|
PR RPLCMT OI IMPLT SKULL PERQ ATTACHMENT ESP
|
Professional
|
Both
|
$2,217.00
|
|
|
Service Code
|
HCPCS 69717
|
| Min. Negotiated Rate |
$360.18 |
| Max. Negotiated Rate |
$1,881.80 |
| Rate for Payer: Aetna Commercial |
$1,259.55
|
| Rate for Payer: BCBS Complete |
$378.19
|
| Rate for Payer: BCBS Trust/PPO |
$1,881.80
|
| Rate for Payer: Cash Price |
$1,773.60
|
| Rate for Payer: Cash Price |
$1,773.60
|
| Rate for Payer: Meridian Medicaid |
$378.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$360.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,551.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$793.46
|
| Rate for Payer: Priority Health Narrow Network |
$793.46
|
| Rate for Payer: Priority Health SBD |
$793.46
|
| Rate for Payer: UMR Bronson Commercial |
$1,019.82
|
|
|
PR RPLCMT PROST AORTIC VALVE OPEN XCP HOMOGRF/STENT
|
Professional
|
Both
|
$4,659.32
|
|
|
Service Code
|
HCPCS 33405
|
| Min. Negotiated Rate |
$683.09 |
| Max. Negotiated Rate |
$3,539.12 |
| Rate for Payer: Aetna Commercial |
$3,049.41
|
| Rate for Payer: BCBS Complete |
$1,493.09
|
| Rate for Payer: BCBS Trust/PPO |
$683.09
|
| Rate for Payer: Cash Price |
$3,727.46
|
| Rate for Payer: Cash Price |
$3,727.46
|
| Rate for Payer: Meridian Medicaid |
$1,493.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,421.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,261.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,539.12
|
| Rate for Payer: Priority Health Narrow Network |
$3,539.12
|
| Rate for Payer: Priority Health SBD |
$3,539.12
|
| Rate for Payer: UMR Bronson Commercial |
$2,143.29
|
|
|
PR RPLCMT/REVJ CSF SHUNT VALVE/CATH SHUNT SYS
|
Professional
|
Both
|
$3,485.00
|
|
|
Service Code
|
HCPCS 62230
|
| Min. Negotiated Rate |
$547.84 |
| Max. Negotiated Rate |
$2,439.50 |
| Rate for Payer: Aetna Commercial |
$1,086.68
|
| Rate for Payer: BCBS Complete |
$575.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,261.05
|
| Rate for Payer: Cash Price |
$2,788.00
|
| Rate for Payer: Cash Price |
$2,788.00
|
| Rate for Payer: Meridian Medicaid |
$575.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$547.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,439.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,442.18
|
| Rate for Payer: Priority Health Narrow Network |
$1,442.18
|
| Rate for Payer: Priority Health SBD |
$1,442.18
|
| Rate for Payer: UMR Bronson Commercial |
$1,603.10
|
|
|
PR RPLJ DGT EXCLUDING THMB SUBLIMIS TDN COMPL AMP
|
Professional
|
Both
|
$3,847.00
|
|
|
Service Code
|
HCPCS 20822
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$2,700.82 |
| Rate for Payer: Aetna Commercial |
$2,367.56
|
| Rate for Payer: BCBS Complete |
$1,190.71
|
| Rate for Payer: BCBS Trust/PPO |
$35.00
|
| Rate for Payer: Cash Price |
$3,077.60
|
| Rate for Payer: Cash Price |
$3,077.60
|
| Rate for Payer: Meridian Medicaid |
$1,190.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,134.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,692.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,700.82
|
| Rate for Payer: Priority Health Narrow Network |
$2,700.82
|
| Rate for Payer: Priority Health SBD |
$2,700.82
|
| Rate for Payer: UMR Bronson Commercial |
$1,769.62
|
|
|
PR RPR 1ST FEM HERNIA ANY AGE INCARCERATED
|
Facility
|
IP
|
$1,107.00
|
|
|
Service Code
|
CPT 49553
|
| Hospital Charge Code |
49553
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$487.08 |
| Max. Negotiated Rate |
$996.30 |
| Rate for Payer: Aetna American Axle |
$719.55
|
| Rate for Payer: Aetna Commercial |
$940.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$719.55
|
| Rate for Payer: Cash Price |
$885.60
|
| Rate for Payer: Cofinity Commercial |
$774.90
|
| Rate for Payer: Cofinity Commercial |
$952.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$885.60
|
| Rate for Payer: Healthscope Commercial |
