104.19
|
| Rate for Payer: PHP Commercial |
$650.85
|
| Rate for Payer: PHP Medicare Advantage |
$104.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$497.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$327.48
|
| Rate for Payer: Priority Health Medicare |
$104.19
|
| Rate for Payer: Priority Health Narrow Network |
$261.98
|
| Rate for Payer: Priority Health SBD |
$482.40
|
| Rate for Payer: Railroad Medicare Medicare |
$104.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$109.48
|
| Rate for Payer: UHC Core |
$367.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.19
|
| Rate for Payer: UHC Exchange |
$99.53
|
| Rate for Payer: UHC Medicare Advantage |
$104.19
|
| Rate for Payer: UHCCP Medicaid |
$55.85
|
| Rate for Payer: UMR Bronson Commercial |
$283.31
|
| Rate for Payer: VA VA |
$104.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$574.28
|
|
|
HC US RETROPERITONEAL LTD
|
Facility
|
IP
|
$765.71
|
|
|
Service Code
|
CPT 76775
|
| Hospital Charge Code |
40200012
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$336.91 |
| Max. Negotiated Rate |
$689.14 |
| Rate for Payer: Aetna American Axle |
$497.71
|
| Rate for Payer: Aetna Commercial |
$650.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$497.71
|
| Rate for Payer: Cash Price |
$612.57
|
| Rate for Payer: Cofinity Commercial |
$536.00
|
| Rate for Payer: Cofinity Commercial |
$658.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$536.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$612.57
|
| Rate for Payer: Healthscope Commercial |
$689.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$536.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$574.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$650.85
|
| Rate for Payer: PHP Commercial |
$650.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$497.71
|
| Rate for Payer: Priority Health SBD |
$482.40
|
| Rate for Payer: UMR Bronson Commercial |
$336.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$574.28
|
|
|
HC US RETROPERITONEAL LTD
|
Facility
|
OP
|
$765.71
|
|
|
Service Code
|
CPT 76775
|
| Hospital Charge Code |
40200012
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$55.43 |
| Max. Negotiated Rate |
$689.14 |
| Rate for Payer: Aetna American Axle |
$497.71
|
| Rate for Payer: Aetna Commercial |
$650.85
|
| Rate for Payer: Aetna Medicare |
$108.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$497.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.24
|
| Rate for Payer: BCBS Complete |
$58.64
|
| Rate for Payer: BCBS MAPPO |
$104.19
|
| Rate for Payer: BCBS Trust/PPO |
$67.04
|
| Rate for Payer: BCN Commercial |
$67.04
|
| Rate for Payer: BCN Medicare Advantage |
$104.19
|
| Rate for Payer: Cash Price |
$612.57
|
| Rate for Payer: Cash Price |
$612.57
|
| Rate for Payer: Cofinity Commercial |
$658.51
|
| Rate for Payer: Cofinity Commercial |
$536.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$536.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$612.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.19
|
| Rate for Payer: Healthscope Commercial |
$689.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$536.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$574.28
|
| Rate for Payer: Mclaren Medicaid |
$55.85
|
| Rate for Payer: Mclaren Medicare |
$104.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.40
|
| Rate for Payer: Meridian Medicaid |
$58.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$650.85
|
| Rate for Payer: Nomi Health Commercial |
$312.57
|
| Rate for Payer: PACE Medicare |
$98.98
|
| Rate for Payer: PACE SWMI |
$104.19
|
| Rate for Payer: PHP Commercial |
$650.85
|
| Rate for Payer: PHP Medicare Advantage |
$104.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$497.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$327.48
|
| Rate for Payer: Priority Health Medicare |
$104.19
|
| Rate for Payer: Priority Health Narrow Network |
$261.98
|
| Rate for Payer: Priority Health SBD |
$482.40
|
| Rate for Payer: Railroad Medicare Medicare |
$104.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.97
|
| Rate for Payer: UHC Core |
$367.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.19
|
| Rate for Payer: UHC Exchange |
$55.43
|
| Rate for Payer: UHC Medicare Advantage |
$104.19
|
| Rate for Payer: UHCCP Medicaid |
$55.85
|
| Rate for Payer: UMR Bronson Commercial |
$283.31
|
| Rate for Payer: VA VA |
$104.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$574.28
|
|
|
HC US SCROTUM AND CONTENTS
|
Facility
|
OP
|
$714.62
|
|
|
Service Code
|
CPT 76870
|
