|
HC VERT AUG W MECH DEV LUMB 1ST
|
Facility
|
IP
|
$11,266.87
|
|
|
Service Code
|
CPT 22514
|
| Hospital Charge Code |
36100468
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,957.42 |
| Max. Negotiated Rate |
$10,140.18 |
| Rate for Payer: Aetna American Axle |
$7,323.47
|
| Rate for Payer: Aetna Commercial |
$9,576.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,323.47
|
| Rate for Payer: Cash Price |
$9,013.50
|
| Rate for Payer: Cofinity Commercial |
$7,886.81
|
| Rate for Payer: Cofinity Commercial |
$9,689.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$7,886.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,013.50
|
| Rate for Payer: Healthscope Commercial |
$10,140.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7,886.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,450.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,576.84
|
| Rate for Payer: PHP Commercial |
$9,576.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,323.47
|
| Rate for Payer: Priority Health SBD |
$7,098.13
|
| Rate for Payer: UMR Bronson Commercial |
$4,957.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,450.15
|
|
|
HC VERT AUG W MECH DEV LUMB 1ST
|
Facility
|
OP
|
$11,266.87
|
|
|
Service Code
|
CPT 22514
|
| Hospital Charge Code |
36100468
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$459.14 |
| Max. Negotiated Rate |
$21,998.64 |
| Rate for Payer: Aetna American Axle |
$7,323.47
|
| Rate for Payer: Aetna Commercial |
$9,576.84
|
| Rate for Payer: Aetna Medicare |
$7,279.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,323.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,749.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,749.10
|
| Rate for Payer: BCBS Complete |
$3,939.19
|
| Rate for Payer: BCBS MAPPO |
$6,999.28
|
| Rate for Payer: BCBS Trust/PPO |
$6,636.14
|
| Rate for Payer: BCN Commercial |
$6,636.14
|
| Rate for Payer: BCN Medicare Advantage |
$6,999.28
|
| Rate for Payer: Cash Price |
$9,013.50
|
| Rate for Payer: Cash Price |
$9,013.50
|
| Rate for Payer: Cash Price |
$9,013.50
|
| Rate for Payer: Cofinity Commercial |
$9,689.51
|
| Rate for Payer: Cofinity Commercial |
$7,886.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$7,886.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,013.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,999.28
|
| Rate for Payer: Healthscope Commercial |
$10,140.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7,886.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,450.15
|
| Rate for Payer: Mclaren Medicaid |
$3,751.61
|
| Rate for Payer: Mclaren Medicare |
$6,999.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,349.24
|
| Rate for Payer: Meridian Medicaid |
$3,939.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,049.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,576.84
|
| Rate for Payer: Nomi Health Commercial |
$14,698.49
|
| Rate for Payer: PACE Medicare |
$6,649.32
|
| Rate for Payer: PACE SWMI |
$6,999.28
|
| Rate for Payer: PHP Commercial |
$9,576.84
|
| Rate for Payer: PHP Medicare Advantage |
$6,999.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,751.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,323.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,998.64
|
| Rate for Payer: Priority Health Medicare |
$6,999.28
|
| Rate for Payer: Priority Health Narrow Network |
$17,598.91
|
| Rate for Payer: Priority Health SBD |
$7,098.13
|
| Rate for Payer: Railroad Medicare Medicare |
$6,999.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$505.05
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,999.28
|
| Rate for Payer: UHC Exchange |
$459.14
|
| Rate for Payer: UHC Medicare Advantage |
$6,999.28
|
| Rate for Payer: UHCCP Medicaid |
$3,751.61
|
| Rate for Payer: UMR Bronson Commercial |
$4,168.74
|
| Rate for Payer: VA VA |
$6,999.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,450.15
|
|
|
HC VERT AUG W MECH DEV THOR 1ST
|
Facility
|
OP
|
$11,123.75
|
|
|
Service Code
|
CPT 22513
|
| Hospital Charge Code |
36100467
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$492.91 |
| Max. Negotiated Rate |
$21,998.64 |
| Rate for Payer: Aetna American Axle |
$7,230.44
|
| Rate for Payer: Aetna Commercial |
$9,455.19
|
| Rate for Payer: Aetna Medicare |
$7,279.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,230.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,749.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,749.10
|
| Rate for Payer: BCBS Complete |
$3,939.19
|
| Rate for Payer: BCBS MAPPO |
$6,999.28
|
| Rate for Payer: BCBS Trust/PPO |
$6,551.85
|
| Rate for Payer: BCN Commercial |
$6,551.85
|
| Rate for Payer: BCN Medicare Advantage |
$6,999.28