$996.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$774.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$830.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$940.95
|
| Rate for Payer: PHP Commercial |
$940.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$774.90
|
| Rate for Payer: Priority Health SBD |
$697.41
|
| Rate for Payer: UMR Bronson Commercial |
$487.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$830.25
|
|
|
PR RPR 1ST FEM HERNIA ANY AGE INCARCERATED
|
Professional
|
Both
|
$1,107.00
|
|
|
Service Code
|
HCPCS 49553
|
| Hospital Charge Code |
49553
|
| Min. Negotiated Rate |
$406.83 |
| Max. Negotiated Rate |
$1,814.71 |
| Rate for Payer: Aetna Commercial |
$852.48
|
| Rate for Payer: BCBS Complete |
$427.17
|
| Rate for Payer: BCBS Trust/PPO |
$1,814.71
|
| Rate for Payer: Cash Price |
$885.60
|
| Rate for Payer: Cash Price |
$885.60
|
| Rate for Payer: Meridian Medicaid |
$427.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$406.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$774.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,117.15
|
| Rate for Payer: Priority Health Narrow Network |
$1,117.15
|
| Rate for Payer: Priority Health SBD |
$1,117.15
|
| Rate for Payer: UMR Bronson Commercial |
$509.22
|
|
|
PR RPR 1ST FEM HERNIA ANY AGE INCARCERATED
|
Professional
|
Both
|
$1,107.00
|
|
|
Service Code
|
HCPCS 49553
|
| Min. Negotiated Rate |
$406.83 |
| Max. Negotiated Rate |
$1,814.71 |
| Rate for Payer: Aetna Commercial |
$852.48
|
| Rate for Payer: BCBS Complete |
$427.17
|
| Rate for Payer: BCBS Trust/PPO |
$1,814.71
|
| Rate for Payer: Cash Price |
$885.60
|
| Rate for Payer: Cash Price |
$885.60
|
| Rate for Payer: Meridian Medicaid |
$427.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$406.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$774.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,117.15
|
| Rate for Payer: Priority Health Narrow Network |
$1,117.15
|
| Rate for Payer: Priority Health SBD |
$1,117.15
|
| Rate for Payer: UMR Bronson Commercial |
$509.22
|
|
|
PR RPR 1ST FEM HERNIA ANY AGE INCARCERATED
|
Facility
|
OP
|
$1,107.00
|
|
|
Service Code
|
CPT 49553
|
| Hospital Charge Code |
49553
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$409.59 |
| Max. Negotiated Rate |
$9,680.93 |
| Rate for Payer: Aetna American Axle |
$719.55
|
| Rate for Payer: Aetna Commercial |
$940.95
|
| Rate for Payer: Aetna Medicare |
$3,198.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$719.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,844.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,844.02
|
| Rate for Payer: BCBS Complete |
$1,766.41
|
| Rate for Payer: BCBS MAPPO |
$3,075.22
|
| Rate for Payer: BCBS Trust/PPO |
$2,519.12
|
| Rate for Payer: BCN Medicare Advantage |
$3,075.22
|
| Rate for Payer: Cash Price |
$885.60
|
| Rate for Payer: Cash Price |
$885.60
|
| Rate for Payer: Cofinity Commercial |
$774.90
|
| Rate for Payer: Cofinity Commercial |
$952.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$885.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,075.22
|
| Rate for Payer: Healthscope Commercial |
$996.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$774.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$830.25
|
| Rate for Payer: Mclaren Medicaid |
$1,682.15
|
| Rate for Payer: Mclaren Medicare |
$3,075.22
|
| Rate for Payer: Meridian Medicaid |
$1,766.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,228.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,536.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$940.95
|
| Rate for Payer: PACE Medicare |
$2,921.46
|
| Rate for Payer: PACE SWMI |
$3,075.22
|
| Rate for Payer: PHP Commercial |
$940.95
|
| Rate for Payer: PHP Medicare Advantage |
$3,075.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,682.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$774.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,680.93
|
| Rate for Payer: Priority Health Medicare |
$3,075.22
|
