|
PR REVSC OPN/PRQ TIB/PERO W/ATHRC/ANGIOP UNI EA VSL
|
Professional
|
Both
|
$1,119.00
|
|
|
Service Code
|
HCPCS 37233
|
| Min. Negotiated Rate |
$199.37 |
| Max. Negotiated Rate |
$783.30 |
| Rate for Payer: Aetna Commercial |
$437.50
|
| Rate for Payer: BCBS Complete |
$209.34
|
| Rate for Payer: BCBS Trust/PPO |
$495.55
|
| Rate for Payer: Cash Price |
$895.20
|
| Rate for Payer: Cash Price |
$895.20
|
| Rate for Payer: Meridian Medicaid |
$209.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$199.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$783.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$498.44
|
| Rate for Payer: Priority Health Narrow Network |
$498.44
|
| Rate for Payer: Priority Health SBD |
$498.44
|
| Rate for Payer: UMR Bronson Commercial |
$514.74
|
|
|
PR REVSC OPN/PRQ TIB/PERO W/STNT/ANGIOP SM VSL
|
Professional
|
Both
|
$2,685.00
|
|
|
Service Code
|
HCPCS 37230
|
| Min. Negotiated Rate |
$429.41 |
| Max. Negotiated Rate |
$1,879.50 |
| Rate for Payer: Aetna Commercial |
$935.98
|
| Rate for Payer: BCBS Complete |
$450.88
|
| Rate for Payer: BCBS Trust/PPO |
$709.51
|
| Rate for Payer: Cash Price |
$2,148.00
|
| Rate for Payer: Cash Price |
$2,148.00
|
| Rate for Payer: Meridian Medicaid |
$450.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$429.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,879.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,071.37
|
| Rate for Payer: Priority Health Narrow Network |
$1,071.37
|
| Rate for Payer: Priority Health SBD |
$1,071.37
|
| Rate for Payer: UMR Bronson Commercial |
$1,235.10
|
|
|
PR REVSC OPN/PRQ TIB/PERO W/STNT/ANGIOP UNI EA VSL
|
Professional
|
Both
|
$510.00
|
|
|
Service Code
|
HCPCS 37234
|
| Min. Negotiated Rate |
$174.23 |
| Max. Negotiated Rate |
$790.87 |
| Rate for Payer: Aetna Commercial |
$383.02
|
| Rate for Payer: BCBS Complete |
$182.94
|
| Rate for Payer: BCBS Trust/PPO |
$790.87
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Meridian Medicaid |
$182.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$174.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$357.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$434.08
|
| Rate for Payer: Priority Health Narrow Network |
$434.08
|
| Rate for Payer: Priority Health SBD |
$434.08
|
| Rate for Payer: UMR Bronson Commercial |
$234.60
|
|
|
PR RHINOPLASTY EXTERNAL
|
Professional
|
Both
|
$3,100.00
|
|
|
Service Code
|
HCPCS 00536
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$1,240.00 |
| Max. Negotiated Rate |
$2,170.00 |
| Rate for Payer: BCBS Complete |
$1,240.00
|
| Rate for Payer: Cash Price |
$2,480.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,170.00
|
| Rate for Payer: UMR Bronson Commercial |
$1,426.00
|
|
|
PR RHINOPLASTY PRIMARY W/MAJOR SEPTAL REPAIR
|
Professional
|
Both
|
$2,416.00
|
|
|
Service Code
|
HCPCS 30420
|
| Min. Negotiated Rate |
$782.41 |
| Max. Negotiated Rate |
$2,037.40 |
| Rate for Payer: Aetna Commercial |
$1,845.15
|
| Rate for Payer: BCBS Complete |
$979.59
|
| Rate for Payer: BCBS Trust/PPO |
$782.41
|
| Rate for Payer: Cash Price |
$1,932.80
|
| Rate for Payer: Cash Price |
$1,932.80
|
| Rate for Payer: Meridian Medicaid |
$979.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$932.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,691.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,037.40
|
| Rate for Payer: Priority Health Narrow Network |
$2,037.40
|
| Rate for Payer: Priority Health SBD |
$2,037.40
|
| Rate for Payer: UMR Bronson Commercial |
$1,111.36
|
|
|
PR RHINOPLASTY SECONDARY INTERMEDIATE REVISION
|
Professional
|
Both
|
$1,990.00
|
|
|
Service Code
|
HCPCS 30435
|
| Min. Negotiated Rate |
$859.24 |
| Max. Negotiated Rate |
$1,879.03 |
| Rate for Payer: Aetna Commercial |
$1,717.52
|
| Rate for Payer: BCBS Complete |
$902.20
|
| Rate for Payer: BCBS Trust/PPO |