| Hospital Charge Code |
40200035
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$55.85 |
| Max. Negotiated Rate |
$643.16 |
| Rate for Payer: Aetna American Axle |
$464.50
|
| Rate for Payer: Aetna Commercial |
$607.43
|
| Rate for Payer: Aetna Medicare |
$108.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$464.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.24
|
| Rate for Payer: BCBS Complete |
$58.64
|
| Rate for Payer: BCBS MAPPO |
$104.19
|
| Rate for Payer: BCBS Trust/PPO |
$144.36
|
| Rate for Payer: BCN Commercial |
$144.36
|
| Rate for Payer: BCN Medicare Advantage |
$104.19
|
| Rate for Payer: Cash Price |
$571.70
|
| Rate for Payer: Cash Price |
$571.70
|
| Rate for Payer: Cofinity Commercial |
$614.57
|
| Rate for Payer: Cofinity Commercial |
$500.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$500.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$571.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.19
|
| Rate for Payer: Healthscope Commercial |
$643.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$500.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$535.96
|
| Rate for Payer: Mclaren Medicaid |
$55.85
|
| Rate for Payer: Mclaren Medicare |
$104.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.40
|
| Rate for Payer: Meridian Medicaid |
$58.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$607.43
|
| Rate for Payer: Nomi Health Commercial |
$312.57
|
| Rate for Payer: PACE Medicare |
$98.98
|
| Rate for Payer: PACE SWMI |
$104.19
|
| Rate for Payer: PHP Commercial |
$607.43
|
| Rate for Payer: PHP Medicare Advantage |
$104.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$464.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$327.48
|
| Rate for Payer: Priority Health Medicare |
$104.19
|
| Rate for Payer: Priority Health Narrow Network |
$261.98
|
| Rate for Payer: Priority Health SBD |
$450.21
|
| Rate for Payer: Railroad Medicare Medicare |
$104.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$100.87
|
| Rate for Payer: UHC Core |
$367.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.19
|
| Rate for Payer: UHC Exchange |
$91.70
|
| Rate for Payer: UHC Medicare Advantage |
$104.19
|
| Rate for Payer: UHCCP Medicaid |
$55.85
|
| Rate for Payer: UMR Bronson Commercial |
$264.41
|
| Rate for Payer: VA VA |
$104.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$535.96
|
|
|
HC US SCROTUM AND CONTENTS
|
Facility
|
IP
|
$714.62
|
|
|
Service Code
|
CPT 76870
|
| Hospital Charge Code |
40200035
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$314.43 |
| Max. Negotiated Rate |
$643.16 |
| Rate for Payer: Aetna American Axle |
$464.50
|
| Rate for Payer: Aetna Commercial |
$607.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$464.50
|
| Rate for Payer: Cash Price |
$571.70
|
| Rate for Payer: Cofinity Commercial |
$500.23
|
| Rate for Payer: Cofinity Commercial |
$614.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$500.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$571.70
|
| Rate for Payer: Healthscope Commercial |
$643.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$500.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$535.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$607.43
|
| Rate for Payer: PHP Commercial |
$607.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$464.50
|
| Rate for Payer: Priority Health SBD |
$450.21
|
| Rate for Payer: UMR Bronson Commercial |
$314.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$535.96
|
|
|
HC U.S. SKIN PREP PACK
|
Facility
|
IP
|
$16.89
|
|
| Hospital Charge Code |
27000163
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.43 |
| Max. Negotiated Rate |
$15.20 |
| Rate for Payer: PHP Commercial |
$14.36
|
| Rate for Payer: Aetna American Axle |
$10.98
|
| Rate for Payer: Aetna Commercial |
$14.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.98
|
| Rate for Payer: Cash Price |
$13.51
|
| Rate for Payer: Cofinity Commercial |
$11.82
|
| Rate for Payer: Cofinity Commercial |
$14.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.51
|
| Rate for Payer: Healthscope Commercial |
$15.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.98
|
| Rate for Payer: Priority Health SBD |
$10.64
|
| Rate for Payer: UMR Bronson Commercial |
$7.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.67
|
|
|
HC U.S. SKIN PREP PACK
|
Facility
|
OP
|
$16.89
|
|
| Hospital Charge Code |
27000163
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.25 |
| Max. Negotiated Rate |
$15.20 |
| Rate for Payer: Aetna American Axle |
$10.98
|