| Rate for Payer: Priority Health Narrow Network |
$7,744.74
|
| Rate for Payer: Priority Health SBD |
$697.41
|
| Rate for Payer: Railroad Medicare Medicare |
$3,075.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$687.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,075.22
|
| Rate for Payer: UHC Exchange |
$625.41
|
| Rate for Payer: UHC Medicare Advantage |
$3,167.48
|
| Rate for Payer: UMR Bronson Commercial |
$409.59
|
| Rate for Payer: VA VA |
$3,075.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$830.25
|
|
|
PR RPR 1ST FEM HRNA ANY AGE REDUCIBLE
|
Facility
|
IP
|
$847.00
|
|
|
Service Code
|
CPT 49550
|
| Hospital Charge Code |
49550
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$372.68 |
| Max. Negotiated Rate |
$762.30 |
| Rate for Payer: Aetna American Axle |
$550.55
|
| Rate for Payer: Aetna Commercial |
$719.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$550.55
|
| Rate for Payer: Cash Price |
$677.60
|
| Rate for Payer: Cofinity Commercial |
$592.90
|
| Rate for Payer: Cofinity Commercial |
$728.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$677.60
|
| Rate for Payer: Healthscope Commercial |
$762.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$592.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$635.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$719.95
|
| Rate for Payer: PHP Commercial |
$719.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$592.90
|
| Rate for Payer: Priority Health SBD |
$533.61
|
| Rate for Payer: UMR Bronson Commercial |
$372.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$635.25
|
|
|
PR RPR 1ST FEM HRNA ANY AGE REDUCIBLE
|
Facility
|
OP
|
$847.00
|
|
|
Service Code
|
CPT 49550
|
| Hospital Charge Code |
49550
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$313.39 |
| Max. Negotiated Rate |
$9,680.93 |
| Rate for Payer: Aetna American Axle |
$550.55
|
| Rate for Payer: Aetna Commercial |
$719.95
|
| Rate for Payer: Aetna Medicare |
$3,198.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$550.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,844.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,844.02
|
| Rate for Payer: BCBS Complete |
$1,766.41
|
| Rate for Payer: BCBS MAPPO |
$3,075.22
|
| Rate for Payer: BCBS Trust/PPO |
$2,519.12
|
| Rate for Payer: BCN Medicare Advantage |
$3,075.22
|
| Rate for Payer: Cash Price |
$677.60
|
| Rate for Payer: Cash Price |
$677.60
|
| Rate for Payer: Cofinity Commercial |
$592.90
|
| Rate for Payer: Cofinity Commercial |
$728.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$677.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,075.22
|
| Rate for Payer: Healthscope Commercial |
$762.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$592.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$635.25
|
| Rate for Payer: Mclaren Medicaid |
$1,682.15
|
| Rate for Payer: Mclaren Medicare |
$3,075.22
|
| Rate for Payer: Meridian Medicaid |
$1,766.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,228.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,536.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$719.95
|
| Rate for Payer: PACE Medicare |
$2,921.46
|
| Rate for Payer: PACE SWMI |
$3,075.22
|
| Rate for Payer: PHP Commercial |
$719.95
|
| Rate for Payer: PHP Medicare Advantage |
$3,075.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,682.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$592.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,680.93
|
| Rate for Payer: Priority Health Medicare |
$3,075.22
|
| Rate for Payer: Priority Health Narrow Network |
$7,744.74
|
| Rate for Payer: Priority Health SBD |
$533.61
|
| Rate for Payer: Railroad Medicare Medicare |
$3,075.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$629.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,075.22
|
| Rate for Payer: UHC Exchange |
$572.04
|
| Rate for Payer: UHC Medicare Advantage |
$3,167.48
|
| Rate for Payer: UMR Bronson Commercial |
