|
HC V5160 DISPENSING FEE BINAURAL
|
Facility
|
IP
|
$484.50
|
|
|
Service Code
|
CPT V5160
|
| Hospital Charge Code |
47000006
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$213.18 |
| Max. Negotiated Rate |
$436.05 |
| Rate for Payer: Aetna American Axle |
$314.92
|
| Rate for Payer: Aetna Commercial |
$411.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$314.92
|
| Rate for Payer: Cash Price |
$387.60
|
| Rate for Payer: Cofinity Commercial |
$339.15
|
| Rate for Payer: Cofinity Commercial |
$416.67
|
| 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: UMR Bronson Commercial |
$213.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$363.38
|
|
|
HC V5241 DISPENSING FEE MONAURAL HEARING AID ANY TYPE
|
Facility
|
IP
|
$280.50
|
|
|
Service Code
|
CPT V5241
|
| Hospital Charge Code |
47000004
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$123.42 |
| Max. Negotiated Rate |
$252.45 |
| Rate for Payer: Aetna American Axle |
$182.32
|
| Rate for Payer: Aetna Commercial |
$238.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.32
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cofinity Commercial |
$196.35
|
| Rate for Payer: Cofinity Commercial |
$241.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$196.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.40
|
| Rate for Payer: Healthscope Commercial |
$252.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$196.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.42
|
| Rate for Payer: PHP Commercial |
$238.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.32
|
| Rate for Payer: Priority Health SBD |
$176.72
|
| Rate for Payer: UMR Bronson Commercial |
$123.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.38
|
|
|
HC V5241 DISPENSING FEE MONAURAL HEARING AID ANY TYPE
|
Facility
|
OP
|
$280.50
|
|
|
Service Code
|
CPT V5241
|
| Hospital Charge Code |
47000004
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$103.78 |
| Max. Negotiated Rate |
$294.00 |
| Rate for Payer: Aetna American Axle |
$182.32
|
| Rate for Payer: Aetna Commercial |
$238.42
|
| Rate for Payer: Aetna Medicare |
$140.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.32
|
| Rate for Payer: BCBS Complete |
$112.20
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cofinity Commercial |
$241.23
|
| Rate for Payer: Cofinity Commercial |
$196.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$196.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.40
|
| Rate for Payer: Healthscope Commercial |
$252.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$196.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.42
|
| Rate for Payer: PHP Commercial |
$238.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.32
|
| Rate for Payer: Priority Health SBD |
$176.72
|
| Rate for Payer: UHC Core |
$294.00
|
| Rate for Payer: UMR Bronson Commercial |
$103.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.38
|
|
|
HC V5264 EAR MOLD INSERT NOT DISPOSABLE ANY TYPE
|
Facility
|
IP
|
$71.40
|
|
|
Service Code
|
CPT V5264
|
| Hospital Charge Code |
47000005
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$31.42 |
| Max. Negotiated Rate |
$64.26 |
| Rate for Payer: Aetna American Axle |
$46.41
|
| Rate for Payer: Aetna Commercial |
$60.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.41
|
| Rate for Payer: Cash Price |
$57.12
|
| Rate for Payer: Cofinity Commercial |
$49.98
|
| Rate for Payer: Cofinity Commercial |
$61.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$49.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.12
|
| Rate for Payer: Healthscope Commercial |
$64.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.69
|
| Rate for Payer: PHP Commercial |
$60.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.41
|
| Rate for Payer: Priority Health SBD |
$44.98
|
| Rate for Payer: UMR Bronson Commercial |
$31.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.55
|
|
|
HC V5264 EAR MOLD INSERT NOT DISPOSABLE ANY TYPE
|
Facility
|
OP
|
$71.40
|
|
|
Service Code
|
CPT V5264
|
| Hospital Charge Code |
47000005
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$26.42 |
| Max. Negotiated Rate |
$294.00 |
| Rate for Payer: Aetna American Axle |
$46.41
|
| Rate for Payer: Aetna Commercial |
$60.69
|
| Rate for Payer: Aetna Medicare |
$35.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.41
|
| Rate for Payer: BCBS Complete |
$28.56
|
| Rate for Payer: Cash Price |
$57.12
|
| Rate for Payer: Cash Price |
$57.12
|
| Rate for Payer: Cofinity Commercial |
$61.40
|
| Rate for Payer: Cofinity Commercial |
$49.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$49.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.12
|
| Rate for Payer: Healthscope Commercial |
$64.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.69
|
| Rate for Payer: PHP Commercial |
$60.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.41
