|
HC ZONISAMIDE
|
Facility
|
IP
|
$76.50
|
|
|
Service Code
|
CPT 80203
|
| Hospital Charge Code |
30100052
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.66 |
| Max. Negotiated Rate |
$68.85 |
| Rate for Payer: Aetna American Axle |
$49.73
|
| Rate for Payer: Aetna Commercial |
$65.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.73
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cofinity Commercial |
$53.55
|
| Rate for Payer: Cofinity Commercial |
$65.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$53.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.20
|
| Rate for Payer: Healthscope Commercial |
$68.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$53.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.03
|
| Rate for Payer: PHP Commercial |
$65.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.73
|
| Rate for Payer: Priority Health SBD |
$48.20
|
| Rate for Payer: UMR Bronson Commercial |
$33.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.38
|
|
|
HC ZOSTER VACCINE (HZV) RECOMB ADJ, IM
|
Facility
|
OP
|
$174.79
|
|
|
Service Code
|
CPT 90750
|
| Hospital Charge Code |
63600123
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.67 |
| Max. Negotiated Rate |
$157.31 |
| Rate for Payer: Aetna American Axle |
$113.61
|
| Rate for Payer: Aetna Commercial |
$148.57
|
| Rate for Payer: Aetna Medicare |
$87.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.61
|
| Rate for Payer: BCBS Complete |
$69.92
|
| Rate for Payer: Cash Price |
$139.83
|
| Rate for Payer: Cofinity Commercial |
$122.35
|
| Rate for Payer: Cofinity Commercial |
$150.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$122.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.83
|
| Rate for Payer: Healthscope Commercial |
$157.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$122.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$131.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$148.57
|
| Rate for Payer: PHP Commercial |
$148.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.61
|
| Rate for Payer: Priority Health SBD |
$110.12
|
| Rate for Payer: UMR Bronson Commercial |
$64.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$131.09
|
|
|
HC ZOSTER VACCINE (HZV) RECOMB ADJ, IM
|
Facility
|
IP
|
$174.79
|
|
|
Service Code
|
CPT 90750
|
| Hospital Charge Code |
63600123
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$76.91 |
| Max. Negotiated Rate |
$157.31 |
| Rate for Payer: Aetna American Axle |
$113.61
|
| Rate for Payer: Aetna Commercial |
$148.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.61
|
| Rate for Payer: Cash Price |
$139.83
|
| Rate for Payer: Cofinity Commercial |
$122.35
|
| Rate for Payer: Cofinity Commercial |
$150.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$122.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.83
|
| Rate for Payer: Healthscope Commercial |
$157.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$122.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$131.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$148.57
|
| Rate for Payer: PHP Commercial |
$148.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.61
|
| Rate for Payer: Priority Health SBD |
$110.12
|
| Rate for Payer: UMR Bronson Commercial |
$76.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$131.09
|
|
|
HC Z RETRIEVAL SNARE
|
Facility
|
OP
|
$1,332.83
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
27200094
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$493.15 |
| Max. Negotiated Rate |
$1,199.55 |
| Rate for Payer: Aetna American Axle |
$866.34
|
| Rate for Payer: Aetna Commercial |
$1,132.91
|
| Rate for Payer: Aetna Medicare |
$666.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$866.34
|
| Rate for Payer: BCBS Complete |
$533.13
|
| Rate for Payer: Cash Price |
$1,066.26
|
| Rate for Payer: Cofinity Commercial |
$1,146.23
|
| Rate for Payer: Cofinity Commercial |
$932.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$932.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,066.26
|
| Rate for Payer: Healthscope Commercial |
$1,199.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$932.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$999.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,132.91
|
| Rate for Payer: PHP Commercial |
$1,132.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$866.34
|
| Rate for Payer: Priority Health SBD |
$839.68
|
| Rate for Payer: UMR Bronson Commercial |
$493.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$999.62