$313.39
|
| Rate for Payer: VA VA |
$3,075.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$635.25
|
|
|
PR RPR 1ST FEM HRNA ANY AGE REDUCIBLE
|
Professional
|
Both
|
$847.00
|
|
|
Service Code
|
HCPCS 49550
|
| Hospital Charge Code |
49550
|
| Min. Negotiated Rate |
$372.11 |
| Max. Negotiated Rate |
$6,312.66 |
| Rate for Payer: Aetna Commercial |
$777.96
|
| Rate for Payer: BCBS Complete |
$390.72
|
| Rate for Payer: BCBS Trust/PPO |
$6,312.66
|
| Rate for Payer: Cash Price |
$677.60
|
| Rate for Payer: Cash Price |
$677.60
|
| Rate for Payer: Meridian Medicaid |
$390.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$372.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$592.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,020.72
|
| Rate for Payer: Priority Health Narrow Network |
$1,020.72
|
| Rate for Payer: Priority Health SBD |
$1,020.72
|
| Rate for Payer: UMR Bronson Commercial |
$389.62
|
|
|
PR RPR 1ST FEM HRNA ANY AGE REDUCIBLE
|
Professional
|
Both
|
$847.00
|
|
|
Service Code
|
HCPCS 49550
|
| Min. Negotiated Rate |
$372.11 |
| Max. Negotiated Rate |
$6,312.66 |
| Rate for Payer: Aetna Commercial |
$777.96
|
| Rate for Payer: BCBS Complete |
$390.72
|
| Rate for Payer: BCBS Trust/PPO |
$6,312.66
|
| Rate for Payer: Cash Price |
$677.60
|
| Rate for Payer: Cash Price |
$677.60
|
| Rate for Payer: Meridian Medicaid |
$390.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$372.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$592.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,020.72
|
| Rate for Payer: Priority Health Narrow Network |
$1,020.72
|
| Rate for Payer: Priority Health SBD |
$1,020.72
|
| Rate for Payer: UMR Bronson Commercial |
$389.62
|
|
|
PR RPR 1ST INCAL/VNT HERNIA INCARCERATED
|
Professional
|
Both
|
$2,199.00
|
|
|
Service Code
|
HCPCS 49561
|
| Min. Negotiated Rate |
$879.60 |
| Max. Negotiated Rate |
$1,539.30 |
| Rate for Payer: BCBS Complete |
$879.60
|
| Rate for Payer: Cash Price |
$1,759.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,539.30
|
| Rate for Payer: UMR Bronson Commercial |
$1,011.54
|
|
|
PR RPR 1ST INGUN HRNA AGE 5 YRS/> INCARCERATED
|
Professional
|
Both
|
$1,632.00
|
|
|
Service Code
|
HCPCS 49507
|
| Min. Negotiated Rate |
$378.50 |
| Max. Negotiated Rate |
$1,142.40 |
| Rate for Payer: Aetna Commercial |
$790.43
|
| Rate for Payer: BCBS Complete |
$397.42
|
| Rate for Payer: BCBS Trust/PPO |
$781.36
|
| Rate for Payer: Cash Price |
$1,305.60
|
| Rate for Payer: Cash Price |
$1,305.60
|
| Rate for Payer: Meridian Medicaid |
$397.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$378.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,142.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,038.36
|
| Rate for Payer: Priority Health Narrow Network |
$1,038.36
|
| Rate for Payer: Priority Health SBD |
$1,038.36
|
| Rate for Payer: UMR Bronson Commercial |
$750.72
|
|
|
PR RPR 1ST INGUN HRNA AGE 5 YRS/> INCARCERATED
|
Facility
|
OP
|
$1,632.00
|
|
|
Service Code
|
CPT 49507
|
| Hospital Charge Code |
49507
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$581.86 |
| Max. Negotiated Rate |
$9,680.93 |
| Rate for Payer: Aetna American Axle |
$1,060.80
|
| Rate for Payer: Aetna Commercial |
$1,387.20
|
| Rate for Payer: Aetna Medicare |
$3,198.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,060.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,844.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,844.02
|
| Rate for Payer: BCBS Complete |
$1,766.41
|
| Rate for Payer: BCBS MAPPO |
$3,075.22
|
| Rate for Payer: BCBS Trust/PPO |
$3,888.71
|
| Rate for Payer: BCN Medicare Advantage |
$3,075.22
|
| Rate for Payer: Cash Price |
$1,305.60
|
| Rate for Payer: Cash Price |
$1,305.60
|
| Rate for Payer: Cofinity Commercial |
$1,403.52
|
| Rate for Payer: Cofinity Commercial |
$1,142.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,305.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,075.22