| Rate for Payer: Aetna Commercial |
$14.36
|
| Rate for Payer: Aetna Medicare |
$8.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.98
|
| Rate for Payer: BCBS Complete |
$6.76
|
| Rate for Payer: Cash Price |
$13.51
|
| Rate for Payer: Cofinity Commercial |
$11.82
|
| Rate for Payer: Cofinity Commercial |
$14.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.51
|
| Rate for Payer: Healthscope Commercial |
$15.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.36
|
| Rate for Payer: PHP Commercial |
$14.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.98
|
| Rate for Payer: Priority Health SBD |
$10.64
|
| Rate for Payer: UMR Bronson Commercial |
$6.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.67
|
|
|
HC US SOFT TISSUE HEAD NECK
|
Facility
|
IP
|
$785.96
|
|
|
Service Code
|
CPT 76536
|
| Hospital Charge Code |
40200006
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$345.82 |
| Max. Negotiated Rate |
$707.36 |
| Rate for Payer: Aetna American Axle |
$510.87
|
| Rate for Payer: Aetna Commercial |
$668.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$510.87
|
| Rate for Payer: Cash Price |
$628.77
|
| Rate for Payer: Cofinity Commercial |
$550.17
|
| Rate for Payer: Cofinity Commercial |
$675.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$550.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$628.77
|
| Rate for Payer: Healthscope Commercial |
$707.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$550.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$589.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$668.07
|
| Rate for Payer: PHP Commercial |
$668.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$510.87
|
| Rate for Payer: Priority Health SBD |
$495.15
|
| Rate for Payer: UMR Bronson Commercial |
$345.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$589.47
|
|
|
HC US SOFT TISSUE HEAD NECK
|
Facility
|
OP
|
$785.96
|
|
|
Service Code
|
CPT 76536
|
| Hospital Charge Code |
40200006
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$55.85 |
| Max. Negotiated Rate |
$707.36 |
| Rate for Payer: Aetna American Axle |
$510.87
|
| Rate for Payer: Aetna Commercial |
$668.07
|
| Rate for Payer: Aetna Medicare |
$108.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$510.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.24
|
| Rate for Payer: BCBS Complete |
$58.64
|
| Rate for Payer: BCBS MAPPO |
$104.19
|
| Rate for Payer: BCBS Trust/PPO |
$172.42
|
| Rate for Payer: BCN Commercial |
$172.42
|
| Rate for Payer: BCN Medicare Advantage |
$104.19
|
| Rate for Payer: Cash Price |
$628.77
|
| Rate for Payer: Cash Price |
$628.77
|
| Rate for Payer: Cofinity Commercial |
$675.93
|
| Rate for Payer: Cofinity Commercial |
$550.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$550.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$628.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.19
|
| Rate for Payer: Healthscope Commercial |
$707.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$550.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$589.47
|
| Rate for Payer: Mclaren Medicaid |
$55.85
|
| Rate for Payer: Mclaren Medicare |
$104.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.40
|
| Rate for Payer: Meridian Medicaid |
$58.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$668.07
|
| Rate for Payer: Nomi Health Commercial |
$312.57
|
| Rate for Payer: PACE Medicare |
$98.98
|
| Rate for Payer: PACE SWMI |
$104.19
|
| Rate for Payer: PHP Commercial |
$668.07
|
| Rate for Payer: PHP Medicare Advantage |
$104.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$510.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$327.48
|
| Rate for Payer: Priority Health Medicare |
$104.19
|
| Rate for Payer: Priority Health Narrow Network |
$261.98
|
| Rate for Payer: Priority Health SBD |
$495.15
|
| Rate for Payer: Railroad Medicare Medicare |
$104.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$110.78
|
| Rate for Payer: UHC Core |
$367.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.19
|
| Rate for Payer: UHC Exchange |
$100.71
|
| Rate for Payer: UHC Medicare Advantage |
$104.19
|
| Rate for Payer: UHCCP Medicaid |
$55.85
|
| Rate for Payer: UMR Bronson Commercial |
$290.81
|
| Rate for Payer: VA VA |
$104.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$589.47
|
|
|
HC US SPINAL CANAL AND CONTENTS
|
Facility
|
OP
|
$486.00
|
|
|
Service Code
|
CPT 76800
|
| Hospital Charge Code |
40200014
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$55.85 |
| Max. Negotiated Rate |
$437.40 |
| Rate for Payer: Aetna American Axle |