|
|
|
HC Z RETRIEVAL SNARE
|
Facility
|
IP
|
$1,332.83
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
27200094
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$586.45 |
| Max. Negotiated Rate |
$1,199.55 |
| Rate for Payer: Aetna American Axle |
$866.34
|
| Rate for Payer: Aetna Commercial |
$1,132.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$866.34
|
| Rate for Payer: Cash Price |
$1,066.26
|
| Rate for Payer: Cofinity Commercial |
$1,146.23
|
| Rate for Payer: Cofinity Commercial |
$932.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$932.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,066.26
|
| Rate for Payer: Healthscope Commercial |
$1,199.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$932.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$999.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,132.91
|
| Rate for Payer: PHP Commercial |
$1,132.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$866.34
|
| Rate for Payer: Priority Health SBD |
$839.68
|
| Rate for Payer: UMR Bronson Commercial |
$586.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$999.62
|
|
|
HC Z STENT URETERAL
|
Facility
|
IP
|
$1,212.86
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27800041
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$533.66 |
| Max. Negotiated Rate |
$1,091.57 |
| Rate for Payer: Aetna American Axle |
$788.36
|
| Rate for Payer: Aetna Commercial |
$1,030.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$788.36
|
| Rate for Payer: Cash Price |
$970.29
|
| Rate for Payer: Cofinity Commercial |
$1,043.06
|
| Rate for Payer: Cofinity Commercial |
$849.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$849.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$970.29
|
| Rate for Payer: Healthscope Commercial |
$1,091.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$849.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$909.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,030.93
|
| Rate for Payer: PHP Commercial |
$1,030.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$788.36
|
| Rate for Payer: Priority Health SBD |
$764.10
|
| Rate for Payer: UMR Bronson Commercial |
$533.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$909.64
|
|
|
HC Z STENT URETERAL
|
Facility
|
OP
|
$1,212.86
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27800041
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$448.76 |
| Max. Negotiated Rate |
$1,091.57 |
| Rate for Payer: Aetna American Axle |
$788.36
|
| Rate for Payer: Aetna Commercial |
$1,030.93
|
| Rate for Payer: Aetna Medicare |
$606.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$788.36
|
| Rate for Payer: BCBS Complete |
$485.14
|
| Rate for Payer: Cash Price |
$970.29
|
| Rate for Payer: Cofinity Commercial |
$1,043.06
|
| Rate for Payer: Cofinity Commercial |
$849.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$849.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$970.29
|
| Rate for Payer: Healthscope Commercial |
$1,091.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$849.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$909.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,030.93
|
| Rate for Payer: PHP Commercial |
$1,030.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$788.36
|
| Rate for Payer: Priority Health SBD |
$764.10
|
| Rate for Payer: UMR Bronson Commercial |
$448.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$909.64
|
|
|
HC Z TUNNELED PLEURAL CATHETER
|
Facility
|
OP
|
$1,756.94
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
27200097
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$650.07 |
| Max. Negotiated Rate |
$1,581.25 |
| Rate for Payer: Aetna American Axle |
$1,142.01
|
| Rate for Payer: Aetna Commercial |
$1,493.40
|
| Rate for Payer: Aetna Medicare |
$878.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,142.01
|
| Rate for Payer: BCBS Complete |
$702.78
|
| Rate for Payer: Cash Price |
$1,405.55
|
| Rate for Payer: Cofinity Commercial |
$1,229.86
|
| Rate for Payer: Cofinity Commercial |
$1,510.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,229.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,405.55
|
| Rate for Payer: Healthscope Commercial |
$1,581.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,229.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,317.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,493.40
|
| Rate for Payer: PHP Commercial |
$1,493.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,142.01