|
| Rate for Payer: Healthscope Commercial |
$1,468.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,142.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,224.00
|
| Rate for Payer: Mclaren Medicaid |
$1,682.15
|
| Rate for Payer: Mclaren Medicare |
$3,075.22
|
| Rate for Payer: Meridian Medicaid |
$1,766.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,228.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,536.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,387.20
|
| Rate for Payer: PACE Medicare |
$2,921.46
|
| Rate for Payer: PACE SWMI |
$3,075.22
|
| Rate for Payer: PHP Commercial |
$1,387.20
|
| Rate for Payer: PHP Medicare Advantage |
$3,075.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,682.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,142.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,680.93
|
| Rate for Payer: Priority Health Medicare |
$3,075.22
|
| Rate for Payer: Priority Health Narrow Network |
$7,744.74
|
| Rate for Payer: Priority Health SBD |
$1,028.16
|
| Rate for Payer: Railroad Medicare Medicare |
$3,075.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$640.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,075.22
|
| Rate for Payer: UHC Exchange |
$581.86
|
| Rate for Payer: UHC Medicare Advantage |
$3,167.48
|
| Rate for Payer: UMR Bronson Commercial |
$603.84
|
| Rate for Payer: VA VA |
$3,075.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,224.00
|
|
|
PR RPR 1ST INGUN HRNA AGE 5 YRS/> INCARCERATED
|
Professional
|
Both
|
$1,632.00
|
|
|
Service Code
|
HCPCS 49507
|
| Hospital Charge Code |
49507
|
| Min. Negotiated Rate |
$378.50 |
| Max. Negotiated Rate |
$1,142.40 |
| Rate for Payer: Aetna Commercial |
$790.43
|
| Rate for Payer: BCBS Complete |
$397.42
|
| Rate for Payer: BCBS Trust/PPO |
$781.36
|
| Rate for Payer: Cash Price |
$1,305.60
|
| Rate for Payer: Cash Price |
$1,305.60
|
| Rate for Payer: Meridian Medicaid |
$397.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$378.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,142.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,038.36
|
| Rate for Payer: Priority Health Narrow Network |
$1,038.36
|
| Rate for Payer: Priority Health SBD |
$1,038.36
|
| Rate for Payer: UMR Bronson Commercial |
$750.72
|
|
|
PR RPR 1ST INGUN HRNA AGE 5 YRS/> INCARCERATED
|
Facility
|
IP
|
$1,632.00
|
|
|
Service Code
|
CPT 49507
|
| Hospital Charge Code |
49507
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$718.08 |
| Max. Negotiated Rate |
$1,468.80 |
| Rate for Payer: Aetna American Axle |
$1,060.80
|
| Rate for Payer: Aetna Commercial |
$1,387.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,060.80
|
| Rate for Payer: Cash Price |
$1,305.60
|
| Rate for Payer: Cofinity Commercial |
$1,142.40
|
| Rate for Payer: Cofinity Commercial |
$1,403.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,305.60
|
| Rate for Payer: Healthscope Commercial |
$1,468.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,142.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,224.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,387.20
|
| Rate for Payer: PHP Commercial |
$1,387.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,142.40
|
| Rate for Payer: Priority Health SBD |
$1,028.16
|
| Rate for Payer: UMR Bronson Commercial |
$718.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,224.00
|
|
|
PR RPR 1ST INGUN HRNA AGE 5 YRS/> REDUCIBLE
|
Facility
|
OP
|
$1,655.00
|
|
|
Service Code
|
CPT 49505
|
| Hospital Charge Code |
49505
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$518.01 |
| Max. Negotiated Rate |
$9,680.93 |
| Rate for Payer: Aetna American Axle |
$1,075.75
|
| Rate for Payer: Aetna Commercial |
$1,406.75
|
| Rate for Payer: Aetna Medicare |
$3,198.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,075.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,844.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,844.02