$315.90
|
| Rate for Payer: Aetna Commercial |
$413.10
|
| Rate for Payer: Aetna Medicare |
$108.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$315.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.24
|
| Rate for Payer: BCBS Complete |
$58.64
|
| Rate for Payer: BCBS MAPPO |
$104.19
|
| Rate for Payer: BCBS Trust/PPO |
$229.20
|
| Rate for Payer: BCN Commercial |
$229.20
|
| Rate for Payer: BCN Medicare Advantage |
$104.19
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Cofinity Commercial |
$417.96
|
| Rate for Payer: Cofinity Commercial |
$340.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$340.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$388.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.19
|
| Rate for Payer: Healthscope Commercial |
$437.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$340.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$364.50
|
| Rate for Payer: Mclaren Medicaid |
$55.85
|
| Rate for Payer: Mclaren Medicare |
$104.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.40
|
| Rate for Payer: Meridian Medicaid |
$58.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$413.10
|
| Rate for Payer: Nomi Health Commercial |
$312.57
|
| Rate for Payer: PACE Medicare |
$98.98
|
| Rate for Payer: PACE SWMI |
$104.19
|
| Rate for Payer: PHP Commercial |
$413.10
|
| Rate for Payer: PHP Medicare Advantage |
$104.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$327.48
|
| Rate for Payer: Priority Health Medicare |
$104.19
|
| Rate for Payer: Priority Health Narrow Network |
$261.98
|
| Rate for Payer: Priority Health SBD |
$306.18
|
| Rate for Payer: Railroad Medicare Medicare |
$104.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$175.81
|
| Rate for Payer: UHC Core |
$367.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.19
|
| Rate for Payer: UHC Exchange |
$159.83
|
| Rate for Payer: UHC Medicare Advantage |
$104.19
|
| Rate for Payer: UHCCP Medicaid |
$55.85
|
| Rate for Payer: UMR Bronson Commercial |
$179.82
|
| Rate for Payer: VA VA |
$104.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$364.50
|
|
|
HC US SPINAL CANAL AND CONTENTS
|
Facility
|
IP
|
$486.00
|
|
|
Service Code
|
CPT 76800
|
| Hospital Charge Code |
40200014
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$213.84 |
| Max. Negotiated Rate |
$437.40 |
| Rate for Payer: Aetna American Axle |
$315.90
|
| Rate for Payer: Aetna Commercial |
$413.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$315.90
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Cofinity Commercial |
$340.20
|
| Rate for Payer: Cofinity Commercial |
$417.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$340.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$388.80
|
| Rate for Payer: Healthscope Commercial |
$437.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$340.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$364.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$413.10
|
| Rate for Payer: PHP Commercial |
$413.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.90
|
| Rate for Payer: Priority Health SBD |
$306.18
|
| Rate for Payer: UMR Bronson Commercial |
$213.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$364.50
|
|
|
HC US SURGERY INTRAOPERATIVE
|
Facility
|
OP
|
$680.42
|
|
|
Service Code
|
CPT 76998
|
| Hospital Charge Code |
40200050
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$190.20 |
| Max. Negotiated Rate |
$612.38 |
| Rate for Payer: Aetna American Axle |
$442.27
|
| Rate for Payer: Aetna Commercial |
$578.36
|
| Rate for Payer: Aetna Medicare |
$340.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$442.27
|
| Rate for Payer: BCBS Complete |
$272.17
|
| Rate for Payer: BCBS Trust/PPO |
$190.20
|
| Rate for Payer: BCN Commercial |
$190.20
|
| Rate for Payer: Cash Price |
$544.34
|
| Rate for Payer: Cash Price |
$544.34
|
| Rate for Payer: Cofinity Commercial |
$585.16
|
| Rate for Payer: Cofinity Commercial |
$476.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$476.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$544.34
|
| Rate for Payer: Healthscope Commercial |
$612.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$476.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$510.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$578.36
|
| Rate for Payer: PHP Commercial |
$578.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$442.27
|
| Rate for Payer: Priority Health SBD |
$428.66
|
| Rate for Payer: UHC Core |
$367.00
|
| Rate for Payer: UMR Bronson Commercial |