|
| Rate for Payer: Cash Price |
$8,899.00
|
| Rate for Payer: Cash Price |
$8,899.00
|
| Rate for Payer: Cash Price |
$8,899.00
|
| Rate for Payer: Cofinity Commercial |
$9,566.42
|
| Rate for Payer: Cofinity Commercial |
$7,786.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$7,786.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,899.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,999.28
|
| Rate for Payer: Healthscope Commercial |
$10,011.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7,786.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,342.81
|
| Rate for Payer: Mclaren Medicaid |
$3,751.61
|
| Rate for Payer: Mclaren Medicare |
$6,999.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,349.24
|
| Rate for Payer: Meridian Medicaid |
$3,939.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,049.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,455.19
|
| Rate for Payer: Nomi Health Commercial |
$14,698.49
|
| Rate for Payer: PACE Medicare |
$6,649.32
|
| Rate for Payer: PACE SWMI |
$6,999.28
|
| Rate for Payer: PHP Commercial |
$9,455.19
|
| Rate for Payer: PHP Medicare Advantage |
$6,999.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,751.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,230.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,998.64
|
| Rate for Payer: Priority Health Medicare |
$6,999.28
|
| Rate for Payer: Priority Health Narrow Network |
$17,598.91
|
| Rate for Payer: Priority Health SBD |
$7,007.96
|
| Rate for Payer: Railroad Medicare Medicare |
$6,999.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$542.20
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,999.28
|
| Rate for Payer: UHC Exchange |
$492.91
|
| Rate for Payer: UHC Medicare Advantage |
$6,999.28
|
| Rate for Payer: UHCCP Medicaid |
$3,751.61
|
| Rate for Payer: UMR Bronson Commercial |
$4,115.79
|
| Rate for Payer: VA VA |
$6,999.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,342.81
|
|
|
HC VERT AUG W MECH DEV THOR 1ST
|
Facility
|
IP
|
$11,123.75
|
|
|
Service Code
|
CPT 22513
|
| Hospital Charge Code |
36100467
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,894.45 |
| Max. Negotiated Rate |
$10,011.38 |
| Rate for Payer: Aetna American Axle |
$7,230.44
|
| Rate for Payer: Aetna Commercial |
$9,455.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,230.44
|
| Rate for Payer: Cash Price |
$8,899.00
|
| Rate for Payer: Cofinity Commercial |
$7,786.62
|
| Rate for Payer: Cofinity Commercial |
$9,566.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$7,786.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,899.00
|
| Rate for Payer: Healthscope Commercial |
$10,011.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7,786.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,342.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,455.19
|
| Rate for Payer: PHP Commercial |
$9,455.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,230.44
|
| Rate for Payer: Priority Health SBD |
$7,007.96
|
| Rate for Payer: UMR Bronson Commercial |
$4,894.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,342.81
|
|
|
HC VERTEBROPLASTY CEMENT
|
Facility
|
OP
|
$1,251.02
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27800112
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$462.88 |
| Max. Negotiated Rate |
$1,125.92 |
| Rate for Payer: Aetna American Axle |
$813.16
|
| Rate for Payer: Aetna Commercial |
$1,063.37
|
| Rate for Payer: Aetna Medicare |
$625.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$813.16
|
| Rate for Payer: BCBS Complete |
$500.41
|
| Rate for Payer: Cash Price |
$1,000.82
|
| Rate for Payer: Cofinity Commercial |
$1,075.88
|
| Rate for Payer: Cofinity Commercial |
$875.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$875.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,000.82
|
| Rate for Payer: Healthscope Commercial |
$1,125.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$875.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$938.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,063.37
|
| Rate for Payer: PHP Commercial |
$1,063.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$813.16
|
| Rate for Payer: Priority Health SBD |
$788.14
|
| Rate for Payer: UMR Bronson Commercial |
$462.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$938.26
|
|
|
HC VERTEBROPLASTY CEMENT
|
Facility
|
IP
|
$1,251.02
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27800112
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$550.45 |
| Max. Negotiated Rate |
$1,125.92 |
| Rate for Payer: Aetna American Axle |
$813.16
|
| Rate for Payer: Aetna Commercial |
$1,063.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$813.16