|
| Rate for Payer: BCBS Complete |
$1,766.41
|
| Rate for Payer: BCBS MAPPO |
$3,075.22
|
| Rate for Payer: BCBS Trust/PPO |
$3,638.47
|
| Rate for Payer: BCN Medicare Advantage |
$3,075.22
|
| Rate for Payer: Cash Price |
$1,324.00
|
| Rate for Payer: Cash Price |
$1,324.00
|
| Rate for Payer: Cofinity Commercial |
$1,423.30
|
| Rate for Payer: Cofinity Commercial |
$1,158.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,324.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,075.22
|
| Rate for Payer: Healthscope Commercial |
$1,489.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,158.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,241.25
|
| Rate for Payer: Mclaren Medicaid |
$1,682.15
|
| Rate for Payer: Mclaren Medicare |
$3,075.22
|
| Rate for Payer: Meridian Medicaid |
$1,766.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,228.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,536.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,406.75
|
| Rate for Payer: PACE Medicare |
$2,921.46
|
| Rate for Payer: PACE SWMI |
$3,075.22
|
| Rate for Payer: PHP Commercial |
$1,406.75
|
| Rate for Payer: PHP Medicare Advantage |
$3,075.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,682.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,158.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,680.93
|
| Rate for Payer: Priority Health Medicare |
$3,075.22
|
| Rate for Payer: Priority Health Narrow Network |
$7,744.74
|
| Rate for Payer: Priority Health SBD |
$1,042.65
|
| Rate for Payer: Railroad Medicare Medicare |
$3,075.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$569.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,075.22
|
| Rate for Payer: UHC Exchange |
$518.01
|
| Rate for Payer: UHC Medicare Advantage |
$3,167.48
|
| Rate for Payer: UMR Bronson Commercial |
$612.35
|
| Rate for Payer: VA VA |
$3,075.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,241.25
|
|
|
PR RPR 1ST INGUN HRNA AGE 5 YRS/> REDUCIBLE
|
Facility
|
IP
|
$1,655.00
|
|
|
Service Code
|
CPT 49505
|
| Hospital Charge Code |
49505
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$728.20 |
| Max. Negotiated Rate |
$1,489.50 |
| Rate for Payer: Aetna American Axle |
$1,075.75
|
| Rate for Payer: Aetna Commercial |
$1,406.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,075.75
|
| Rate for Payer: Cash Price |
$1,324.00
|
| Rate for Payer: Cofinity Commercial |
$1,158.50
|
| Rate for Payer: Cofinity Commercial |
$1,423.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,324.00
|
| Rate for Payer: Healthscope Commercial |
$1,489.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,158.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,241.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,406.75
|
| Rate for Payer: PHP Commercial |
$1,406.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,158.50
|
| Rate for Payer: Priority Health SBD |
$1,042.65
|
| Rate for Payer: UMR Bronson Commercial |
$728.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,241.25
|
|
|
PR RPR 1ST INGUN HRNA AGE 5 YRS/> REDUCIBLE
|
Professional
|
Both
|
$1,655.00
|
|
|
Service Code
|
HCPCS 49505
|
| Hospital Charge Code |
49505
|
| Min. Negotiated Rate |
$336.97 |
| Max. Negotiated Rate |
$1,158.50 |
| Rate for Payer: Aetna Commercial |
$703.82
|
| Rate for Payer: BCBS Complete |
$353.82
|
| Rate for Payer: BCBS Trust/PPO |
$749.13
|
| Rate for Payer: Cash Price |
$1,324.00
|
| Rate for Payer: Cash Price |
$1,324.00
|
| Rate for Payer: Meridian Medicaid |
$353.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$336.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,158.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$923.71
|
| Rate for Payer: Priority Health Narrow Network |
$923.71
|
| Rate for Payer: Priority Health SBD |
$923.71
|
| Rate for Payer: UMR Bronson Commercial |
$761.30
|
|
|
PR RPR 1ST INGUN HRNA AGE 5 YRS/> REDUCIBLE
|