$987.39
|
| Rate for Payer: Cash Price |
$1,592.00
|
| Rate for Payer: Cash Price |
$1,592.00
|
| Rate for Payer: Meridian Medicaid |
$902.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$859.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,393.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,879.03
|
| Rate for Payer: Priority Health Narrow Network |
$1,879.03
|
| Rate for Payer: Priority Health SBD |
$1,879.03
|
| Rate for Payer: UMR Bronson Commercial |
$915.40
|
|
|
PR RHINOPLASTY SECONDARY MAJOR REVISION
|
Professional
|
Both
|
$3,431.00
|
|
|
Service Code
|
HCPCS 30450
|
| Min. Negotiated Rate |
$858.49 |
| Max. Negotiated Rate |
$2,448.59 |
| Rate for Payer: Aetna Commercial |
$2,252.58
|
| Rate for Payer: BCBS Complete |
$1,176.85
|
| Rate for Payer: BCBS Trust/PPO |
$858.49
|
| Rate for Payer: Cash Price |
$2,744.80
|
| Rate for Payer: Cash Price |
$2,744.80
|
| Rate for Payer: Meridian Medicaid |
$1,176.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,120.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,401.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,448.59
|
| Rate for Payer: Priority Health Narrow Network |
$2,448.59
|
| Rate for Payer: Priority Health SBD |
$2,448.59
|
| Rate for Payer: UMR Bronson Commercial |
$1,578.26
|
|
|
PR RHINP DFRM W/COLUM LNGTH TIP ONLY
|
Professional
|
Both
|
$1,343.00
|
|
|
Service Code
|
HCPCS 30460
|
| Min. Negotiated Rate |
$531.44 |
| Max. Negotiated Rate |
$1,158.54 |
| Rate for Payer: Aetna Commercial |
$1,069.66
|
| Rate for Payer: BCBS Complete |
$558.01
|
| Rate for Payer: BCBS Trust/PPO |
$557.88
|
| Rate for Payer: Cash Price |
$1,074.40
|
| Rate for Payer: Cash Price |
$1,074.40
|
| Rate for Payer: Meridian Medicaid |
$558.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$531.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$940.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,158.54
|
| Rate for Payer: Priority Health Narrow Network |
$1,158.54
|
| Rate for Payer: Priority Health SBD |
$1,158.54
|
| Rate for Payer: UMR Bronson Commercial |
$617.78
|
|
|
PR RHINP PRIM COMPLETE XTRNL PARTS
|
Professional
|
Both
|
$3,000.00
|
|
|
Service Code
|
HCPCS 30410
|
| Min. Negotiated Rate |
$562.64 |
| Max. Negotiated Rate |
$2,100.00 |
| Rate for Payer: Aetna Commercial |
$1,815.03
|
| Rate for Payer: Aetna Commercial |
$1,815.03
|
| Rate for Payer: BCBS Complete |
$952.75
|
| Rate for Payer: BCBS Complete |
$952.75
|
| Rate for Payer: BCBS Trust/PPO |
$562.64
|
| Rate for Payer: BCBS Trust/PPO |
$562.64
|
| Rate for Payer: Cash Price |
$2,419.20
|
| Rate for Payer: Cash Price |
$2,400.00
|
| Rate for Payer: Cash Price |
$2,400.00
|
| Rate for Payer: Cash Price |
$2,419.20
|
| Rate for Payer: Meridian Medicaid |
$952.75
|
| Rate for Payer: Meridian Medicaid |
$952.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$907.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$907.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,116.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,100.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,983.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,983.22
|
| Rate for Payer: Priority Health Narrow Network |
$1,983.22
|
| Rate for Payer: Priority Health Narrow Network |
$1,983.22
|
| Rate for Payer: Priority Health SBD |
$1,983.22
|
| Rate for Payer: Priority Health SBD |
$1,983.22
|
| Rate for Payer: UMR Bronson Commercial |
$1,380.00
|
| Rate for Payer: UMR Bronson Commercial |
$1,391.04
|
|
|
PR RHINP PRIM LAT&ALAR CRTLGS&/ELVTN NASAL TI
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 30400
|
| Min. Negotiated Rate |
$690.00 |
| Max. Negotiated Rate |
$1,845.35 |
| Rate for Payer: Aetna Commercial |
$1,572.55
|
| Rate for Payer: BCBS Complete |
$828.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,845.35
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Meridian Medicaid |