|
| Rate for Payer: Cash Price |
$1,000.82
|
| Rate for Payer: Cofinity Commercial |
$1,075.88
|
| Rate for Payer: Cofinity Commercial |
$875.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$875.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,000.82
|
| Rate for Payer: Healthscope Commercial |
$1,125.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$875.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$938.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,063.37
|
| Rate for Payer: PHP Commercial |
$1,063.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$813.16
|
| Rate for Payer: Priority Health SBD |
$788.14
|
| Rate for Payer: UMR Bronson Commercial |
$550.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$938.26
|
|
|
HC VERTEBROPLASTY SACRUM BIL W WO BONE BX AND IMAGING
|
Facility
|
OP
|
$6,262.84
|
|
|
Service Code
|
CPT 0201T
|
| Hospital Charge Code |
36100298
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,317.25 |
| Max. Negotiated Rate |
$21,998.64 |
| Rate for Payer: Aetna American Axle |
$4,070.85
|
| Rate for Payer: Aetna Commercial |
$5,323.41
|
| Rate for Payer: Aetna Medicare |
$7,279.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,070.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,749.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,749.10
|
| Rate for Payer: BCBS Complete |
$3,939.19
|
| Rate for Payer: BCBS MAPPO |
$6,999.28
|
| Rate for Payer: BCN Medicare Advantage |
$6,999.28
|
| Rate for Payer: Cash Price |
$5,010.27
|
| Rate for Payer: Cash Price |
$5,010.27
|
| Rate for Payer: Cash Price |
$5,010.27
|
| Rate for Payer: Cofinity Commercial |
$5,386.04
|
| Rate for Payer: Cofinity Commercial |
$4,383.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,383.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,010.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,999.28
|
| Rate for Payer: Healthscope Commercial |
$5,636.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,383.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,697.13
|
| Rate for Payer: Mclaren Medicaid |
$3,751.61
|
| Rate for Payer: Mclaren Medicare |
$6,999.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,349.24
|
| Rate for Payer: Meridian Medicaid |
$3,939.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,049.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,323.41
|
| Rate for Payer: Nomi Health Commercial |
$14,698.49
|
| Rate for Payer: PACE Medicare |
$6,649.32
|
| Rate for Payer: PACE SWMI |
$6,999.28
|
| Rate for Payer: PHP Commercial |
$5,323.41
|
| Rate for Payer: PHP Medicare Advantage |
$6,999.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,751.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,070.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,998.64
|
| Rate for Payer: Priority Health Medicare |
$6,999.28
|
| Rate for Payer: Priority Health Narrow Network |
$17,598.91
|
| Rate for Payer: Priority Health SBD |
$3,945.59
|
| Rate for Payer: Railroad Medicare Medicare |
$6,999.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,702.27
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,999.28
|
| Rate for Payer: UHC Exchange |
$13,376.32
|
| Rate for Payer: UHC Medicare Advantage |
$6,999.28
|
| Rate for Payer: UHCCP Medicaid |
$3,751.61
|
| Rate for Payer: UMR Bronson Commercial |
$2,317.25
|
| Rate for Payer: VA VA |
$6,999.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,697.13
|
|
|
HC VERTEBROPLASTY SACRUM BIL W WO BONE BX AND IMAGING
|
Facility
|
IP
|
$6,262.84
|
|
|
Service Code
|
CPT 0201T
|
| Hospital Charge Code |
36100298
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,755.65 |
| Max. Negotiated Rate |
$5,636.56 |
| Rate for Payer: Aetna American Axle |
$4,070.85
|
| Rate for Payer: Aetna Commercial |
$5,323.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,070.85
|
| Rate for Payer: Cash Price |
$5,010.27
|
| Rate for Payer: Cofinity Commercial |
$4,383.99
|
| Rate for Payer: Cofinity Commercial |
$5,386.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,383.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,010.27
|
| Rate for Payer: Healthscope Commercial |
$5,636.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,383.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,697.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,323.41
|
| Rate for Payer: PHP Commercial |
$5,323.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,070.85
|
| Rate for Payer: Priority Health SBD |
$3,945.59
|
| Rate for Payer: UMR Bronson Commercial |
$2,755.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,697.13
|
|
|
HC VERTEBROPLASTY SACRUM UNI W WO BONE BX AND IMAGING
|
Facility
|