Professional
|
Both
|
$1,655.00
|
|
|
Service Code
|
HCPCS 49505
|
| Min. Negotiated Rate |
$336.97 |
| Max. Negotiated Rate |
$1,158.50 |
| Rate for Payer: Aetna Commercial |
$703.82
|
| Rate for Payer: BCBS Complete |
$353.82
|
| Rate for Payer: BCBS Trust/PPO |
$749.13
|
| Rate for Payer: Cash Price |
$1,324.00
|
| Rate for Payer: Cash Price |
$1,324.00
|
| Rate for Payer: Meridian Medicaid |
$353.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$336.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,158.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$923.71
|
| Rate for Payer: Priority Health Narrow Network |
$923.71
|
| Rate for Payer: Priority Health SBD |
$923.71
|
| Rate for Payer: UMR Bronson Commercial |
$761.30
|
|
|
PR RPR 1ST INGUN HRNA AGE 6 MO-5 YRS INCARCERATED
|
Professional
|
Both
|
$1,700.00
|
|
|
Service Code
|
HCPCS 49501
|
| Min. Negotiated Rate |
$390.86 |
| Max. Negotiated Rate |
$1,190.00 |
| Rate for Payer: Aetna Commercial |
$818.16
|
| Rate for Payer: BCBS Complete |
$410.40
|
| Rate for Payer: BCBS Trust/PPO |
$622.87
|
| Rate for Payer: Cash Price |
$1,360.00
|
| Rate for Payer: Cash Price |
$1,360.00
|
| Rate for Payer: Meridian Medicaid |
$410.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$390.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,190.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,071.87
|
| Rate for Payer: Priority Health Narrow Network |
$1,071.87
|
| Rate for Payer: Priority Health SBD |
$1,071.87
|
| Rate for Payer: UMR Bronson Commercial |
$782.00
|
|
|
PR RPR 1ST INGUN HRNA AGE 6 MO-5 YRS REDUCIBLE
|
Professional
|
Both
|
$1,335.00
|
|
|
Service Code
|
HCPCS 49500
|
| Min. Negotiated Rate |
$269.23 |
| Max. Negotiated Rate |
$934.50 |
| Rate for Payer: Aetna Commercial |
$557.36
|
| Rate for Payer: BCBS Complete |
$282.69
|
| Rate for Payer: BCBS Trust/PPO |
$542.04
|
| Rate for Payer: Cash Price |
$1,068.00
|
| Rate for Payer: Cash Price |
$1,068.00
|
| Rate for Payer: Meridian Medicaid |
$282.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$269.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$934.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$736.74
|
| Rate for Payer: Priority Health Narrow Network |
$736.74
|
| Rate for Payer: Priority Health SBD |
$736.74
|
| Rate for Payer: UMR Bronson Commercial |
$614.10
|
|
|
PR RPR 1ST INGUN HRNA FULL TERM INFT <6 MO INCARCER
|
Professional
|
Both
|
$1,764.00
|
|
|
Service Code
|
HCPCS 49496
|
| Min. Negotiated Rate |
$396.82 |
| Max. Negotiated Rate |
$1,234.80 |
| Rate for Payer: Aetna Commercial |
$828.71
|
| Rate for Payer: BCBS Complete |
$416.66
|
| Rate for Payer: BCBS Trust/PPO |
$704.75
|
| Rate for Payer: Cash Price |
$1,411.20
|
| Rate for Payer: Cash Price |
$1,411.20
|
| Rate for Payer: Meridian Medicaid |
$416.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$396.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,234.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,086.58
|
| Rate for Payer: Priority Health Narrow Network |
$1,086.58
|
| Rate for Payer: Priority Health SBD |
$1,086.58
|
| Rate for Payer: UMR Bronson Commercial |
$811.44
|
|
|
PR RPR 1ST INGUN HRNA FULL TERM INFT <6 MO RDC
|
Professional
|
Both
|
$1,484.00
|
|
|
Service Code
|
HCPCS 49495
|
| Min. Negotiated Rate |
$263.69 |
| Max. Negotiated Rate |
$1,038.80 |
| Rate for Payer: Aetna Commercial |
$551.37
|
| Rate for Payer: BCBS Complete |
$276.87
|
| Rate for Payer: BCBS Trust/PPO |
$878.03
|
| Rate for Payer: Cash Price |
$1,187.20
|
| Rate for Payer: Cash Price |
$1,187.20
|
| Rate for Payer: Meridian Medicaid |
$276.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$263.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,038.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$723.20
|
| Rate for Payer: Priority Health Narrow Network |
$723.20
|
| Rate for Payer: Priority Health SBD |
$723.20
|
| Rate for Payer: UMR Bronson Commercial |
$682.64
|
|