|
| Rate for Payer: Priority Health SBD |
$44.98
|
| Rate for Payer: UHC Core |
$294.00
|
| Rate for Payer: UMR Bronson Commercial |
$26.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.55
|
|
|
HC VACC AIIV4 NO PRSRV 0.5ML IM
|
Facility
|
IP
|
$181.83
|
|
|
Service Code
|
CPT 90694
|
| Hospital Charge Code |
63600224
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$80.01 |
| Max. Negotiated Rate |
$163.65 |
| Rate for Payer: Aetna American Axle |
$118.19
|
| Rate for Payer: Aetna Commercial |
$154.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.19
|
| Rate for Payer: Cash Price |
$145.46
|
| Rate for Payer: Cofinity Commercial |
$127.28
|
| Rate for Payer: Cofinity Commercial |
$156.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$127.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.46
|
| Rate for Payer: Healthscope Commercial |
$163.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$127.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$136.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.56
|
| Rate for Payer: PHP Commercial |
$154.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.19
|
| Rate for Payer: Priority Health SBD |
$114.55
|
| Rate for Payer: UMR Bronson Commercial |
$80.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$136.37
|
|
|
HC VACC AIIV4 NO PRSRV 0.5ML IM
|
Facility
|
OP
|
$181.83
|
|
|
Service Code
|
CPT 90694
|
| Hospital Charge Code |
63600224
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$61.89 |
| Max. Negotiated Rate |
$204.73 |
| Rate for Payer: Aetna American Axle |
$118.19
|
| Rate for Payer: Aetna Commercial |
$154.56
|
| Rate for Payer: Aetna Medicare |
$90.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.19
|
| Rate for Payer: BCBS Complete |
$72.73
|
| Rate for Payer: BCBS Trust/PPO |
$204.73
|
| Rate for Payer: BCN Commercial |
$204.73
|
| Rate for Payer: Cash Price |
$145.46
|
| Rate for Payer: Cash Price |
$145.46
|
| Rate for Payer: Cofinity Commercial |
$127.28
|
| Rate for Payer: Cofinity Commercial |
$156.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$127.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.46
|
| Rate for Payer: Healthscope Commercial |
$163.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$127.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$136.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.56
|
| Rate for Payer: PHP Commercial |
$154.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$77.36
|
| Rate for Payer: Priority Health Narrow Network |
$61.89
|
| Rate for Payer: Priority Health SBD |
$114.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.96
|
| Rate for Payer: UHC Exchange |
$65.96
|
| Rate for Payer: UMR Bronson Commercial |
$67.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$136.37
|
|
|
HC VACC CCIIV4 ABX FREE 0.5 ML IM
|
Facility
|
IP
|
$68.02
|
|
|
Service Code
|
CPT 90756
|
| Hospital Charge Code |
63600223
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.93 |
| Max. Negotiated Rate |
$61.22 |
| Rate for Payer: Aetna American Axle |
$44.21
|
| Rate for Payer: Aetna Commercial |
$57.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.21
|
| Rate for Payer: Cash Price |
$54.42
|
| Rate for Payer: Cofinity Commercial |
$47.61
|
| Rate for Payer: Cofinity Commercial |
$58.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$47.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.42
|
| Rate for Payer: Healthscope Commercial |
$61.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.82
|
| Rate for Payer: PHP Commercial |
$57.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.21
|
| Rate for Payer: Priority Health SBD |
$42.85
|
| Rate for Payer: UMR Bronson Commercial |
$29.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.02
|
|
|
HC VACC CCIIV4 ABX FREE 0.5 ML IM
|
Facility
|
OP
|
$68.02
|
|
|
Service Code
|
CPT 90756
|
| Hospital Charge Code |
63600223
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.17 |
| Max. Negotiated Rate |
$87.33 |
| Rate for Payer: Aetna American Axle |
$44.21
|
| Rate for Payer: Aetna Commercial |
$57.82
|
| Rate for Payer: Aetna Medicare |
$34.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.21
|
| Rate for Payer: BCBS Complete |
$27.21
|
| Rate for Payer: BCBS Trust/PPO |
$87.33
|
| Rate for Payer: BCN Commercial |
$87.33
|
| Rate for Payer: Cash Price |
$54.42
|
| Rate for Payer: Cash Price |
$54.42
|
| Rate for Payer: Cofinity Commercial |
$47.61
|
| Rate for Payer: Cofinity Commercial |
$58.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$47.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.42
|
| Rate for Payer: Healthscope Commercial |
$61.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.82
|
| Rate for Payer: PHP Commercial |
$57.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$32.38
|
| Rate for Payer: Priority Health Narrow Network |