$251.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$510.32
|
|
|
HC US SURGERY INTRAOPERATIVE
|
Facility
|
IP
|
$680.42
|
|
|
Service Code
|
CPT 76998
|
| Hospital Charge Code |
40200050
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$299.38 |
| Max. Negotiated Rate |
$612.38 |
| Rate for Payer: Aetna American Axle |
$442.27
|
| Rate for Payer: Aetna Commercial |
$578.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$442.27
|
| Rate for Payer: Cash Price |
$544.34
|
| Rate for Payer: Cofinity Commercial |
$476.29
|
| Rate for Payer: Cofinity Commercial |
$585.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$476.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$544.34
|
| Rate for Payer: Healthscope Commercial |
$612.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$476.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$510.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$578.36
|
| Rate for Payer: PHP Commercial |
$578.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$442.27
|
| Rate for Payer: Priority Health SBD |
$428.66
|
| Rate for Payer: UMR Bronson Commercial |
$299.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$510.32
|
|
|
HC USTEKINUMAB AND AB
|
Facility
|
OP
|
$166.26
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100673
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.26 |
| Max. Negotiated Rate |
$149.63 |
| Rate for Payer: Aetna American Axle |
$108.07
|
| Rate for Payer: Aetna Commercial |
$141.32
|
| Rate for Payer: Aetna Medicare |
$17.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.59
|
| Rate for Payer: BCBS Complete |
$9.72
|
| Rate for Payer: BCBS MAPPO |
$17.27
|
| Rate for Payer: BCBS Trust/PPO |
$16.64
|
| Rate for Payer: BCN Commercial |
$16.64
|
| Rate for Payer: BCN Medicare Advantage |
$17.27
|
| Rate for Payer: Cash Price |
$133.01
|
| Rate for Payer: Cash Price |
$133.01
|
| Rate for Payer: Cofinity Commercial |
$142.98
|
| Rate for Payer: Cofinity Commercial |
$116.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$116.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.27
|
| Rate for Payer: Healthscope Commercial |
$149.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$116.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$124.70
|
| Rate for Payer: Mclaren Medicaid |
$9.26
|
| Rate for Payer: Mclaren Medicare |
$17.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.13
|
| Rate for Payer: Meridian Medicaid |
$9.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.32
|
| Rate for Payer: Nomi Health Commercial |
$25.90
|
| Rate for Payer: PACE Medicare |
$16.41
|
| Rate for Payer: PACE SWMI |
$17.27
|
| Rate for Payer: PHP Commercial |
$141.32
|
| Rate for Payer: PHP Medicare Advantage |
$17.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.27
|
| Rate for Payer: Priority Health Medicare |
$17.27
|
| Rate for Payer: Priority Health Narrow Network |
$13.82
|
| Rate for Payer: Priority Health SBD |
$104.74
|
| Rate for Payer: Railroad Medicare Medicare |
$17.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.27
|
| Rate for Payer: UHC Exchange |
$17.27
|
| Rate for Payer: UHC Medicare Advantage |
$17.27
|
| Rate for Payer: UHCCP Medicaid |
$9.26
|
| Rate for Payer: UMR Bronson Commercial |
$61.52
|
| Rate for Payer: VA VA |
$17.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$124.70
|
|
|
HC USTEKINUMAB AND AB
|
Facility
|
IP
|
$166.26
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100673
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$73.15 |
| Max. Negotiated Rate |
$149.63 |
| Rate for Payer: Aetna American Axle |
$108.07
|
| Rate for Payer: Aetna Commercial |
$141.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.07
|
| Rate for Payer: Cash Price |
$133.01
|
| Rate for Payer: Cofinity Commercial |
$116.38
|
| Rate for Payer: Cofinity Commercial |
$142.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$116.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.01
|
| Rate for Payer: Healthscope Commercial |
$149.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$116.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$124.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.32
|
| Rate for Payer: PHP Commercial |
$141.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.07
|
| Rate for Payer: Priority Health SBD |
$104.74
|
| Rate for Payer: UMR Bronson Commercial |
$73.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$124.70
|
|
|
HC USTEKINUMAB AND AB CMPT
|
Facility
|
OP
|
$165.24
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100674
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.99 |