$828.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$788.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,050.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,726.23
|
| Rate for Payer: Priority Health Narrow Network |
$1,726.23
|
| Rate for Payer: Priority Health SBD |
$1,726.23
|
| Rate for Payer: UMR Bronson Commercial |
$690.00
|
|
|
PR RHO(D) IMMUNE GLOBULIN HUMAN FULL-DOSE IM
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 90384
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Aetna Commercial |
$78.10
|
| Rate for Payer: BCBS Complete |
$60.00
|
| Rate for Payer: BCBS Trust/PPO |
$91.88
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.00
|
| Rate for Payer: UMR Bronson Commercial |
$69.00
|
|
|
PR RHO D IMMUNE GLOBULIN INJ
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS J2790
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Aetna Commercial |
$83.60
|
| Rate for Payer: BCBS Complete |
$60.00
|
| Rate for Payer: BCBS Trust/PPO |
$64.41
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.00
|
| Rate for Payer: UMR Bronson Commercial |
$69.00
|
|
|
PR RHYTHM ECG 1-3 LEADS INTERPRETATION & REPRT ON
|
Professional
|
Both
|
$27.00
|
|
|
Service Code
|
HCPCS 93042
|
| Min. Negotiated Rate |
$4.26 |
| Max. Negotiated Rate |
$2,070.41 |
| Rate for Payer: Aetna Commercial |
$9.24
|
| Rate for Payer: BCBS Complete |
$4.47
|
| Rate for Payer: BCBS Trust/PPO |
$2,070.41
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Meridian Medicaid |
$4.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.46
|
| Rate for Payer: Priority Health Narrow Network |
$9.46
|
| Rate for Payer: Priority Health SBD |
$9.46
|
| Rate for Payer: UMR Bronson Commercial |
$12.42
|
|
|
PR RHYTHM ECG 1-3 LEADS TRACING ONLY W/O I&R
|
Professional
|
Both
|
$16.00
|
|
|
Service Code
|
HCPCS 93041
|
| Min. Negotiated Rate |
$6.40 |
| Max. Negotiated Rate |
$1,926.71 |
| Rate for Payer: Aetna Commercial |
$7.33
|
| Rate for Payer: BCBS Complete |
$6.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,926.71
|
| Rate for Payer: Cash Price |
$12.80
|
| Rate for Payer: Cash Price |
$12.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.51
|
| Rate for Payer: Priority Health Narrow Network |
$8.51
|
| Rate for Payer: Priority Health SBD |
$8.51
|
| Rate for Payer: UMR Bronson Commercial |
$7.36
|
|
|
PR RHYTHM ECG 1-3 LEADS W/INTERPRETATION & REPORT
|
Professional
|
Both
|
$44.00
|
|
|
Service Code
|
HCPCS 93040
|
| Min. Negotiated Rate |
$16.57 |
| Max. Negotiated Rate |
$2,312.90 |
| Rate for Payer: Aetna Commercial |
$16.57
|
| Rate for Payer: BCBS Complete |
$17.60
|
| Rate for Payer: BCBS Trust/PPO |
$2,312.90
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.97
|
| Rate for Payer: Priority Health Narrow Network |
$17.97
|
| Rate for Payer: Priority Health SBD |
$17.97
|
| Rate for Payer: UMR Bronson Commercial |
$20.24
|
|
|
PR RHYTIDECTOMY 3 HOURS
|
Professional
|
Both
|
$4,800.00
|
|
|
Service Code
|
HCPCS 00539
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$1,920.00 |
| Max. Negotiated Rate |
$3,360.00 |
| Rate for Payer: BCBS Complete |
$1,920.00
|
| Rate for Payer: Cash Price |
$3,840.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,360.00
|
| Rate for Payer: UMR Bronson Commercial |
$2,208.00
|
|
|
PR RHYTIDECTOMY SMAS FLAP
|
Professional
|
Both
|
$4,800.00
|
|
|
Service Code
|
HCPCS 15829
|
| Min. Negotiated Rate |
$129.77 |
| Max. Negotiated Rate |
$3,360.00 |
| Rate for Payer: Aetna Commercial |
$2,885.67
|
| Rate for Payer: BCBS Complete |
$1,920.00
|
| Rate for Payer: BCBS Trust/PPO |
$129.77
|
| Rate for Payer: Cash Price |
$3,840.00
|
| Rate for Payer: Cash Price |
$3,840.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,360.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,276.80
|
| Rate for Payer: Priority Health Narrow Network |