|
| Rate for Payer: Priority Health SBD |
$1,106.87
|
| Rate for Payer: UMR Bronson Commercial |
$650.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,317.70
|
|
|
HC Z TUNNELED PLEURAL CATHETER
|
Facility
|
IP
|
$1,756.94
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
27200097
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$773.05 |
| Max. Negotiated Rate |
$1,581.25 |
| Rate for Payer: Aetna American Axle |
$1,142.01
|
| Rate for Payer: Aetna Commercial |
$1,493.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,142.01
|
| Rate for Payer: Cash Price |
$1,405.55
|
| Rate for Payer: Cofinity Commercial |
$1,229.86
|
| Rate for Payer: Cofinity Commercial |
$1,510.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,229.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,405.55
|
| Rate for Payer: Healthscope Commercial |
$1,581.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,229.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,317.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,493.40
|
| Rate for Payer: PHP Commercial |
$1,493.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,142.01
|
| Rate for Payer: Priority Health SBD |
$1,106.87
|
| Rate for Payer: UMR Bronson Commercial |
$773.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,317.70
|
|
|
HC Z VACUUM BIOPSY DEVICE
|
Facility
|
OP
|
$646.29
|
|
| Hospital Charge Code |
27200129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$239.13 |
| Max. Negotiated Rate |
$581.66 |
| Rate for Payer: Aetna American Axle |
$420.09
|
| Rate for Payer: Aetna Commercial |
$549.35
|
| Rate for Payer: Aetna Medicare |
$323.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$420.09
|
| Rate for Payer: BCBS Complete |
$258.52
|
| Rate for Payer: Cash Price |
$517.03
|
| Rate for Payer: Cofinity Commercial |
$452.40
|
| Rate for Payer: Cofinity Commercial |
$555.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$452.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$517.03
|
| Rate for Payer: Healthscope Commercial |
$581.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$452.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$484.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$549.35
|
| Rate for Payer: PHP Commercial |
$549.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$420.09
|
| Rate for Payer: Priority Health SBD |
$407.16
|
| Rate for Payer: UMR Bronson Commercial |
$239.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$484.72
|
|
|
HC Z VACUUM BIOPSY DEVICE
|
Facility
|
IP
|
$646.29
|
|
| Hospital Charge Code |
27200129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$284.37 |
| Max. Negotiated Rate |
$581.66 |
| Rate for Payer: Aetna American Axle |
$420.09
|
| Rate for Payer: Aetna Commercial |
$549.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$420.09
|
| Rate for Payer: Cash Price |
$517.03
|
| Rate for Payer: Cofinity Commercial |
$452.40
|
| Rate for Payer: Cofinity Commercial |
$555.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$452.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$517.03
|
| Rate for Payer: Healthscope Commercial |
$581.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$452.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$484.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$549.35
|
| Rate for Payer: PHP Commercial |
$549.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$420.09
|
| Rate for Payer: Priority Health SBD |
$407.16
|
| Rate for Payer: UMR Bronson Commercial |
$284.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$484.72
|
|
|
HC Z VASCULAR CLOSURE
|
Facility
|
IP
|
$1,020.90
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
27200098
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$449.20 |
| Max. Negotiated Rate |
$918.81 |
| Rate for Payer: Aetna American Axle |
$663.59
|
| Rate for Payer: Aetna Commercial |
$867.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$663.59
|
| Rate for Payer: Cash Price |
$816.72
|
| Rate for Payer: Cofinity Commercial |
$714.63
|
| Rate for Payer: Cofinity Commercial |
$877.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$714.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$816.72
|
| Rate for Payer: Healthscope Commercial |
$918.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$714.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$765.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$867.76
|
| Rate for Payer: PHP Commercial |