| Max. Negotiated Rate |
$148.72 |
| Rate for Payer: Meridian Medicaid |
$10.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.45
|
| Rate for Payer: Nomi Health Commercial |
$27.96
|
| Rate for Payer: PACE Medicare |
$17.71
|
| Rate for Payer: PACE SWMI |
$18.64
|
| Rate for Payer: PHP Commercial |
$140.45
|
| Rate for Payer: PHP Medicare Advantage |
$18.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.41
|
| Rate for Payer: Priority Health Medicare |
$18.64
|
| Rate for Payer: Priority Health SBD |
$104.10
|
| Rate for Payer: Railroad Medicare Medicare |
$18.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.64
|
| Rate for Payer: UHC Exchange |
$18.64
|
| Rate for Payer: UHC Medicare Advantage |
$18.64
|
| Rate for Payer: UHCCP Medicaid |
$9.99
|
| Rate for Payer: UMR Bronson Commercial |
$61.14
|
| Rate for Payer: VA VA |
$18.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.93
|
| Rate for Payer: Aetna American Axle |
$107.41
|
| Rate for Payer: Aetna Commercial |
$140.45
|
| Rate for Payer: Aetna Medicare |
$19.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.30
|
| Rate for Payer: BCBS Complete |
$10.49
|
| Rate for Payer: BCBS MAPPO |
$18.64
|
| Rate for Payer: BCBS Trust/PPO |
$17.96
|
| Rate for Payer: BCN Commercial |
$17.96
|
| Rate for Payer: BCN Medicare Advantage |
$18.64
|
| Rate for Payer: Cash Price |
$132.19
|
| Rate for Payer: Cash Price |
$132.19
|
| Rate for Payer: Cofinity Commercial |
$142.11
|
| Rate for Payer: Cofinity Commercial |
$115.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$115.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.64
|
| Rate for Payer: Healthscope Commercial |
$148.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$115.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.93
|
| Rate for Payer: Mclaren Medicaid |
$9.99
|
| Rate for Payer: Mclaren Medicare |
$18.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.57
|
|
|
HC USTEKINUMAB AND AB CMPT
|
Facility
|
IP
|
$165.24
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100674
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$72.71 |
| Max. Negotiated Rate |
$148.72 |
| Rate for Payer: Aetna American Axle |
$107.41
|
| Rate for Payer: Aetna Commercial |
$140.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.41
|
| Rate for Payer: Cash Price |
$132.19
|
| Rate for Payer: Cofinity Commercial |
$115.67
|
| Rate for Payer: Cofinity Commercial |
$142.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$115.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.19
|
| Rate for Payer: Healthscope Commercial |
$148.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$115.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.45
|
| Rate for Payer: PHP Commercial |
$140.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.41
|
| Rate for Payer: Priority Health SBD |
$104.10
|
| Rate for Payer: UMR Bronson Commercial |
$72.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.93
|
|
|
HC US TRANSPLANTED KIDNEY
|
Facility
|
IP
|
$510.39
|
|
|
Service Code
|
CPT 76776
|
| Hospital Charge Code |
40200013
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$224.57 |
| Max. Negotiated Rate |
$459.35 |
| Rate for Payer: Aetna American Axle |
$331.75
|
| Rate for Payer: Aetna Commercial |
$433.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$331.75
|
| Rate for Payer: Cash Price |
$408.31
|
| Rate for Payer: Cofinity Commercial |
$357.27
|
| Rate for Payer: Cofinity Commercial |
$438.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$357.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.31
|
| Rate for Payer: Healthscope Commercial |
$459.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$357.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$382.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$433.83
|
| Rate for Payer: PHP Commercial |
$433.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.75
|
| Rate for Payer: Priority Health SBD |
$321.55
|
| Rate for Payer: UMR Bronson Commercial |
$224.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$382.79
|
|
|
HC US TRANSPLANTED KIDNEY
|
Facility
|
OP
|
$510.39
|
|
|
Service Code
|
CPT 76776
|
| Hospital Charge Code |
40200013
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$55.85 |
| Max. Negotiated Rate |
$459.35 |
| Rate for Payer: Aetna American Axle |
$331.75
|
| Rate for Payer: Aetna Commercial |
$433.83
|
| Rate for Payer: Aetna Medicare |
$108.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$331.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.24