$3,276.80
|
| Rate for Payer: Priority Health SBD |
$3,276.80
|
| Rate for Payer: UMR Bronson Commercial |
$2,208.00
|
|
|
PR RIGHT HEART CATH O2 SATURATION & CARDIAC OUTPUT
|
Professional
|
Both
|
$437.00
|
|
|
Service Code
|
HCPCS 93451
|
| Min. Negotiated Rate |
$174.80 |
| Max. Negotiated Rate |
$1,711.69 |
| Rate for Payer: Aetna Commercial |
$1,160.68
|
| Rate for Payer: BCBS Complete |
$174.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,711.69
|
| Rate for Payer: Cash Price |
$349.60
|
| Rate for Payer: Cash Price |
$349.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$305.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$180.16
|
| Rate for Payer: Priority Health Narrow Network |
$180.16
|
| Rate for Payer: Priority Health SBD |
$1,229.46
|
| Rate for Payer: UMR Bronson Commercial |
$201.02
|
|
|
PR RIMPLTJ VISC ART INFRARNL AORTIC PROSTH EA ART
|
Professional
|
Both
|
$322.00
|
|
|
Service Code
|
HCPCS 35697
|
| Min. Negotiated Rate |
$90.95 |
| Max. Negotiated Rate |
$1,973.73 |
| Rate for Payer: Aetna Commercial |
$199.90
|
| Rate for Payer: BCBS Complete |
$95.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,973.73
|
| Rate for Payer: Cash Price |
$257.60
|
| Rate for Payer: Cash Price |
$257.60
|
| Rate for Payer: Meridian Medicaid |
$95.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$90.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$225.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$227.15
|
| Rate for Payer: Priority Health Narrow Network |
$227.15
|
| Rate for Payer: Priority Health SBD |
$227.15
|
| Rate for Payer: UMR Bronson Commercial |
$148.12
|
|
|
PR RINGERS LACTATE INFUSION
|
Professional
|
Both
|
$30.00
|
|
|
Service Code
|
HCPCS J7120
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: Aetna Commercial |
$2.67
|
| Rate for Payer: BCBS Complete |
$12.00
|
| Rate for Payer: BCBS Trust/PPO |
$0.74
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.00
|
| Rate for Payer: UMR Bronson Commercial |
$13.80
|
|
|
PR RINSJ RPTD BICEPS/TRICEPS TDN DSTL W/WO TDN GRF
|
Professional
|
Both
|
$2,580.00
|
|
|
Service Code
|
HCPCS 24342
|
| Min. Negotiated Rate |
$117.28 |
| Max. Negotiated Rate |
$1,806.00 |
| Rate for Payer: Aetna Commercial |
$1,036.16
|
| Rate for Payer: BCBS Complete |
$525.80
|
| Rate for Payer: BCBS Trust/PPO |
$117.28
|
| Rate for Payer: Cash Price |
$2,064.00
|
| Rate for Payer: Cash Price |
$2,064.00
|
| Rate for Payer: Meridian Medicaid |
$525.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$500.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,806.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,191.35
|
| Rate for Payer: Priority Health Narrow Network |
$1,191.35
|
| Rate for Payer: Priority Health SBD |
$1,191.35
|
| Rate for Payer: UMR Bronson Commercial |
$1,186.80
|
|
|
PR RINSJ RPTD BICEPS/TRICEPS TDN DSTL W/WO TDN GRF
|
Facility
|
IP
|
$2,580.00
|
|
|
Service Code
|
CPT 24342
|
| Hospital Charge Code |
24342
|
| Min. Negotiated Rate |
$1,135.20 |
| Max. Negotiated Rate |
$2,322.00 |
| Rate for Payer: Aetna American Axle |
$1,677.00
|
| Rate for Payer: Aetna Commercial |
$2,193.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,677.00
|
| Rate for Payer: Cash Price |
$2,064.00
|
| Rate for Payer: Cofinity Commercial |
$1,806.00
|
| Rate for Payer: Cofinity Commercial |
$2,218.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,064.00
|
| Rate for Payer: Healthscope Commercial |
$2,322.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,806.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,935.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,193.00
|
| Rate for Payer: PHP Commercial |
$2,193.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,806.00
|
| Rate for Payer: Priority Health SBD |
$1,625.40
|
| Rate for Payer: UMR Bronson Commercial |
$1,135.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,935.00