$25.90
|
| Rate for Payer: Priority Health SBD |
$42.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.60
|
| Rate for Payer: UHC Exchange |
$27.60
|
| Rate for Payer: UMR Bronson Commercial |
$25.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.02
|
|
|
HC VACC CCIIV4 NO PRSV 0.5 ML IM
|
Facility
|
IP
|
$72.83
|
|
|
Service Code
|
CPT 90674
|
| Hospital Charge Code |
63600222
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.05 |
| Max. Negotiated Rate |
$65.55 |
| Rate for Payer: Aetna American Axle |
$47.34
|
| Rate for Payer: Aetna Commercial |
$61.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.34
|
| Rate for Payer: Cash Price |
$58.26
|
| Rate for Payer: Cofinity Commercial |
$50.98
|
| Rate for Payer: Cofinity Commercial |
$62.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$50.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.26
|
| Rate for Payer: Healthscope Commercial |
$65.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.91
|
| Rate for Payer: PHP Commercial |
$61.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.34
|
| Rate for Payer: Priority Health SBD |
$45.88
|
| Rate for Payer: UMR Bronson Commercial |
$32.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.62
|
|
|
HC VACC CCIIV4 NO PRSV 0.5 ML IM
|
Facility
|
OP
|
$72.83
|
|
|
Service Code
|
CPT 90674
|
| Hospital Charge Code |
63600222
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.95 |
| Max. Negotiated Rate |
$78.04 |
| Rate for Payer: Aetna American Axle |
$47.34
|
| Rate for Payer: Aetna Commercial |
$61.91
|
| Rate for Payer: Aetna Medicare |
$36.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.34
|
| Rate for Payer: BCBS Complete |
$29.13
|
| Rate for Payer: BCBS Trust/PPO |
$78.04
|
| Rate for Payer: BCN Commercial |
$78.04
|
| Rate for Payer: Cash Price |
$58.26
|
| Rate for Payer: Cash Price |
$58.26
|
| Rate for Payer: Cofinity Commercial |
$50.98
|
| Rate for Payer: Cofinity Commercial |
$62.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$50.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.26
|
| Rate for Payer: Healthscope Commercial |
$65.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.91
|
| Rate for Payer: PHP Commercial |
$61.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34.17
|
| Rate for Payer: Priority Health Narrow Network |
$27.34
|
| Rate for Payer: Priority Health SBD |
$45.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.13
|
| Rate for Payer: UHC Exchange |
$29.13
|
| Rate for Payer: UMR Bronson Commercial |
$26.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.62
|
|
|
HC VACC RSV PREF BIVALENT IM
|
Facility
|
IP
|
$839.51
|
|
|
Service Code
|
CPT 90678
|
| Hospital Charge Code |
63600226
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$369.38 |
| Max. Negotiated Rate |
$755.56 |
| Rate for Payer: Aetna American Axle |
$545.68
|
| Rate for Payer: Aetna Commercial |
$713.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$545.68
|
| Rate for Payer: Cash Price |
$671.61
|
| Rate for Payer: Cofinity Commercial |
$587.66
|
| Rate for Payer: Cofinity Commercial |
$721.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$587.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$671.61
|
| Rate for Payer: Healthscope Commercial |
$755.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$587.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$629.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$713.58
|
| Rate for Payer: PHP Commercial |
$713.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$545.68
|
| Rate for Payer: Priority Health SBD |
$528.89
|
| Rate for Payer: UMR Bronson Commercial |
$369.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$629.63
|
|
|
HC VACC RSV PREF BIVALENT IM
|
Facility
|
OP
|
$839.51
|
|
|
Service Code
|
CPT 90678
|
| Hospital Charge Code |
63600226
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$269.04 |
| Max. Negotiated Rate |
$798.92 |
| Rate for Payer: Aetna American Axle |
$545.68
|
| Rate for Payer: Aetna Commercial |
$713.58
|
| Rate for Payer: Aetna Medicare |
$419.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$545.68
|
| Rate for Payer: BCBS Complete |
$335.80
|
| Rate for Payer: BCBS Trust/PPO |
$798.92
|
| Rate for Payer: BCN Commercial |
$798.92
|
| Rate for Payer: Cash Price |
$671.61
|
| Rate for Payer: Cash Price |
$671.61
|
| Rate for Payer: Cofinity Commercial |
$587.66
|
| Rate for Payer: Cofinity Commercial |
$721.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$587.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$671.61
|
| Rate for Payer: Healthscope Commercial |
$755.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$587.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$629.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$713.58
|
| Rate for Payer: PHP Commercial |