OP
|
$5,010.27
|
|
|
Service Code
|
CPT 0200T
|
| Hospital Charge Code |
36100299
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,853.80 |
| Max. Negotiated Rate |
$21,998.64 |
| Rate for Payer: Aetna American Axle |
$3,256.68
|
| Rate for Payer: Aetna Commercial |
$4,258.73
|
| Rate for Payer: Aetna Medicare |
$7,279.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,256.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,749.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,749.10
|
| Rate for Payer: BCBS Complete |
$3,939.19
|
| Rate for Payer: BCBS MAPPO |
$6,999.28
|
| Rate for Payer: BCN Medicare Advantage |
$6,999.28
|
| Rate for Payer: Cash Price |
$4,008.22
|
| Rate for Payer: Cash Price |
$4,008.22
|
| Rate for Payer: Cash Price |
$4,008.22
|
| Rate for Payer: Cofinity Commercial |
$4,308.83
|
| Rate for Payer: Cofinity Commercial |
$3,507.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,507.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,008.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,999.28
|
| Rate for Payer: Healthscope Commercial |
$4,509.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,507.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,757.70
|
| Rate for Payer: Mclaren Medicaid |
$3,751.61
|
| Rate for Payer: Mclaren Medicare |
$6,999.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,349.24
|
| Rate for Payer: Meridian Medicaid |
$3,939.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,049.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,258.73
|
| Rate for Payer: Nomi Health Commercial |
$14,698.49
|
| Rate for Payer: PACE Medicare |
$6,649.32
|
| Rate for Payer: PACE SWMI |
$6,999.28
|
| Rate for Payer: PHP Commercial |
$4,258.73
|
| Rate for Payer: PHP Medicare Advantage |
$6,999.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,751.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,256.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,998.64
|
| Rate for Payer: Priority Health Medicare |
$6,999.28
|
| Rate for Payer: Priority Health Narrow Network |
$17,598.91
|
| Rate for Payer: Priority Health SBD |
$3,156.47
|
| Rate for Payer: Railroad Medicare Medicare |
$6,999.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,702.27
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,999.28
|
| Rate for Payer: UHC Exchange |
$13,376.32
|
| Rate for Payer: UHC Medicare Advantage |
$6,999.28
|
| Rate for Payer: UHCCP Medicaid |
$3,751.61
|
| Rate for Payer: UMR Bronson Commercial |
$1,853.80
|
| Rate for Payer: VA VA |
$6,999.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,757.70
|
|
|
HC VERTEBROPLASTY SACRUM UNI W WO BONE BX AND IMAGING
|
Facility
|
IP
|
$5,010.27
|
|
|
Service Code
|
CPT 0200T
|
| Hospital Charge Code |
36100299
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,204.52 |
| Max. Negotiated Rate |
$4,509.24 |
| Rate for Payer: Aetna American Axle |
$3,256.68
|
| Rate for Payer: Aetna Commercial |
$4,258.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,256.68
|
| Rate for Payer: Cash Price |
$4,008.22
|
| Rate for Payer: Cofinity Commercial |
$3,507.19
|
| Rate for Payer: Cofinity Commercial |
$4,308.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,507.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,008.22
|
| Rate for Payer: Healthscope Commercial |
$4,509.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,507.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,757.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,258.73
|
| Rate for Payer: PHP Commercial |
$4,258.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,256.68
|
| Rate for Payer: Priority Health SBD |
$3,156.47
|
| Rate for Payer: UMR Bronson Commercial |
$2,204.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,757.70
|
|
|
HC VEST SUPPLY
|
Facility
|
OP
|
$464.71
|
|
| Hospital Charge Code |
27000169
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$171.94 |
| Max. Negotiated Rate |
$418.24 |
| Rate for Payer: Aetna American Axle |
$302.06
|
| Rate for Payer: Aetna Commercial |
$395.00
|
| Rate for Payer: Aetna Medicare |
$232.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$302.06
|
| Rate for Payer: BCBS Complete |
$185.88
|
| Rate for Payer: Cash Price |
$371.77
|
| Rate for Payer: Cofinity Commercial |
$325.30
|
| Rate for Payer: Cofinity Commercial |
$399.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$325.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$371.77
|
| Rate for Payer: Healthscope Commercial |
$418.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$325.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$348.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$395.00
|