|
| Rate for Payer: BCBS Complete |
$58.64
|
| Rate for Payer: BCBS MAPPO |
$104.19
|
| Rate for Payer: BCBS Trust/PPO |
$229.88
|
| Rate for Payer: BCN Commercial |
$229.88
|
| Rate for Payer: BCN Medicare Advantage |
$104.19
|
| Rate for Payer: Cash Price |
$408.31
|
| Rate for Payer: Cash Price |
$408.31
|
| Rate for Payer: Cofinity Commercial |
$438.94
|
| Rate for Payer: Cofinity Commercial |
$357.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$357.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.19
|
| Rate for Payer: Healthscope Commercial |
$459.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$357.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$382.79
|
| Rate for Payer: Mclaren Medicaid |
$55.85
|
| Rate for Payer: Mclaren Medicare |
$104.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.40
|
| Rate for Payer: Meridian Medicaid |
$58.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$433.83
|
| Rate for Payer: Nomi Health Commercial |
$312.57
|
| Rate for Payer: PACE Medicare |
$98.98
|
| Rate for Payer: PACE SWMI |
$104.19
|
| Rate for Payer: PHP Commercial |
$433.83
|
| Rate for Payer: PHP Medicare Advantage |
$104.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$327.48
|
| Rate for Payer: Priority Health Medicare |
$104.19
|
| Rate for Payer: Priority Health Narrow Network |
$261.98
|
| Rate for Payer: Priority Health SBD |
$321.55
|
| Rate for Payer: Railroad Medicare Medicare |
$104.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$148.04
|
| Rate for Payer: UHC Core |
$367.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.19
|
| Rate for Payer: UHC Exchange |
$134.58
|
| Rate for Payer: UHC Medicare Advantage |
$104.19
|
| Rate for Payer: UHCCP Medicaid |
$55.85
|
| Rate for Payer: UMR Bronson Commercial |
$188.84
|
| Rate for Payer: VA VA |
$104.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$382.79
|
|
|
HC UVULECTOMY EXCISION UVULA
|
Facility
|
OP
|
$8,058.00
|
|
|
Service Code
|
CPT 42140
|
| Hospital Charge Code |
76100468
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$154.67 |
| Max. Negotiated Rate |
$9,986.81 |
| Rate for Payer: Aetna American Axle |
$5,237.70
|
| Rate for Payer: Aetna Commercial |
$6,849.30
|
| Rate for Payer: Aetna Medicare |
$3,304.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,237.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,971.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,971.88
|
| Rate for Payer: BCBS Complete |
$1,788.30
|
| Rate for Payer: BCBS MAPPO |
$3,177.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,708.82
|
| Rate for Payer: BCN Commercial |
$1,708.82
|
| Rate for Payer: BCN Medicare Advantage |
$3,177.50
|
| Rate for Payer: Cash Price |
$6,446.40
|
| Rate for Payer: Cash Price |
$6,446.40
|
| Rate for Payer: Cash Price |
$6,446.40
|
| Rate for Payer: Cofinity Commercial |
$6,929.88
|
| Rate for Payer: Cofinity Commercial |
$5,640.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,640.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,446.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,177.50
|
| Rate for Payer: Healthscope Commercial |
$7,252.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,640.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,043.50
|
| Rate for Payer: Mclaren Medicaid |
$1,703.14
|
| Rate for Payer: Mclaren Medicare |
$3,177.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,336.38
|
| Rate for Payer: Meridian Medicaid |
$1,788.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,654.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,849.30
|
| Rate for Payer: Nomi Health Commercial |
$6,672.75
|
| Rate for Payer: PACE Medicare |
$3,018.62
|
| Rate for Payer: PACE SWMI |
$3,177.50
|
| Rate for Payer: PHP Commercial |
$6,849.30
|
| Rate for Payer: PHP Medicare Advantage |
$3,177.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,237.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,986.81
|
| Rate for Payer: Priority Health Medicare |
$3,177.50
|
| Rate for Payer: Priority Health Narrow Network |
$7,989.45
|
| Rate for Payer: Priority Health SBD |
$5,076.54
|
| Rate for Payer: Railroad Medicare Medicare |
$3,177.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$170.14
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,177.50
|
| Rate for Payer: UHC Exchange |
$154.67
|
| Rate for Payer: UHC Medicare Advantage |
$3,177.50
|
| Rate for Payer: UHCCP Medicaid |
$1,703.14
|
| Rate for Payer: UMR Bronson Commercial |
$2,981.46
|
| Rate for Payer: VA VA |
$3,177.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,043.50