$713.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$545.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$336.30
|
| Rate for Payer: Priority Health Narrow Network |
$269.04
|
| Rate for Payer: Priority Health SBD |
$528.89
|
| Rate for Payer: UMR Bronson Commercial |
$310.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$629.63
|
|
|
HC VACC RSV PREF RECOMB ADJT IM
|
Facility
|
OP
|
$796.82
|
|
|
Service Code
|
CPT 90679
|
| Hospital Charge Code |
63600225
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$268.13 |
| Max. Negotiated Rate |
$765.58 |
| Rate for Payer: Aetna American Axle |
$517.93
|
| Rate for Payer: Aetna Commercial |
$677.30
|
| Rate for Payer: Aetna Medicare |
$398.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$517.93
|
| Rate for Payer: BCBS Complete |
$318.73
|
| Rate for Payer: BCBS Trust/PPO |
$765.58
|
| Rate for Payer: BCN Commercial |
$765.58
|
| Rate for Payer: Cash Price |
$637.46
|
| Rate for Payer: Cash Price |
$637.46
|
| Rate for Payer: Cofinity Commercial |
$557.77
|
| Rate for Payer: Cofinity Commercial |
$685.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$557.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$637.46
|
| Rate for Payer: Healthscope Commercial |
$717.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$557.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$597.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$677.30
|
| Rate for Payer: PHP Commercial |
$677.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$517.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$335.16
|
| Rate for Payer: Priority Health Narrow Network |
$268.13
|
| Rate for Payer: Priority Health SBD |
$502.00
|
| Rate for Payer: UMR Bronson Commercial |
$294.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$597.62
|
|
|
HC VACC RSV PREF RECOMB ADJT IM
|
Facility
|
IP
|
$796.82
|
|
|
Service Code
|
CPT 90679
|
| Hospital Charge Code |
63600225
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$350.60 |
| Max. Negotiated Rate |
$717.14 |
| Rate for Payer: Aetna American Axle |
$517.93
|
| Rate for Payer: Aetna Commercial |
$677.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$517.93
|
| Rate for Payer: Cash Price |
$637.46
|
| Rate for Payer: Cofinity Commercial |
$557.77
|
| Rate for Payer: Cofinity Commercial |
$685.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$557.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$637.46
|
| Rate for Payer: Healthscope Commercial |
$717.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$557.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$597.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$677.30
|
| Rate for Payer: PHP Commercial |
$677.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$517.93
|
| Rate for Payer: Priority Health SBD |
$502.00
|
| Rate for Payer: UMR Bronson Commercial |
$350.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$597.62
|
|
|
HC VAC WOUND PREVENA
|
Facility
|
IP
|
$1,482.30
|
|
| Hospital Charge Code |
27000697
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$652.21 |
| Max. Negotiated Rate |
$1,334.07 |
| Rate for Payer: Aetna American Axle |
$963.50
|
| Rate for Payer: Aetna Commercial |
$1,259.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$963.50
|
| Rate for Payer: Cash Price |
$1,185.84
|
| Rate for Payer: Cofinity Commercial |
$1,037.61
|
| Rate for Payer: Cofinity Commercial |
$1,274.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,037.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,185.84
|
| Rate for Payer: Healthscope Commercial |
$1,334.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,037.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,111.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,259.96
|
| Rate for Payer: PHP Commercial |
$1,259.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$963.50
|
| Rate for Payer: Priority Health SBD |
$933.85
|
| Rate for Payer: UMR Bronson Commercial |
$652.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,111.72
|
|
|
HC VAC WOUND PREVENA
|
Facility
|
OP
|
$1,482.30
|
|
| Hospital Charge Code |
27000697
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$548.45 |
| Max. Negotiated Rate |
$1,334.07 |
| Rate for Payer: Aetna American Axle |
$963.50
|
| Rate for Payer: Aetna Commercial |
$1,259.96
|
| Rate for Payer: Aetna Medicare |
$741.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$963.50
|
| Rate for Payer: BCBS Complete |
$592.92
|
| Rate for Payer: Cash Price |
$1,185.84
|
| Rate for Payer: Cofinity Commercial |
$1,037.61
|
| Rate for Payer: Cofinity Commercial |
$1,274.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,037.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,185.84
|
| Rate for Payer: Healthscope Commercial |
$1,334.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,037.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,111.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,259.96