$867.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$663.59
|
| Rate for Payer: Priority Health SBD |
$643.17
|
| Rate for Payer: UMR Bronson Commercial |
$449.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$765.67
|
|
|
HC Z VASCULAR CLOSURE
|
Facility
|
OP
|
$1,020.90
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
27200098
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$377.73 |
| Max. Negotiated Rate |
$918.81 |
| Rate for Payer: Aetna American Axle |
$663.59
|
| Rate for Payer: Aetna Commercial |
$867.76
|
| Rate for Payer: Aetna Medicare |
$510.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$663.59
|
| Rate for Payer: BCBS Complete |
$408.36
|
| Rate for Payer: Cash Price |
$816.72
|
| Rate for Payer: Cofinity Commercial |
$714.63
|
| Rate for Payer: Cofinity Commercial |
$877.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$714.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$816.72
|
| Rate for Payer: Healthscope Commercial |
$918.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$714.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$765.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$867.76
|
| Rate for Payer: PHP Commercial |
$867.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$663.59
|
| Rate for Payer: Priority Health SBD |
$643.17
|
| Rate for Payer: UMR Bronson Commercial |
$377.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$765.67
|
|
|
HC Z VENA CAVA FILTER
|
Facility
|
IP
|
$5,871.33
|
|
|
Service Code
|
HCPCS C1880
|
| Hospital Charge Code |
27800042
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,583.39 |
| Max. Negotiated Rate |
$5,284.20 |
| Rate for Payer: Aetna American Axle |
$3,816.36
|
| Rate for Payer: Aetna Commercial |
$4,990.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,816.36
|
| Rate for Payer: Cash Price |
$4,697.06
|
| Rate for Payer: Cofinity Commercial |
$4,109.93
|
| Rate for Payer: Cofinity Commercial |
$5,049.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,109.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,697.06
|
| Rate for Payer: Healthscope Commercial |
$5,284.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,109.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,403.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,990.63
|
| Rate for Payer: PHP Commercial |
$4,990.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,816.36
|
| Rate for Payer: Priority Health SBD |
$3,698.94
|
| Rate for Payer: UMR Bronson Commercial |
$2,583.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,403.50
|
|
|
HC Z VENA CAVA FILTER
|
Facility
|
OP
|
$5,871.33
|
|
|
Service Code
|
HCPCS C1880
|
| Hospital Charge Code |
27800042
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,172.39 |
| Max. Negotiated Rate |
$5,284.20 |
| Rate for Payer: Aetna American Axle |
$3,816.36
|
| Rate for Payer: Aetna Commercial |
$4,990.63
|
| Rate for Payer: Aetna Medicare |
$2,935.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,816.36
|
| Rate for Payer: BCBS Complete |
$2,348.53
|
| Rate for Payer: Cash Price |
$4,697.06
|
| Rate for Payer: Cofinity Commercial |
$4,109.93
|
| Rate for Payer: Cofinity Commercial |
$5,049.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,109.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,697.06
|
| Rate for Payer: Healthscope Commercial |
$5,284.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,109.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,403.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,990.63
|
| Rate for Payer: PHP Commercial |
$4,990.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,816.36
|
| Rate for Payer: Priority Health SBD |
$3,698.94
|
| Rate for Payer: UMR Bronson Commercial |
$2,172.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,403.50
|
|
|
HEARING AID RESTOCKING FEE
|
Professional
|
Both
|
$133.00
|
|
|
Service Code
|
HCPCS 00663
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$53.20 |
| Max. Negotiated Rate |
$86.45 |
| Rate for Payer: Aetna Medicare |
$66.50
|
| Rate for Payer: BCBS Complete |
$53.20
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.45
|
| Rate for Payer: UMR Bronson Commercial |
$61.18
|
|
|
HEMIN 350 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
IP
|
$28,445.28
|
|
|
Service Code
|
HCPCS J1640
|
| Hospital Charge Code |
183624
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12,515.92 |
| Max. Negotiated Rate |
$25,600.75 |
| Rate for Payer: Aetna American Axle |
$18,489.43
|
| Rate for Payer: Aetna Commercial |