| Rate for Payer: PHP Commercial |
$395.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$302.06
|
| Rate for Payer: Priority Health SBD |
$292.77
|
| Rate for Payer: UMR Bronson Commercial |
$171.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$348.53
|
|
|
HC VEST SUPPLY
|
Facility
|
IP
|
$464.71
|
|
| Hospital Charge Code |
27000169
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$204.47 |
| Max. Negotiated Rate |
$418.24 |
| Rate for Payer: Aetna American Axle |
$302.06
|
| Rate for Payer: Aetna Commercial |
$395.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$302.06
|
| Rate for Payer: Cash Price |
$371.77
|
| Rate for Payer: Cofinity Commercial |
$325.30
|
| Rate for Payer: Cofinity Commercial |
$399.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$325.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$371.77
|
| Rate for Payer: Healthscope Commercial |
$418.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$325.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$348.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$395.00
|
| Rate for Payer: PHP Commercial |
$395.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$302.06
|
| Rate for Payer: Priority Health SBD |
$292.77
|
| Rate for Payer: UMR Bronson Commercial |
$204.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$348.53
|
|
|
HC VIABAHN 2
|
Facility
|
IP
|
$8,114.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27800034
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,570.16 |
| Max. Negotiated Rate |
$7,302.60 |
| Rate for Payer: Aetna American Axle |
$5,274.10
|
| Rate for Payer: Aetna Commercial |
$6,896.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,274.10
|
| Rate for Payer: Cash Price |
$6,491.20
|
| Rate for Payer: Cofinity Commercial |
$5,679.80
|
| Rate for Payer: Cofinity Commercial |
$6,978.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,679.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,491.20
|
| Rate for Payer: Healthscope Commercial |
$7,302.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,679.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,085.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,896.90
|
| Rate for Payer: PHP Commercial |
$6,896.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,274.10
|
| Rate for Payer: Priority Health SBD |
$5,111.82
|
| Rate for Payer: UMR Bronson Commercial |
$3,570.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,085.50
|
|
|
HC VIABAHN 2
|
Facility
|
OP
|
$8,114.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27800034
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,002.18 |
| Max. Negotiated Rate |
$7,302.60 |
| Rate for Payer: Aetna American Axle |
$5,274.10
|
| Rate for Payer: Aetna Commercial |
$6,896.90
|
| Rate for Payer: Aetna Medicare |
$4,057.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,274.10
|
| Rate for Payer: BCBS Complete |
$3,245.60
|
| Rate for Payer: Cash Price |
$6,491.20
|
| Rate for Payer: Cofinity Commercial |
$5,679.80
|
| Rate for Payer: Cofinity Commercial |
$6,978.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,679.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,491.20
|
| Rate for Payer: Healthscope Commercial |
$7,302.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,679.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,085.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,896.90
|
| Rate for Payer: PHP Commercial |
$6,896.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,274.10
|
| Rate for Payer: Priority Health SBD |
$5,111.82
|
| Rate for Payer: UMR Bronson Commercial |
$3,002.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,085.50
|
|
|
HC VISCOSITY
|
Facility
|
OP
|
$70.75
|
|
|
Service Code
|
CPT 85810
|
| Hospital Charge Code |
30500065
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.26 |
| Max. Negotiated Rate |
$63.68 |
| Rate for Payer: Aetna American Axle |
$45.99
|
| Rate for Payer: Aetna Commercial |
$60.14
|
| Rate for Payer: Aetna Medicare |
$12.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.59
|
| Rate for Payer: BCBS Complete |
$6.57
|
| Rate for Payer: BCBS MAPPO |
$11.67
|
| Rate for Payer: BCBS Trust/PPO |
$11.24
|
| Rate for Payer: BCN Commercial |
$11.24
|
| Rate for Payer: BCN Medicare Advantage |
$11.67
|
| Rate for Payer: Cash Price |
$56.60
|
| Rate for Payer: Cash Price |
$56.60
|
| Rate for Payer: Cofinity Commercial |
$60.84
|
| Rate for Payer: Cofinity Commercial |
$49.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$49.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.67
|
| Rate for Payer: Healthscope Commercial |
$63.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.06
|