|
| Rate for Payer: PHP Commercial |
$1,259.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$963.50
|
| Rate for Payer: Priority Health SBD |
$933.85
|
| Rate for Payer: UMR Bronson Commercial |
$548.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,111.72
|
|
|
HC VAGINAL DELIVERY (OB)
|
Facility
|
IP
|
$1,792.41
|
|
| Hospital Charge Code |
72000006
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$788.66 |
| Max. Negotiated Rate |
$1,613.17 |
| Rate for Payer: Aetna American Axle |
$1,165.07
|
| Rate for Payer: Aetna Commercial |
$1,523.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,165.07
|
| Rate for Payer: Cash Price |
$1,433.93
|
| Rate for Payer: Cofinity Commercial |
$1,254.69
|
| Rate for Payer: Cofinity Commercial |
$1,541.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,254.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,433.93
|
| Rate for Payer: Healthscope Commercial |
$1,613.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,254.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,344.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,523.55
|
| Rate for Payer: PHP Commercial |
$1,523.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,165.07
|
| Rate for Payer: Priority Health SBD |
$1,129.22
|
| Rate for Payer: UMR Bronson Commercial |
$788.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,344.31
|
|
|
HC VAGINAL DELIVERY (OB)
|
Facility
|
OP
|
$1,792.41
|
|
| Hospital Charge Code |
72000006
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$663.19 |
| Max. Negotiated Rate |
$2,286.00 |
| Rate for Payer: Aetna American Axle |
$1,165.07
|
| Rate for Payer: Aetna Commercial |
$1,523.55
|
| Rate for Payer: Aetna Medicare |
$896.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,165.07
|
| Rate for Payer: BCBS Complete |
$716.96
|
| Rate for Payer: Cash Price |
$1,433.93
|
| Rate for Payer: Cash Price |
$1,433.93
|
| Rate for Payer: Cofinity Commercial |
$1,254.69
|
| Rate for Payer: Cofinity Commercial |
$1,541.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,254.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,433.93
|
| Rate for Payer: Healthscope Commercial |
$1,613.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,254.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,344.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,523.55
|
| Rate for Payer: PHP Commercial |
$1,523.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,165.07
|
| Rate for Payer: Priority Health SBD |
$1,129.22
|
| Rate for Payer: UHC Core |
$2,286.00
|
| Rate for Payer: UMR Bronson Commercial |
$663.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,344.31
|
|
|
HC VALPROIC ACID DEPAKENE LVL
|
Facility
|
IP
|
$107.51
|
|
|
Service Code
|
CPT 80164
|
| Hospital Charge Code |
30100589
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.30 |
| Max. Negotiated Rate |
$96.76 |
| Rate for Payer: Aetna American Axle |
$69.88
|
| Rate for Payer: Aetna Commercial |
$91.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.88
|
| Rate for Payer: Cash Price |
$86.01
|
| Rate for Payer: Cofinity Commercial |
$75.26
|
| Rate for Payer: Cofinity Commercial |
$92.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$75.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.01
|
| Rate for Payer: Healthscope Commercial |
$96.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$75.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.38
|
| Rate for Payer: PHP Commercial |
$91.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.88
|
| Rate for Payer: Priority Health SBD |
$67.73
|
| Rate for Payer: UMR Bronson Commercial |
$47.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.63
|
|
|
HC VALPROIC ACID DEPAKENE LVL
|
Facility
|
OP
|
$107.51
|
|
|
Service Code
|
CPT 80164
|
| Hospital Charge Code |
30100589
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.26 |
| Max. Negotiated Rate |
$96.76 |
| Rate for Payer: Aetna American Axle |
$69.88
|
| Rate for Payer: Aetna Commercial |
$91.38
|
| Rate for Payer: Aetna Medicare |
$14.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.92
|
| Rate for Payer: BCBS Complete |
$7.62
|
| Rate for Payer: BCBS MAPPO |
$13.54
|
| Rate for Payer: BCBS Trust/PPO |
$13.05
|
| Rate for Payer: BCN Commercial |
$13.05
|
| Rate for Payer: BCN Medicare Advantage |
$13.54
|
| Rate for Payer: Cash Price |
$86.01
|
| Rate for Payer: Cash Price |
$86.01
|
| Rate for Payer: Cofinity Commercial |
$92.46
|
| Rate for Payer: Cofinity Commercial |
$75.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$75.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.54
|
| Rate for Payer: Healthscope Commercial |
$96.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$75.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.63
|
| Rate for Payer: Mclaren Medicaid |
$7.26
|