$24,178.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18,489.43
|
| Rate for Payer: Cash Price |
$22,756.22
|
| Rate for Payer: Cofinity Commercial |
$19,911.70
|
| Rate for Payer: Cofinity Commercial |
$24,462.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$19,911.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22,756.22
|
| Rate for Payer: Healthscope Commercial |
$25,600.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19,911.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21,333.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,178.49
|
| Rate for Payer: PHP Commercial |
$24,178.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18,489.43
|
| Rate for Payer: Priority Health SBD |
$17,920.53
|
| Rate for Payer: UMR Bronson Commercial |
$12,515.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21,333.96
|
|
|
HEMIN 350 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
OP
|
$28,445.28
|
|
|
Service Code
|
HCPCS J1640
|
| Hospital Charge Code |
183624
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.32 |
| Max. Negotiated Rate |
$25,600.75 |
| Rate for Payer: Aetna American Axle |
$18,489.43
|
| Rate for Payer: Aetna Commercial |
$24,178.49
|
| Rate for Payer: Aetna Medicare |
$35.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18,489.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$42.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$42.73
|
| Rate for Payer: BCBS Complete |
$19.24
|
| Rate for Payer: BCBS MAPPO |
$34.18
|
| Rate for Payer: BCN Medicare Advantage |
$34.18
|
| Rate for Payer: Cash Price |
$22,756.22
|
| Rate for Payer: Cash Price |
$22,756.22
|
| Rate for Payer: Cofinity Commercial |
$24,462.94
|
| Rate for Payer: Cofinity Commercial |
$19,911.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$19,911.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22,756.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34.18
|
| Rate for Payer: Healthscope Commercial |
$25,600.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19,911.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21,333.96
|
| Rate for Payer: Mclaren Medicaid |
$18.32
|
| Rate for Payer: Mclaren Medicare |
$34.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$35.89
|
| Rate for Payer: Meridian Medicaid |
$19.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,178.49
|
| Rate for Payer: PACE Medicare |
$32.47
|
| Rate for Payer: PACE SWMI |
$34.18
|
| Rate for Payer: PHP Commercial |
$24,178.49
|
| Rate for Payer: PHP Medicare Advantage |
$34.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18,489.43
|
| Rate for Payer: Priority Health Medicare |
$34.18
|
| Rate for Payer: Priority Health SBD |
$17,920.53
|
| Rate for Payer: Railroad Medicare Medicare |
$34.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$96.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$34.18
|
| Rate for Payer: UHC Exchange |
$65.32
|
| Rate for Payer: UHC Medicare Advantage |
$34.18
|
| Rate for Payer: UHCCP Medicaid |
$18.32
|
| Rate for Payer: UMR Bronson Commercial |
$10,524.75
|
| Rate for Payer: VA VA |
$34.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21,333.96
|
|
|
HEMIPHALANGECTOMY OR INTERPHALANGEAL JOINT EXCISION, TOE, PROXIMAL END OF PHALANX, EACH
|
Facility
|
OP
|
$8,907.47
|
|
|
Service Code
|
CPT 28160
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,696.12 |
| Max. Negotiated Rate |
$8,907.47 |
| Rate for Payer: Aetna Medicare |
$3,290.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,955.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,955.50
|
| Rate for Payer: BCBS Complete |
$1,780.92
|
| Rate for Payer: BCBS MAPPO |
$3,164.40
|
| Rate for Payer: BCN Medicare Advantage |
$3,164.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,164.40
|
| Rate for Payer: Mclaren Medicaid |
$1,696.12
|
| Rate for Payer: Mclaren Medicare |
$3,164.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,322.62
|
| Rate for Payer: Meridian Medicaid |
$1,780.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,639.06
|
| Rate for Payer: PACE Medicare |
$3,006.18
|
| Rate for Payer: PACE SWMI |
$3,164.40
|
| Rate for Payer: PHP Medicare Advantage |
$3,164.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,696.12
|
| Rate for Payer: Priority Health Medicare |
$3,164.40
|
| Rate for Payer: Railroad Medicare Medicare |
$3,164.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,907.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,164.40
|
| Rate for Payer: UHC Exchange |
$6,047.48
|