|
|
|
PR RINSJ RPTD BICEPS/TRICEPS TDN DSTL W/WO TDN GRF
|
Professional
|
Both
|
$2,580.00
|
|
|
Service Code
|
HCPCS 24342
|
| Hospital Charge Code |
24342
|
| Min. Negotiated Rate |
$117.28 |
| Max. Negotiated Rate |
$1,806.00 |
| Rate for Payer: Aetna Commercial |
$1,036.16
|
| Rate for Payer: BCBS Complete |
$525.80
|
| Rate for Payer: BCBS Trust/PPO |
$117.28
|
| Rate for Payer: Cash Price |
$2,064.00
|
| Rate for Payer: Cash Price |
$2,064.00
|
| Rate for Payer: Meridian Medicaid |
$525.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$500.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,806.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,191.35
|
| Rate for Payer: Priority Health Narrow Network |
$1,191.35
|
| Rate for Payer: Priority Health SBD |
$1,191.35
|
| Rate for Payer: UMR Bronson Commercial |
$1,186.80
|
|
|
PR RINSJ RPTD BICEPS/TRICEPS TDN DSTL W/WO TDN GRF
|
Facility
|
OP
|
$2,580.00
|
|
|
Service Code
|
CPT 24342
|
| Hospital Charge Code |
24342
|
| Min. Negotiated Rate |
$769.82 |
| Max. Negotiated Rate |
$20,018.71 |
| Rate for Payer: Aetna American Axle |
$1,677.00
|
| Rate for Payer: Aetna Commercial |
$2,193.00
|
| Rate for Payer: Aetna Medicare |
$6,613.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,677.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,948.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,948.86
|
| Rate for Payer: BCBS Complete |
$3,652.66
|
| Rate for Payer: BCBS MAPPO |
$6,359.09
|
| Rate for Payer: BCBS Trust/PPO |
$4,450.67
|
| Rate for Payer: BCN Medicare Advantage |
$6,359.09
|
| Rate for Payer: Cash Price |
$2,064.00
|
| Rate for Payer: Cash Price |
$2,064.00
|
| Rate for Payer: Cofinity Commercial |
$2,218.80
|
| Rate for Payer: Cofinity Commercial |
$1,806.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,064.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,359.09
|
| Rate for Payer: Healthscope Commercial |
$2,322.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,806.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,935.00
|
| Rate for Payer: Mclaren Medicaid |
$3,478.42
|
| Rate for Payer: Mclaren Medicare |
$6,359.09
|
| Rate for Payer: Meridian Medicaid |
$3,652.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,677.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,312.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,193.00
|
| Rate for Payer: PACE Medicare |
$6,041.14
|
| Rate for Payer: PACE SWMI |
$6,359.09
|
| Rate for Payer: PHP Commercial |
$2,193.00
|
| Rate for Payer: PHP Medicare Advantage |
$6,359.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,478.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,806.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,018.71
|
| Rate for Payer: Priority Health Medicare |
$6,359.09
|
| Rate for Payer: Priority Health Narrow Network |
$16,014.97
|
| Rate for Payer: Priority Health SBD |
$1,625.40
|
| Rate for Payer: Railroad Medicare Medicare |
$6,359.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$846.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,359.09
|
| Rate for Payer: UHC Exchange |
$769.82
|
| Rate for Payer: UHC Medicare Advantage |
$6,549.86
|
| Rate for Payer: UMR Bronson Commercial |
$954.60
|
| Rate for Payer: VA VA |
$6,359.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,935.00
|
|
|
PR RIV4 VACC RECOMBINANT DNA PRSRV ANTIBIO FREE IM
|
Professional
|
Both
|
$91.47
|
|
|
Service Code
|
HCPCS 90682
|
| Min. Negotiated Rate |
$36.59 |
| Max. Negotiated Rate |
$73.62 |
| Rate for Payer: Aetna Commercial |
$73.40
|
| Rate for Payer: BCBS Complete |
$36.59
|
| Rate for Payer: BCBS Trust/PPO |
$73.62
|
| Rate for Payer: Cash Price |
$73.18
|
| Rate for Payer: Cash Price |
$73.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.03
|
| Rate for Payer: UMR Bronson Commercial |
$42.08
|
|