| Rate for Payer: Mclaren Medicare |
$13.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.22
|
| Rate for Payer: Meridian Medicaid |
$7.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.38
|
| Rate for Payer: Nomi Health Commercial |
$20.31
|
| Rate for Payer: PACE Medicare |
$12.86
|
| Rate for Payer: PACE SWMI |
$13.54
|
| Rate for Payer: PHP Commercial |
$91.38
|
| Rate for Payer: PHP Medicare Advantage |
$13.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.94
|
| Rate for Payer: Priority Health Medicare |
$13.54
|
| Rate for Payer: Priority Health Narrow Network |
$11.15
|
| Rate for Payer: Priority Health SBD |
$67.73
|
| Rate for Payer: Railroad Medicare Medicare |
$13.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.54
|
| Rate for Payer: UHC Exchange |
$13.54
|
| Rate for Payer: UHC Medicare Advantage |
$13.54
|
| Rate for Payer: UHCCP Medicaid |
$7.26
|
| Rate for Payer: UMR Bronson Commercial |
$39.78
|
| Rate for Payer: VA VA |
$13.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.63
|
|
|
HC VALVE VENT NONADJ
|
Facility
|
OP
|
$52.02
|
|
| Hospital Charge Code |
27000277
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$19.25 |
| Max. Negotiated Rate |
$46.82 |
| Rate for Payer: Aetna American Axle |
$33.81
|
| Rate for Payer: Aetna Commercial |
$44.22
|
| Rate for Payer: Aetna Medicare |
$26.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.81
|
| Rate for Payer: BCBS Complete |
$20.81
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$36.41
|
| Rate for Payer: Cofinity Commercial |
$44.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$36.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Healthscope Commercial |
$46.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$36.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: PHP Commercial |
$44.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: Priority Health SBD |
$32.77
|
| Rate for Payer: UMR Bronson Commercial |
$19.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.02
|
|
|
HC VALVE VENT NONADJ
|
Facility
|
IP
|
$52.02
|
|
| Hospital Charge Code |
27000277
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$22.89 |
| Max. Negotiated Rate |
$46.82 |
| Rate for Payer: Aetna American Axle |
$33.81
|
| Rate for Payer: Aetna Commercial |
$44.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.81
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$36.41
|
| Rate for Payer: Cofinity Commercial |
$44.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$36.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Healthscope Commercial |
$46.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$36.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: PHP Commercial |
$44.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: Priority Health SBD |
$32.77
|
| Rate for Payer: UMR Bronson Commercial |
$22.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.02
|
|
|
HC VALVE VENT ONE WAY
|
Facility
|
IP
|
$42.84
|
|
| Hospital Charge Code |
27000662
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$18.85 |
| Max. Negotiated Rate |
$38.56 |
| Rate for Payer: Aetna American Axle |
$27.85
|
| Rate for Payer: Aetna Commercial |
$36.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.85
|
| Rate for Payer: Cash Price |
$34.27
|
| Rate for Payer: Cofinity Commercial |
$29.99
|
| Rate for Payer: Cofinity Commercial |
$36.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$29.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.27
|
| Rate for Payer: Healthscope Commercial |
$38.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.41
|
| Rate for Payer: PHP Commercial |
$36.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.85
|
| Rate for Payer: Priority Health SBD |
$26.99
|
| Rate for Payer: UMR Bronson Commercial |
$18.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.13
|
|
|
HC VALVE VENT ONE WAY
|
Facility
|
OP
|
$42.84
|
|
| Hospital Charge Code |
27000662
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.85 |
| Max. Negotiated Rate |
$38.56 |
| Rate for Payer: Aetna American Axle |
$27.85
|
| Rate for Payer: Aetna Commercial |
$36.41
|
| Rate for Payer: Aetna Medicare |
$21.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.85
|
| Rate for Payer: BCBS Complete |
$17.14
|
| Rate for Payer: Cash Price |
$34.27
|
| Rate for Payer: Cofinity Commercial |
$29.99
|
| Rate for Payer: Cofinity Commercial |
$36.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$29.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.27
|
| Rate for Payer: Healthscope Commercial |
$38.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.41
|
| Rate for Payer: PHP Commercial |
$36.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.85
|
| Rate for Payer: Priority Health SBD |
$26.99
|
| Rate for Payer: UMR Bronson Commercial |
$15.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.13
|
|