| Rate for Payer: UHC Medicare Advantage |
$3,164.40
|
| Rate for Payer: UHCCP Medicaid |
$1,696.12
|
| Rate for Payer: VA VA |
$3,164.40
|
|
|
HEMORRHOIDECTOMY, EXTERNAL, 2 OR MORE COLUMNS/GROUPS
|
Facility
|
OP
|
$7,528.73
|
|
|
Service Code
|
CPT 46250
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,433.59 |
| Max. Negotiated Rate |
$7,528.73 |
| Rate for Payer: Aetna Medicare |
$2,781.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,343.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,343.25
|
| Rate for Payer: BCBS Complete |
$1,505.26
|
| Rate for Payer: BCBS MAPPO |
$2,674.60
|
| Rate for Payer: BCN Medicare Advantage |
$2,674.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,674.60
|
| Rate for Payer: Mclaren Medicaid |
$1,433.59
|
| Rate for Payer: Mclaren Medicare |
$2,674.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,808.33
|
| Rate for Payer: Meridian Medicaid |
$1,505.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,075.79
|
| Rate for Payer: PACE Medicare |
$2,540.87
|
| Rate for Payer: PACE SWMI |
$2,674.60
|
| Rate for Payer: PHP Medicare Advantage |
$2,674.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,433.59
|
| Rate for Payer: Priority Health Medicare |
$2,674.60
|
| Rate for Payer: Railroad Medicare Medicare |
$2,674.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,528.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,674.60
|
| Rate for Payer: UHC Exchange |
$5,111.43
|
| Rate for Payer: UHC Medicare Advantage |
$2,674.60
|
| Rate for Payer: UHCCP Medicaid |
$1,433.59
|
| Rate for Payer: VA VA |
$2,674.60
|
|
|
HEMORRHOIDECTOMY, INTERNAL AND EXTERNAL, 2 OR MORE COLUMNS/GROUPS;
|
Facility
|
OP
|
$7,528.73
|
|
|
Service Code
|
CPT 46260
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,433.59 |
| Max. Negotiated Rate |
$7,528.73 |
| Rate for Payer: Aetna Medicare |
$2,781.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,343.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,343.25
|
| Rate for Payer: BCBS Complete |
$1,505.26
|
| Rate for Payer: BCBS MAPPO |
$2,674.60
|
| Rate for Payer: BCN Medicare Advantage |
$2,674.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,674.60
|
| Rate for Payer: Mclaren Medicaid |
$1,433.59
|
| Rate for Payer: Mclaren Medicare |
$2,674.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,808.33
|
| Rate for Payer: Meridian Medicaid |
$1,505.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,075.79
|
| Rate for Payer: PACE Medicare |
$2,540.87
|
| Rate for Payer: PACE SWMI |
$2,674.60
|
| Rate for Payer: PHP Medicare Advantage |
$2,674.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,433.59
|
| Rate for Payer: Priority Health Medicare |
$2,674.60
|
| Rate for Payer: Railroad Medicare Medicare |
$2,674.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,528.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,674.60
|
| Rate for Payer: UHC Exchange |
$5,111.43
|
| Rate for Payer: UHC Medicare Advantage |
$2,674.60
|
| Rate for Payer: UHCCP Medicaid |
$1,433.59
|
| Rate for Payer: VA VA |
$2,674.60
|
|
|
HEMORRHOIDECTOMY, INTERNAL AND EXTERNAL, 2 OR MORE COLUMNS/GROUPS; WITH FISSURECTOMY
|
Facility
|
OP
|
$7,528.73
|
|
|
Service Code
|
CPT 46261
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,433.59 |
| Max. Negotiated Rate |
$7,528.73 |
| Rate for Payer: Aetna Medicare |
$2,781.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,343.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,343.25
|
| Rate for Payer: BCBS Complete |
$1,505.26
|
| Rate for Payer: BCBS MAPPO |
$2,674.60
|
| Rate for Payer: BCN Medicare Advantage |
$2,674.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,674.60
|
| Rate for Payer: Mclaren Medicaid |
$1,433.59
|
| Rate for Payer: Mclaren Medicare |
$2,674.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,808.33
|
| Rate for Payer: Meridian Medicaid |
$1,505.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,075.79
|
| Rate for Payer: PACE Medicare |
$2,540.87
|
| Rate for Payer: PACE SWMI |
$2,674.60
|
| Rate for Payer: PHP Medicare Advantage |
$2,674.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,433.59
|
| Rate for Payer: Priority Health Medicare |
$2,674.60
|
| Rate for Payer: Railroad Medicare Medicare |
$2,674.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,528.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,674.60
|
| Rate for Payer: UHC Exchange |
$5,111.43
|
| Rate for Payer: UHC Medicare Advantage |
$2,674.60
|
| Rate for Payer: UHCCP Medicaid |
$1,433.59
|