|
|
|
HC UVULECTOMY EXCISION UVULA
|
Facility
|
IP
|
$8,058.00
|
|
|
Service Code
|
CPT 42140
|
| Hospital Charge Code |
76100468
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,545.52 |
| Max. Negotiated Rate |
$7,252.20 |
| Rate for Payer: Aetna American Axle |
$5,237.70
|
| Rate for Payer: Aetna Commercial |
$6,849.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,237.70
|
| Rate for Payer: Cash Price |
$6,446.40
|
| Rate for Payer: Cofinity Commercial |
$5,640.60
|
| Rate for Payer: Cofinity Commercial |
$6,929.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,640.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,446.40
|
| Rate for Payer: Healthscope Commercial |
$7,252.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,640.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,043.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,849.30
|
| Rate for Payer: PHP Commercial |
$6,849.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,237.70
|
| Rate for Payer: Priority Health SBD |
$5,076.54
|
| Rate for Payer: UMR Bronson Commercial |
$3,545.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,043.50
|
|
|
HC V5011 FITTING ORIENTATION CHECKING OF HEARING AID
|
Facility
|
IP
|
$61.20
|
|
|
Service Code
|
CPT V5011
|
| Hospital Charge Code |
47000008
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$26.93 |
| Max. Negotiated Rate |
$55.08 |
| Rate for Payer: Aetna American Axle |
$39.78
|
| Rate for Payer: Aetna Commercial |
$52.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.78
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cofinity Commercial |
$42.84
|
| Rate for Payer: Cofinity Commercial |
$52.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$42.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.96
|
| Rate for Payer: Healthscope Commercial |
$55.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.02
|
| Rate for Payer: PHP Commercial |
$52.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.78
|
| Rate for Payer: Priority Health SBD |
$38.56
|
| Rate for Payer: UMR Bronson Commercial |
$26.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.90
|
|
|
HC V5011 FITTING ORIENTATION CHECKING OF HEARING AID
|
Facility
|
OP
|
$61.20
|
|
|
Service Code
|
CPT V5011
|
| Hospital Charge Code |
47000008
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$22.64 |
| Max. Negotiated Rate |
$294.00 |
| Rate for Payer: Aetna American Axle |
$39.78
|
| Rate for Payer: Aetna Commercial |
$52.02
|
| Rate for Payer: Aetna Medicare |
$30.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.78
|
| Rate for Payer: BCBS Complete |
$24.48
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cofinity Commercial |
$52.63
|
| Rate for Payer: Cofinity Commercial |
$42.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$42.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.96
|
| Rate for Payer: Healthscope Commercial |
$55.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.02
|
| Rate for Payer: PHP Commercial |
$52.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.78
|
| Rate for Payer: Priority Health SBD |
$38.56
|
| Rate for Payer: UHC Core |
$294.00
|
| Rate for Payer: UMR Bronson Commercial |
$22.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.90
|
|
|
HC V5160 DISPENSING FEE BINAURAL
|
Facility
|
OP
|
$484.50
|
|
|
Service Code
|
CPT V5160
|
| Hospital Charge Code |
47000006
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$179.26 |
| Max. Negotiated Rate |
$436.05 |
| Rate for Payer: Aetna American Axle |
$314.92
|
| Rate for Payer: Aetna Commercial |
$411.82
|
| Rate for Payer: Aetna Medicare |
$242.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$314.92
|
| Rate for Payer: BCBS Complete |
$193.80
|
| Rate for Payer: Cash Price |
$387.60
|
| Rate for Payer: Cash Price |
$387.60
|
| Rate for Payer: Cofinity Commercial |
$416.67
|
| Rate for Payer: Cofinity Commercial |
$339.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$339.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$387.60
|
| Rate for Payer: Healthscope Commercial |
$436.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$339.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$363.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$411.82
|
| Rate for Payer: PHP Commercial |
$411.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$314.92
|
| Rate for Payer: Priority Health SBD |
$305.24
|
| Rate for Payer: UHC Core |
$294.00
|
| Rate for Payer: UMR Bronson Commercial |
$179.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$363.38
|
|