| Rate for Payer: Mclaren Medicaid |
$6.26
|
| Rate for Payer: Mclaren Medicare |
$11.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.25
|
| Rate for Payer: Meridian Medicaid |
$6.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.14
|
| Rate for Payer: Nomi Health Commercial |
$17.50
|
| Rate for Payer: PACE Medicare |
$11.09
|
| Rate for Payer: PACE SWMI |
$11.67
|
| Rate for Payer: PHP Commercial |
$60.14
|
| Rate for Payer: PHP Medicare Advantage |
$11.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.01
|
| Rate for Payer: Priority Health Medicare |
$11.67
|
| Rate for Payer: Priority Health Narrow Network |
$9.61
|
| Rate for Payer: Priority Health SBD |
$44.57
|
| Rate for Payer: Railroad Medicare Medicare |
$11.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.67
|
| Rate for Payer: UHC Exchange |
$11.67
|
| Rate for Payer: UHC Medicare Advantage |
$11.67
|
| Rate for Payer: UHCCP Medicaid |
$6.26
|
| Rate for Payer: UMR Bronson Commercial |
$26.18
|
| Rate for Payer: VA VA |
$11.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.06
|
|
|
HC VISCOSITY
|
Facility
|
IP
|
$70.75
|
|
|
Service Code
|
CPT 85810
|
| Hospital Charge Code |
30500065
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$31.13 |
| Max. Negotiated Rate |
$63.68 |
| Rate for Payer: Aetna American Axle |
$45.99
|
| Rate for Payer: Aetna Commercial |
$60.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.99
|
| Rate for Payer: Cash Price |
$56.60
|
| Rate for Payer: Cofinity Commercial |
$49.52
|
| Rate for Payer: Cofinity Commercial |
$60.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$49.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.60
|
| Rate for Payer: Healthscope Commercial |
$63.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.14
|
| Rate for Payer: PHP Commercial |
$60.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.99
|
| Rate for Payer: Priority Health SBD |
$44.57
|
| Rate for Payer: UMR Bronson Commercial |
$31.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.06
|
|
|
HC VISIPAQUE 320 PER ML
|
Facility
|
IP
|
$2.84
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
63600019
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$2.56 |
| Rate for Payer: Aetna American Axle |
$1.85
|
| Rate for Payer: Aetna Commercial |
$2.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.85
|
| Rate for Payer: Cash Price |
$2.27
|
| Rate for Payer: Cofinity Commercial |
$1.99
|
| Rate for Payer: Cofinity Commercial |
$2.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.27
|
| Rate for Payer: Healthscope Commercial |
$2.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.41
|
| Rate for Payer: PHP Commercial |
$2.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.85
|
| Rate for Payer: Priority Health SBD |
$1.79
|
| Rate for Payer: UMR Bronson Commercial |
$1.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.13
|
|
|
HC VISIPAQUE 320 PER ML
|
Facility
|
OP
|
$2.84
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
63600019
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$2.56 |
| Rate for Payer: Aetna American Axle |
$1.85
|
| Rate for Payer: Aetna Commercial |
$2.41
|
| Rate for Payer: Aetna Medicare |
$1.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.85
|
| Rate for Payer: BCBS Complete |
$1.14
|
| Rate for Payer: BCBS Trust/PPO |
$0.17
|
| Rate for Payer: BCN Commercial |
$0.17
|
| Rate for Payer: Cash Price |
$2.27
|
| Rate for Payer: Cash Price |
$2.27
|
| Rate for Payer: Cofinity Commercial |
$1.99
|
| Rate for Payer: Cofinity Commercial |
$2.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.27
|
| Rate for Payer: Healthscope Commercial |
$2.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.41
|
| Rate for Payer: PHP Commercial |
$2.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.85
|
| Rate for Payer: Priority Health SBD |
$1.79
|
| Rate for Payer: UMR Bronson Commercial |
$1.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.13
|
|
|
HC VISUAL ACUITY SCREEN
|
Facility
|
IP
|
$39.73
|
|
|
Service Code
|
CPT 99173
|
| Hospital Charge Code |
51000099
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$17.48 |
| Max. Negotiated Rate |
$35.76 |
| Rate for Payer: Aetna American Axle |
$25.82
|
| Rate for Payer: Aetna Commercial |
$33.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.82
|
| Rate for Payer: Cash Price |
$31.78
|
| Rate for Payer: Cofinity Commercial |
$27.81
|
| Rate for Payer: Cofinity Commercial |
$34.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.78
|
| Rate for Payer: Healthscope Commercial |
$35.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.77
|
| Rate for Payer: PHP Commercial |
$33.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.82