| Rate for Payer: VA VA |
$2,674.60
|
|
|
HEMORRHOIDECTOMY, INTERNAL AND EXTERNAL, 2 OR MORE COLUMNS/GROUPS; WITH FISTULECTOMY, INCLUDING FISSURECTOMY, WHEN PERFORMED
|
Facility
|
OP
|
$7,528.73
|
|
|
Service Code
|
CPT 46262
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,433.59 |
| Max. Negotiated Rate |
$7,528.73 |
| Rate for Payer: Aetna Medicare |
$2,781.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,343.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,343.25
|
| Rate for Payer: BCBS Complete |
$1,505.26
|
| Rate for Payer: BCBS MAPPO |
$2,674.60
|
| Rate for Payer: BCN Medicare Advantage |
$2,674.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,674.60
|
| Rate for Payer: Mclaren Medicaid |
$1,433.59
|
| Rate for Payer: Mclaren Medicare |
$2,674.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,808.33
|
| Rate for Payer: Meridian Medicaid |
$1,505.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,075.79
|
| Rate for Payer: PACE Medicare |
$2,540.87
|
| Rate for Payer: PACE SWMI |
$2,674.60
|
| Rate for Payer: PHP Medicare Advantage |
$2,674.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,433.59
|
| Rate for Payer: Priority Health Medicare |
$2,674.60
|
| Rate for Payer: Railroad Medicare Medicare |
$2,674.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,528.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,674.60
|
| Rate for Payer: UHC Exchange |
$5,111.43
|
| Rate for Payer: UHC Medicare Advantage |
$2,674.60
|
| Rate for Payer: UHCCP Medicaid |
$1,433.59
|
| Rate for Payer: VA VA |
$2,674.60
|
|
|
HEMORRHOIDECTOMY, INTERNAL AND EXTERNAL, SINGLE COLUMN/GROUP;
|
Facility
|
OP
|
$7,528.73
|
|
|
Service Code
|
CPT 46255
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,433.59 |
| Max. Negotiated Rate |
$7,528.73 |
| Rate for Payer: Aetna Medicare |
$2,781.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,343.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,343.25
|
| Rate for Payer: BCBS Complete |
$1,505.26
|
| Rate for Payer: BCBS MAPPO |
$2,674.60
|
| Rate for Payer: BCN Medicare Advantage |
$2,674.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,674.60
|
| Rate for Payer: Mclaren Medicaid |
$1,433.59
|
| Rate for Payer: Mclaren Medicare |
$2,674.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,808.33
|
| Rate for Payer: Meridian Medicaid |
$1,505.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,075.79
|
| Rate for Payer: PACE Medicare |
$2,540.87
|
| Rate for Payer: PACE SWMI |
$2,674.60
|
| Rate for Payer: PHP Medicare Advantage |
$2,674.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,433.59
|
| Rate for Payer: Priority Health Medicare |
$2,674.60
|
| Rate for Payer: Railroad Medicare Medicare |
$2,674.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,528.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,674.60
|
| Rate for Payer: UHC Exchange |
$5,111.43
|
| Rate for Payer: UHC Medicare Advantage |
$2,674.60
|
| Rate for Payer: UHCCP Medicaid |
$1,433.59
|
| Rate for Payer: VA VA |
$2,674.60
|
|
|
HEMORRHOIDECTOMY, INTERNAL AND EXTERNAL, SINGLE COLUMN/GROUP; WITH FISSURECTOMY
|
Facility
|
OP
|
$7,528.73
|
|
|
Service Code
|
CPT 46257
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,433.59 |
| Max. Negotiated Rate |
$7,528.73 |
| Rate for Payer: Aetna Medicare |
$2,781.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,343.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,343.25
|
| Rate for Payer: BCBS Complete |
$1,505.26
|
| Rate for Payer: BCBS MAPPO |
$2,674.60
|
| Rate for Payer: BCN Medicare Advantage |
$2,674.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,674.60
|
| Rate for Payer: Mclaren Medicaid |
$1,433.59
|
| Rate for Payer: Mclaren Medicare |
$2,674.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,808.33
|
| Rate for Payer: Meridian Medicaid |
$1,505.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,075.79
|
| Rate for Payer: PACE Medicare |
$2,540.87
|
| Rate for Payer: PACE SWMI |
$2,674.60
|
| Rate for Payer: PHP Medicare Advantage |
$2,674.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,433.59
|
| Rate for Payer: Priority Health Medicare |
$2,674.60
|
| Rate for Payer: Railroad Medicare Medicare |
$2,674.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,528.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,674.60
|
| Rate for Payer: UHC Exchange |
$5,111.43
|
| Rate for Payer: UHC Medicare Advantage |
$2,674.60
|
| Rate for Payer: UHCCP Medicaid |
$1,433.59
|
| Rate for Payer: VA VA |
$2,674.60
|
|