|
| Rate for Payer: Priority Health SBD |
$25.03
|
| Rate for Payer: UMR Bronson Commercial |
$17.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.80
|
|
|
HC VISUAL ACUITY SCREEN
|
Facility
|
OP
|
$39.73
|
|
|
Service Code
|
CPT 99173
|
| Hospital Charge Code |
51000099
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$12.68 |
| Max. Negotiated Rate |
$35.76 |
| Rate for Payer: Aetna American Axle |
$25.82
|
| Rate for Payer: Aetna Commercial |
$33.77
|
| Rate for Payer: Aetna Medicare |
$19.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.82
|
| Rate for Payer: BCBS Complete |
$15.89
|
| Rate for Payer: BCBS Trust/PPO |
$12.68
|
| Rate for Payer: BCN Commercial |
$12.68
|
| Rate for Payer: Cash Price |
$31.78
|
| Rate for Payer: Cash Price |
$31.78
|
| Rate for Payer: Cofinity Commercial |
$27.81
|
| Rate for Payer: Cofinity Commercial |
$34.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.78
|
| Rate for Payer: Healthscope Commercial |
$35.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.77
|
| Rate for Payer: PHP Commercial |
$33.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.82
|
| Rate for Payer: Priority Health SBD |
$25.03
|
| Rate for Payer: UMR Bronson Commercial |
$14.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.80
|
|
|
HC VISUAL AUDIOMETRY VRA
|
Facility
|
OP
|
$212.17
|
|
|
Service Code
|
CPT 92579
|
| Hospital Charge Code |
47100013
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$34.73 |
| Max. Negotiated Rate |
$481.80 |
| Rate for Payer: Aetna American Axle |
$137.91
|
| Rate for Payer: Aetna Commercial |
$180.34
|
| Rate for Payer: Aetna Medicare |
$159.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$191.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$191.62
|
| Rate for Payer: BCBS Complete |
$86.28
|
| Rate for Payer: BCBS MAPPO |
$153.30
|
| Rate for Payer: BCBS Trust/PPO |
$84.58
|
| Rate for Payer: BCN Commercial |
$84.58
|
| Rate for Payer: BCN Medicare Advantage |
$153.30
|
| Rate for Payer: Cash Price |
$169.74
|
| Rate for Payer: Cash Price |
$169.74
|
| Rate for Payer: Cash Price |
$169.74
|
| Rate for Payer: Cofinity Commercial |
$148.52
|
| Rate for Payer: Cofinity Commercial |
$182.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$148.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$153.30
|
| Rate for Payer: Healthscope Commercial |
$190.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$148.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$159.13
|
| Rate for Payer: Mclaren Medicaid |
$82.17
|
| Rate for Payer: Mclaren Medicare |
$153.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$160.96
|
| Rate for Payer: Meridian Medicaid |
$86.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$176.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.34
|
| Rate for Payer: Nomi Health Commercial |
$459.90
|
| Rate for Payer: PACE Medicare |
$145.64
|
| Rate for Payer: PACE SWMI |
$153.30
|
| Rate for Payer: PHP Commercial |
$180.34
|
| Rate for Payer: PHP Medicare Advantage |
$153.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$481.80
|
| Rate for Payer: Priority Health Medicare |
$153.30
|
| Rate for Payer: Priority Health Narrow Network |
$385.44
|
| Rate for Payer: Priority Health SBD |
$133.67
|
| Rate for Payer: Railroad Medicare Medicare |
$153.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.20
|
| Rate for Payer: UHC Core |
$294.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$153.30
|
| Rate for Payer: UHC Exchange |
$34.73
|
| Rate for Payer: UHC Medicare Advantage |
$153.30
|
| Rate for Payer: UHCCP Medicaid |
$82.17
|
| Rate for Payer: UMR Bronson Commercial |
$78.50
|
| Rate for Payer: VA VA |
$153.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$159.13
|
|
|
HC VISUAL AUDIOMETRY VRA
|
Facility
|
IP
|
$212.17
|
|
|
Service Code
|
CPT 92579
|
| Hospital Charge Code |
47100013
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$93.35 |
| Max. Negotiated Rate |
$190.95 |
| Rate for Payer: Aetna American Axle |
$137.91
|
| Rate for Payer: Aetna Commercial |
$180.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.91
|
| Rate for Payer: Cash Price |
$169.74
|
| Rate for Payer: Cofinity Commercial |
$148.52
|
| Rate for Payer: Cofinity Commercial |
$182.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$148.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.74
|
| Rate for Payer: Healthscope Commercial |
$190.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$148.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$159.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.34
|
| Rate for Payer: PHP Commercial |
$180.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.91
|
| Rate for Payer: Priority Health SBD |
$133.67
|
| Rate for Payer: UMR Bronson Commercial |
$93.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$159.13
|
|
|
HC VITAL CAPACITY
|
Facility
|
IP
|
$268.05
|
|
|
Service Code
|
CPT 94150
|
| Hospital Charge Code |
46000016
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$117.94 |
| Max. Negotiated Rate |
$241.24 |
| Rate for Payer: Aetna American Axle |
$174.23
|
| Rate for Payer: Aetna Commercial |
$227.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.23
|
| Rate for Payer: Cash Price |
$214.44
|
| Rate for Payer: Cofinity Commercial |
$187.64
|
| Rate for Payer: Cofinity Commercial |
$230.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$187.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.44
|
| Rate for Payer: Healthscope Commercial |
$241.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$187.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$201.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.84
|
| Rate for Payer: PHP Commercial |
$227.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.23
|
| Rate for Payer: Priority Health SBD |
$168.87
|
| Rate for Payer: UMR Bronson Commercial |
$117.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$201.04
|
|
|
HC VITAL CAPACITY
|
Facility
|
OP
|
$268.05
|
|
|
Service Code
|
CPT 94150
|
| Hospital Charge Code |
46000016
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$82.17 |
| Max. Negotiated Rate |
$481.80 |
| Rate for Payer: Aetna American Axle |
$174.23
|
| Rate for Payer: Aetna Commercial |
$227.84
|
| Rate for Payer: Aetna Medicare |
$159.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$191.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$191.62
|
| Rate for Payer: BCBS Complete |
$86.28
|
| Rate for Payer: BCBS MAPPO |
$153.30
|
| Rate for Payer: BCBS Trust/PPO |
$91.62
|
| Rate for Payer: BCN Commercial |
$91.62
|
| Rate for Payer: BCN Medicare Advantage |
$153.30
|
| Rate for Payer: Cash Price |
$214.44
|
| Rate for Payer: Cash Price |
$214.44
|
| Rate for Payer: Cash Price |
$214.44
|
| Rate for Payer: Cofinity Commercial |
$187.64
|
| Rate for Payer: Cofinity Commercial |
$230.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$187.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$153.30
|
| Rate for Payer: Healthscope Commercial |
$241.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$187.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$201.04
|
| Rate for Payer: Mclaren Medicaid |
$82.17
|
| Rate for Payer: Mclaren Medicare |
$153.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$160.96
|
| Rate for Payer: Meridian Medicaid |
$86.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$176.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.84
|
| Rate for Payer: Nomi Health Commercial |
$459.90
|
| Rate for Payer: PACE Medicare |
$145.64
|
| Rate for Payer: PACE SWMI |
$153.30
|
| Rate for Payer: PHP Commercial |
$227.84
|
| Rate for Payer: PHP Medicare Advantage |
$153.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$481.80
|
| Rate for Payer: Priority Health Medicare |
$153.30
|
| Rate for Payer: Priority Health Narrow Network |
$385.44
|
| Rate for Payer: Priority Health SBD |
$168.87
|
| Rate for Payer: Railroad Medicare Medicare |
$153.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$431.52
|
| Rate for Payer: UHC Core |
$294.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$153.30
|
| Rate for Payer: UHC Exchange |
$292.97
|
| Rate for Payer: UHC Medicare Advantage |
$153.30
|
| Rate for Payer: UHCCP Medicaid |
$82.17
|
| Rate for Payer: UMR Bronson Commercial |
$99.18
|
| Rate for Payer: VA VA |
$153.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$201.04
|
|
|
HC VITAMIN A LEVEL
|
Facility
|
IP
|
$46.82
|
|
|
Service Code
|
CPT 84590
|
| Hospital Charge Code |
30100458
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.60 |
| Max. Negotiated Rate |
$42.14 |
| Rate for Payer: Aetna American Axle |
$30.43
|
| Rate for Payer: Aetna Commercial |
$39.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.43
|
| Rate for Payer: Cash Price |
$37.46
|
| Rate for Payer: Cofinity Commercial |
$32.77
|
| Rate for Payer: Cofinity Commercial |
$40.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$32.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.46
|
| Rate for Payer: Healthscope Commercial |
$42.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.80
|
| Rate for Payer: PHP Commercial |
$39.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.43
|
| Rate for Payer: Priority Health SBD |
$29.50
|
| Rate for Payer: UMR Bronson Commercial |
$20.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.12
|
|
